Interaksi obat

dengan makanan

Oleh : Helmina Wati, M.Sc., Apt.

 Drug-Food Interactions

 Tetracyclines and milk products

 Warfarin and vitamin K-containing foods*
 Grapefruit juice
 Fam Brassicaceae (Cruciferous)
Tetrasiklin Vs Susu

• Efek : mengurangi absorpsi dari tetrasiklin ketika diberikan bersama susu

• Mekanisme : pembentukan khelat dari tetrasiklin dengan ion kalsium

• Akibat : kegagalan terapi antibiotika

Warfarin Vs vitamin K pada
makanan

• Makanan yang mengandung vitamin K misalnya brokoli, bayam

• Mekanisme : farmakodinamik yaitu efek antagonis

• Akibatnya : efek warfarin menjadi berkurang

• Solusi : peningkatan dosis dari warfarin atau pasien diet makanan yang mengandung vitamin K
 *Foods and Products High in Vitamin K

Alfalfa tablets
Broccoli
Brussels sprouts
Cabbage
Cauliflower (raw)
Green leafy vegetables (spinach, collardgreens)
Green tea
Liver
Soybean
Vegetable oils (canola, soybean)
Watercress
Grapefruit juice

• Terdiri dari bioflavonoid yang menghambat CYP 3A dan menghambat metabolisme pada banyak

obat.

• Hati2x jika menggunakan obat bersama dengan grapefruit juice.

 DRUGS THAT INTERACT WITH

GRAPEFRUIT JUICE

Benzodiazepines:midazolam, diazepam,triazolam

Cytotoxic drugs :cyclosporine, tacrolimus, sirolimus

DyhydropyridineCalcium-channel blockers:

amlodipine,felodipine,nifedipine,nisoldipine,nitrendipine, verapamil

Theopylline

17β-estradiol

Statins :simvastatin, lorvastatin, atorvastatin

Antidepressants: sertraline, buspirone, clomipramine

Antiepileptics: carbamazepine

Antiretroviral agents: saquinavir, indinavir

Antiarrhythmics: amiodarone

Misce: methadone, sildenafil

GFJ increases bioavailability for felodipine by 200%, nifedipine 57% and verapamil by 36%. Inhibition of P-glycoprotein increases bioavailability

of drugs.

GFJ : enzymeand P-glycoproteininhibitor

South Med J. 2009;102(3):308-309.
 Hours after Dose Hours after Dose

E ff e c t s o f g r a p e f r u i t j u i c e o n f e l o d i p i n e p h a r m a c o k i n e t i c s a n d
pharmacodynamics.

Dresser GK et alClin Pharmacol Ther2000;68(1):28–34

 D a y a a n a l g e t i k p a r a s e t a m o l s e b e l u m d a n s e t e l a h p e m b e r i a n b r o ko l i 7 -
kalipadamencitjantanBALB/C

1. Parasetamol mempunyai daya analgetik 54, 74 %

2. Brokoli menaikkan % daya analgetik parasetamol

O nsetdandurasif enobarbital sebelumdansetelahpemberianjusbrokoli7-
kalipadamencitjantan

1. Brokoli memperlama onset fenobarbital tetapi tidak signifikan (P > 0,05)

2. Brokoli mempercepat durasi fenobarbital (P <0,05)

 Cigarette smokingvsOral contraceptive

Risk of OC-induced adversecardiovascular eventsis increased by smoking

• Risk factors:
– Women aged > 35 years old are at greater risk

– Smoking > 15 cigs/day places women at greater risk

• Management:
– Avoid combination.

– Women on OC are adviced not to smoke, or use another contraception method

Hansten & Horn (1998) p. 107

Te r i m a k a s i h