PUNTOS DE CONTROL
6.9.2. Elementos Físico-Químicos
taken without first speaking with your physician or pharmacist. Others may require further explanation (). Refer to the individual drug entry for specific details about an interaction.
Blackcurrant, Boots Cold Relief Hot Lemon, Boots Infant Pain Re- lief, Calpol 6 Plus, Calpol Infant, Calpol Pediatric, Calpol, Cephanol, Children’s Acetaminophen, Children’s Feverhalt, Cupanol Over 6, Cupanol Under 6, Disprol, Dom-Acetaminophen, Fanalgic, Fennings Children’s Cooling Powders, Hill’s Balsam Flu Strength Hot Lemon Powders, Infadrops, Lem-Plus Powders, Medinol, Novogesic, Pain Aid Free, Paldesic, Panaleve 6+, Panaleve Junior, Pandol, Panodol Baby and Infant, Paracetamol, Paracets, Paraclear, Paramin, Pedi- atrix, PMS Acetaminophen, Resolve, Robigesic Elixir, Rounox, Sal- zone, Tantaphen, Tempra, Tixymol, Tramil 500, Trianon, Tylenol, WestCan Extra Strength Acetaminophen, WestCan Regular Strength Acetaminophen
Combination drugs: Alka-Seltzer Plus, Co-Proxamol, Coalgesic,
Darvocet N, Distalgesic, Endocet, Excedrin PM, Fioricet, Lortab, Midrin, Nyquil, Nyquil Hot Therapy Powder, Percocet, Phrenilin, Propacet 100, Roxicet, Theraflu, Tylenol Allergy Sinus, Tylenol Cold, Tylenol Flu NightTime Maximum Strength Powder, Tylenol Multi- Symptom Hot Medication, Tylenol PM, Tylenol Sinus, Tylenol with Codeine,Vicodin,Wygesic
Acetaminophen is used to reduce pain and fever. Unlike NSAIDs (nonsteroidal anti-inflammatory drugs) (page 193), it lacks anti-inflammatory activity. Acetaminophen is available by itself or in nonprescrip- tion and prescription-only combination products used to relieve pain and the symptoms associated with colds and flu.
Summary of Interactions for Acetaminophen
In some cases, an herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.
Interactions with Dietary Supplements
N-acetyl cysteine (NAC)
Hospitals use oral and intravenous N-acetyl cysteine (NAC) to treat liver damage induced by acetamino- phen overdose poisoning.1NAC is often administered intravenously by emergency room doctors. Oral NAC appears to be effective for acetaminophen toxicity.
✓ May be Beneficial: Side effect Milk thistle*
reduction/prevention N-acetyl
cysteine
✓ May be Beneficial: Supportive Vitamin C*
interaction
Ꮬ Avoid: Reduced drug absorption/ Hibiscus
bioavailability
Check: Other Schisandra
Depletion or interference None known
Adverse interaction None known
An uncontrolled trial compared intravenous NAC with oral NAC in children with acetaminophen poi- soning and found that both methods were equally effective in reversing acetaminophen-induced liver toxi- city.2 However, acetaminophen toxicity is a potential medical emergency, and should only be managed by qualified healthcare professionals.
Vitamin C
Taking 3 grams vitamin C with acetaminophen has been shown to prolong the amount of time acetamino- phen stays in the body.3This theoretically might allow people to use less acetaminophen, thereby reducing the risk of side effects. Consult with a doctor about this po- tential before reducing the amount of acetaminophen.
Interactions with Herbs
Hibiscus
One small study found that hibiscus could decrease lev- els of acetaminophen if the drug was taken after the tea was consumed though it was not entirely clear if the de- creases were clinically significant.4
Milk thistle (Silybum marianum)
Silymarin is a collection of complex flavonoids found in milk thistle that has been shown to elevate liver glu- tathione levels in rats.5 Acetaminophen can cause liver damage, which is believed to involve glutathione deple- tion.6 In one study involving rats, silymarin protected against acetaminophen-induced glutathione depletion.7 While studies to confirm this action in humans have not been conducted, some doctors recommend sily- marin supplementation with 200 mg milk thistle ex- tract, containing 70–80% silymarin, three times per day for people taking acetaminophen in large amounts for more than one year and/or with other risk factors for liver problems.
Schisandra (Schisandra chinensis)
Gomisin A is a constituent found in the Chinese herb schisandra. In a study of rats given liver-damaging amounts of acetaminophen, gomisin A appeared to protect against some liver damage but did not prevent glutathione depletion8 (unlike milk thistle, as reported above). Studies have not yet confirmed this action in humans.
Interactions with Foods and Other Compounds
Food
Food, especially foods high in pectin (including jellies), carbohydrates, and large amounts of cruciferous vegeta-
bles (broccoli, Brussels sprouts, cabbage, and others) can interfere with acetaminophen absorption.9It is un- clear how much effect this interaction has on acetamin- ophen activity.
Alcohol
Moderate to high amounts of acetaminophen have caused liver damage in people with alcoholism.10 To prevent problems, people taking acetaminophen should avoid alcohol.
Contains the following ingredients: Captopril (page 47)
Hydrochlorothiazide
Contains the following ingredients: Aluminium
Dimethicone Magnesium Peppermint oil
Common names: Virovir, Zovirax Oral
Acyclovir is an antiviral drug used to treat shingles, gen- ital herpes, and chickenpox.
Summary of Interactions for Oral Acyclovir
In some cases, an herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.
✓ May be Beneficial: Supportive Citrus root
interaction bark* Flavonoids* Geum japonicum* Rhus javanica* Syzygium aromaticum* Terminalia chebula* Tripterygium wilfordii*
A C Y C L OV I R O R A L
A C TO N O R M G E L
A C E Z I D E
Interactions with Dietary Supplements
Flavonoids
The flavonoids quercetin, quercitrin, and apigenin en- hanced the antiviral activity of acyclovir in test tube studies.1 Controlled research is needed to determine whether taking quercetin or other flavonoid supple- ments would increase the effectiveness of acyclovir in humans.
Interactions with Herbs
Citrus species
The alkaloid citrusinine-1 from the root bark of citrus plants has been shown to enhance the antiviral activity of acyclovir.2 Further research is needed to determine whether taking citrus root bark would increase the ef- fectiveness of acyclovir in humans.
Tripterygium wilfordii
Test tube studies show that triptofordin C-2 increases the antiviral activity of acyclovir against the herpes virus.3 Controlled human research is needed to deter- mine whether taking tripterygium would increase the effectiveness of acyclovir in humans.
Other herbs
Animal studies have shown that other herbs, including Geum japonicum, Rhus javanica, Syzygium aromaticum, and Terminalia chebula enhance the antiviral activity of acyclovir.4Controlled human studies are needed to de- termine whether taking these herbs would increase the effectiveness of acyclovir in humans.
Common names: Aciclovir Topical, Boots Avert, Herpetad,
Soothelip,Viralief,Virasorb, Zovirax Topical
Acyclovir is an antiviral drug applied to the skin to treat the first outbreaks of genital herpes as well as herpes in- fections in people with poor immune systems. Topical application of acyclovir speeds up the healing process and the duration of pain.
A C Y C L OV I R TO P I C A L
Depletion or interference None known
Side effect reduction/prevention None known
Reduced drug absorption/bioavailability None known
Adverse interaction None known
Acyclo
vir T
Summary of Interactions for Topical Acyclovir
In some cases, an herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.
Common names: Differin
Adapalene is a vitamin A–related drug that is applied to the skin to treat acne.
Summary of Interactions for Adapalene
In some cases, an herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.
Interaction with Foods and Other Compounds
Topical application of adapalene may cause skin irritation in some individuals. This irritation can be worsened when alcohol, astringents, spices, and lime are also ap- plied to the area.1 Sensitive individuals should use cau- tion when using adapalene and other topical compounds.
Contains the following ingredients: Gramicidin
Neomycin (page 187) Triamcinolone
A D C O RT Y L
W I T H G R A N E O D I N
Depletion or interference None known
Side effect reduction/prevention None known
Supportive interaction None known
Reduced drug absorption/bioavailability None known
Adverse interaction None known
A DA PA L E N E
Depletion or interference None known
Side effect reduction/prevention None known
Supportive interaction None known
Reduced drug absorption/bioavailability None known
Adverse interaction None known
Contains the following ingredients: Estradiol (page 108)
Norethisterone
Contains the following ingredients: Calcium carbonate
Magnesium hydroxide (page 166) Simethicone (page 239)
Common names: Aerolin, Airomir, Albuterol Inhaled, Alti-Salbuta-
mol Sulfate, Asmasal, Asmavent, Gen-Salbutamol, Novo-Salmol, Nu- Salbutamol, PMS-Salbutamol, Proventil, Rho-Salbutamol, Salbutamol, Salmol,Ventodisks,Ventolin,Volmax
Combination drug: Combivent
Albuterol is a short-acting, beta-adrenergic broncho- dilator drug used for relief and prevention of bron- chospasm. It is also used to prevent exercise-induced bronchospasm. While albuterol is available in tablet form, it is most commonly used by oral inhalation into the lungs.
Summary of Interactions for Albuterol
In some cases, an herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.
✓ May be Beneficial: Depletion or Calcium*
interference Magnesium*
Phosphate* Potassium*
✓ May be Beneficial: Supportive Coleus*
interaction
Check: Other Digitalis
Side effect reduction/prevention None known
Reduced drug absorption/bioavailability None known
Adverse interaction None known
A L B U T E RO L
A DVA N C E D F O R M U L A
D I - G E L TA B L E T S
A D G Y N C O M B I
Acyclo vir T opicalInteractions with Dietary Supplements
Minerals
Therapeutic amounts of intravenous salbutamol (al- buterol) in four healthy people were associated with decreased plasma levels of calcium, magnesium, phos- phate, and potassium.1Decreased potassium levels have been reported with oral,2 intramuscular, and subcuta- neous albuterol administration.3 How frequently this effect occurs is not known; whether these changes are preventable through diet or supplementation is also un- known.
Interactions with Herbs
Digitalis (Digitalis lanata, Digitalis purpurea)
Digitalis refers to a family of plants (commonly called foxglove) that contain digitalis glycosides, chemicals with actions and toxicities similar to the prescription drug digoxin (page 90).
In a small study of salbutamol (albuterol) in people receiving digoxin, albuterol was associated with de- creased serum digoxin levels.4No interactions between albuterol and digitalis have been reported. Until more is known, albuterol and digitalis-containing products should be used only under the direct supervision of a doctor trained in their use.
Coleus
A test tube study demonstrated that the bronchodilat- ing effects of salbutamol (albuterol) were significantly increased by the addition of forskolin, the active com- ponent of the herb Coleus forskohlii.5The results of this preliminary research suggest that the combination of forskolin and beta-agonists such as albuterol might pro- vide an alternative to raising the doses of the beta-ago- nist drugs as they lose effectiveness. Until more is known, coleus should not be combined with albuterol without the supervision of a doctor.
Interactions with Foods and Other Compounds
Food
Albuterol may be taken with food to prevent stomach upset.6
Contains the following ingredients: Hydrochlorothiazide
Spironolactone (page 243)
A L DA C TA Z I D E
Contains the following ingredients: Chlorothiazide
Methyldopa (page 174)
Contains the following ingredients: Hydrochlorothiazide
Methyldopa (page 174)
Common names: Alendronic Acid, Biophosphonates, Fosamax
Alendronate is a member of the bisphosphonate family of drugs used to treat/prevent osteoporosis. It is also used to treat some bone diseases and some cases of can- cer that have spread to bones.
Summary of Interactions for Alendronate
In some cases, an herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.
Interactions with Dietary Supplements
Calcium
Calcium supplements may interfere with alendronate absorption.1 However, one researcher suggested that addition of large amounts of supplemental calcium to alendronate therapy in patients with bone metastases (with evidence of osteomalacia) related to prostate cancer might improve the clinical outcome.2 More- over, both calcium and alendronate are commonly used in the treatment of osteoporosis in the same peo- ple. To prevent potential interactions, alendronate
Check: Other Calcium
Magnesium
Depletion or interference None known
Side effect reduction/prevention None known
Supportive interaction None known
Reduced drug absorption/bioavailability None known
Adverse interaction None known
A L E N D RO N AT E
A L D O R I L
A L D O C L O R
Alendr
should be taken two hours before or after calcium supplements.
Magnesium
Absorption of tiludronate, a drug related to alendronate, is reduced when taken with magnesium (page 308) and/or aluminum (page 10)-containing antacids.3This interaction has not yet been reported with alendronate. Until more is known, alendronate should be taken two hours before or after magnesium and/or aluminum-con- taining antacids (page 18).
Interactions with Foods and Other Compounds
Food
Food, coffee, and orange juice significantly reduce ab- sorption of alendronate.4
Alendronate should be taken with a large glass of plain water, upon arising in the morning, and 30 min- utes or more before any food, beverages, supplements, or other medications.5 People taking alendronate should remain upright (do not lie down) for 30 min- utes after taking the drug.6
Common names: UroXatral
Alfuzosin is used to treat the signs and symptoms of be- nign prostatic hyperplasia, also known as BPH. There are currently no reported nutrient or herb interactions involving alfuzosin.
Contains the following ingredients: Aspirin (page 26)
Citric acid
Sodium bicarbonate (page 240)
Contains the following ingredients: Acetaminophen (page 3) Pseudoephedrine Chlorpheniramine (page 59)
A L K A - S E LT Z E R P L U S
A L K A - S E LT Z E R
A L F U Z O S I N
Contains the following ingredients: Fexofenadine (page 115) Pseudoephedrine
Common names: Apo-Allopurinol, Caplenal, Cosuric, Lopurim,
Rimapurinol, Xanthomax, Zyloprim, Zyloric
Allopurinol is a xanthine oxidase inhibitor used to pre- vent gout and to lower blood levels of uric acid in cer- tain people taking drugs for cancer.
Summary of Interactions for Allopurinol
In some cases, an herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.
Interactions with Dietary Supplements
Vitamin D
Individuals with gout have low blood concentration of the active form of vitamin D (1,25 dihydroxycholecal- ciferol), and allopurinol corrects this problem.1
L-carnitine
People who have Duchenne muscular dystrophy have low levels of L-carnitine in their muscles. Allopurinol restores L-carnitine to normal levels, resulting in im- proved muscle strength.2 Whether L-carnitine supple- mentation might improve this effect of allopurinol has not been investigated.
L-tryptophan
In a preliminary study, seven of eight individuals with severe mental depression showed improvement when they took L-tryptophan and allopurinol;3 of these
✓ May be Beneficial: Supportive L-tryptophan
interaction
Check: Other L-carnitine
Vitamin D
Depletion or interference None known
Side effect reduction/prevention None known
Reduced drug absorption/bioavailability None known
Adverse interaction None known
A L L O P U R I N O L
A L L E G R A - D
Alendr
seven, five experienced full remission. Controlled re- search is necessary to determine whether this combina- tion might be more effective for severe depression than standard treatment.
Interactions with Foods and Other Compounds
Food
Allopurinol may be taken with food to prevent stomach upset.4
Protein
Compared with people on high-protein diets, people on low-protein diets excrete less allopurinol, resulting in a threefold increase in the time it takes for the drug to be removed from the body.5 Vegetarians and those who eat low-protein diets (20 grams of protein a day or less) should discuss this possible interaction with their healthcare practitioner before taking allopurinol. Alcohol
According to animal research, alcohol reduces the activ- ity of antioxidant systems involving vitamin E, vitamin C, and selenium, leading to tissue damage in the cere- bellum; however, allopurinol reverses this effect.6 Drinking alcoholic beverages also increases the removal of allopurinol from the body, thereby reducing the ef- fectiveness of the drug.7Therefore, people taking allop- urinol should avoid alcohol.
Contains the following ingredients: Hydrocortisone
Urea
Common names: Xanax
Alprazolam is used to treat anxiety and panic disorder, and is in a family of drugs known as benzodiazepines (page 36).
Summary of Interactions for Alprazolam
In some cases, an herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.
A L P R A Z O L A M
A L P H A D E R M
Interactions with Dietary Supplements
Vinpocetine
In a preliminary trial, an extract of periwinkle called vinpocetine was shown to produce minor improve- ments in short-term memory among people taking flu- nitrazepam, a benzodiazepine.1Further study is needed to determine if vinpocetine would be a helpful adjunct to use of benzodiazepines, or alprazolam specifically.
Interaction with Herbs
Kava (Piper methysticum)
Kava is an herb used to treat anxiety disorder. One indi- vidual who took alprazolam and kava together, along with two other medications (cimetidine [page 61] and terazosin [page 253]) was hospitalized in a lethargic and disoriented condition.2 Further research is needed to determine whether the combination of kava and al- prazolam produces an adverse interaction. However, in- dividuals should not take alprazolam and kava together unless supervised by a doctor.
Interaction with Foods and other Compounds
Alcohol
Drinking alcoholic beverages while taking alprazolam may increase side effects such as drowsiness, confusion, and dizziness.3Consequently, people taking alprazolam should avoid drinking alcohol, especially when they must stay alert.
Contains the following ingredients: Aluminium
Magnesium
Contains the following ingredients: Aluminium
Magnesium