Drug-Food Interaction:

FG

.. ()



28 2550

28 785 . 10400
: ( ) (/) ( )

Rx
1. Itraconazole capsule 100 mg
Sig. 2 capsules PO pc QD
2. Cefuroxime axetil tablet 250 mg
Sig. 1 tablet PO pc bid
3. Warfarin tablet 5 mg
Sig. 1 tablet PO pc QPM
4. HCTZ tablet 25 mg
Sig. 1 tablet PO pc QAM

#28
#14
#30
#30

Prescription Analysis
Patients disease / condition requiring treatment (underlying disease,
pregnancy, lactation)
Patients allergy / hypersensitivity
Pharmacologic action of the prescribed product
Prescribed route of administration
Dose, dosage form, dosage regimen (safe & effectiveness for the
patient)
Drug interactions (drug-drug; drug-disease; drug-food)
Any difficulties of the patient to comply with the regimen
Total quantity of medication (sufficient to complete a course of
therapy?)
Physical / chemical incompatibility

Itraconazole cap.
Cefuroxime axetil
Warfarin
HCTZ

2 capsules
1 tablet
1 tablet

1 tablet
1 tablet
-

Itraconazole cap.
Cefuroxime axetil
Warfarin
HCTZ

2 capsules

1-tablet
1 tablet
-

-
1 tablet

1 tablet?
- ?

15


:
:
:
:

???
???

Gastric emptying time:

: 0.5-1
: 1-2

Fact!!!

0.5-1

Fact!!!

0.5-1

Fact!!!

1-2

0.5-1

Fact!!!

1-2

0.5-1

Fact!!!

0.5-1

Fact!!!

0.5-1

Fact!!!

1-2

0.5-1

Fact!!!

1-2

0.5-1

Fact!!!

1-2

0.5-1

 0.5-1

0.5-1 1-2

pH 4



ciprofloxacin calcium
cyclosporine

0.5-1
1-2

Ciprofloxacin Divalent/trivalent Cation

HN
N

N
O

F
O

O
M

O
F

O
N
2+

2+

3+

M = Mg , Ca , Al

N
NH

pH 4

erythromycin stearate/base,
penicillin G, ampicillin, azithromycin capsule,
omeprozole

ciprofloxacin

Erythromycin stearate/base
erythromycin
estolate
esterase


Penicillin G ampicillin
penicillin V amoxicillin

penicillin V

Degradation of Penicillin in Acid pH (pH <3)

O
R
Penicillin
Active

H+

NH
O

S CH3
CH3
C N
O

OH
N
R

H+

NS

CO2H
CH3

CH3

Penicillenic acid
inactive

Wilson and Gisvolds Textbook of Organic Medicinal and Pharmaceutical Chemistry

Azithromycin capsule
azithromycin suspension

pH 4
pH 4
(ionized form)
: phenobarbital

ciprofloxacin

Phenobarbital Solubility in Acid pH

O
N
HO

O - H+

Take Home Message #1

0.5-1


()

1-2

pH 1.5-2

0.5 ,
, , 1

NSAIDs

pH 1.5-2

()
itraconazole capsule

Itraconazole
capsule

solution

pH 1.5-2

ester form
esterase ester
erythromycin estolate,
cefuroxime axetile, cefditoren pivoxil

Cefditoren pivoxil
F 70%

Take Home Message #2

()
ester form esterase
ester

Grape fruit juice: CYP 3A4

? Cranberry juice
: CYP 3A4 inhibitor


(,
) chocolate, , , ,
MAOIs

warfarin


phytate
hazelnuts
ferrous sulfate
carrier
levodopa



15 -0.5

-glucosidase inhibitors

-glucosidase

Itraconazole cap.

Cefuroxime axetil

esterase

Warfarin

HCTZ

Itraconazole cap.
Cefuroxime axetil
Warfarin
HCTZ

1
-