避免與食物併服的藥品

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1 避免與中草藥 / 健康食品併服的藥品中草藥 / 健康食品 Herb/Nutraceutical 當歸 dong quai 聖約翰草 St John's wort 藥品 (rug) 作用 (Effect) 建議 (Suggestions) Tetracyclines 類抗生素院內現有藥品 : oxycycline Minocycline 等 Quinolones 類抗生素院內現有藥品 : iprofloxacin 西洋蔘 ginseng (American) coenzyme Q10 聖約翰草 St John s wort 酸果莓 cranberry 胡盧巴 fenugreek 銀杏 ginkgo biloba 維骨力 glucosamine 紫花苜蓿 alfalfa 八角 anise 覆盆子 bilberry 菠蘿 bromelain 芹菜 celery 黃春菊 chamomile 彩葉草 coleus 冬蟲夏草 cordyceps 當歸 dong quai 月見草油 evening primrose oil 小白菊 feverfew 大蒜 garlic 薑 ginger 抗凝血劑 ( 例如 :Warfarin) 三七 ginseng (Panax) 西伯利亞蔘 ginseng (Siberian) 葡萄 grapeseed green tea 綠茶七葉樹種子 horse chestnut seed h 辣根 orseradish 甘草 licorice ω-3 脂肪酸 omega-3-acids 花椒 prickly ash 紅三葉草 red clover 靈芝 reishi S- 腺苷甲硫氨酸 SAMe (s-adenosylmethionine) 草木犀 sweet clover 薑黃 turmeric 白柳 white willow 纈草 valerian 聖約翰草 St John's wort 卡瓦卡瓦 kava kava S- 腺苷甲硫氨酸 SAMe (s-adenosylmethionine) herbs with hypertensive properties ( 楊梅 bayberry 藍升麻 blue cohosh 辣椒 cayenne 麻黃 ephedra 薑 ginger 美國西洋蔘 ginseng (American) 科拉 kola 甘草 licorice 育亨賓 yohimbe) herbs with hypotensive properties (St John's wort 聖約翰草黑升麻 black cohosh 加州罌粟 alifornia poppy 彩葉草 coleus 金印 golden seal 山楂 hawthorn 槲寄生 mistletoe 長春花 periwinkle 奎寧 quinine 薺花 shepherd's purse) MAOI 類抗憂鬱藥 ( 例如 :Selegiline 等 ) alcium channel blocker 類降壓藥院內現有藥品 : Nifedipine Felodipine Amlodipine Lacidipine Verapamil iltiazem 聖約翰草當歸可能會降低藥物的血中濃度, 也可能造成光敏感 when take doxycycline doxycycline minocycline minocycline and and ciprofloxacin levels and ciprofloxacin may also cause photosensitization 可能會降低 warfarin 的療效 May change warfarin levels and effects 可能增加 serotonin 過量的危險和引發嗜睡 may increase risk of serotonin syndrome and/or excessive sedation 聖約翰草避免和可能升高或者降降低血壓的草藥併用 of herbs with hypertensive and hypotensive properties 風險分級 (Risk Rating) 聖約翰草 St John's wort HMG-oA Reductase inhibitor 類降血脂藥院內現有藥品 : Simvastatin Atorvastatin Pravastatin 聖約翰草 St John's wort Azole antifungal 類抗黴菌藥院內現有藥品 : Itraconazole Ketoconazole Voriconazole 聖約翰草和 voriconazole 的併用為禁忌 oncurrent use of St John's wort with voriconazole is contraindicated

2 聖約翰草 St John's wort Macrolide 類抗生素 ( 例如 :Erythromycin larithromycin 等 ) 聖約翰草 St John's wort 育亨賓 yohimbe 卡瓦卡瓦 kava kava 纈草 valerian 積雪草 gotu kola 麻黃 ephedra 天然甘草 natural licorice 聖約翰草 St John's wort 甘草 natural licorice 積雪草 Gotu kola 纈草 valerian 卡瓦卡瓦 kava kava 鎮靜安眠類藥物院內現有藥品 : iazepam Alprazolam Midazolam Triazolam lonazepam igoxin Potassium-sparing iuretics 類利尿劑 ( 例如 :Moduretic Spironolacton) 止痛劑類藥品院內現有藥品 : Morphine Meperidine Fentanyl odeine Alfentanil Tramadol) St John's wort and Yohimbe may decrease. 聖約翰草和育亨賓和功效 Kava kava, valerian, and gotu kola may increase NS depression 卡瓦卡瓦纈草積雪草會加強藥物的鎮靜作用 Ephedra:risk of cardiac stimulation 麻黃可能會造成心肌的剌激 Natural licorice: causes sodium and water retention 監測 igoxin 的血中濃 and increases potassium loss 度和療效甘草會造成鈉和水的滯留 Monitor serum 並增加鉀的流失 concentrations /therapeutic effects of 聖約翰草會減少藥物血中 cardiac glycosides if St 濃度 St Johns Wort may Johns Wort is decrease the serum initiated/dose changes concentration of ardiac Glycosides ue to mineralocorticoid activity Licorice may enhance the hypokalemic effect of Thiazide iuretics 可能會增加抑制中樞神經的作用 may increase NS depression Avoid concurrent intake * herbs with hypertensive properties (bayberry, blue cohosh, cayenne, ephedra, ginger, ginseng [American], kola, licorice) * herbs with hypotensive properties (black cohosh, alifornia poppy, coleus, garlic, goldenseal, hawthorn, mistletoe, periwinkle, quinine, shepherd's purse)

3 避免與食物併服的藥品食物 (Food) 藥品 (rug) 作用 (Effect) 建議 (Suggestions) 含鈣食品 : 牛奶或奶製口優格鈣片等 Milk or food with calcium ion Tetracyclines 類抗生素院內現有藥品 : oxycycline Minocycline 等 Quinolones 類抗生素院內現有藥品 : iprofloxacin 富含維他命 K 食物 (foods rich in vitamin K): 花椰菜 auliflower 豆莢 pod 包心菜 cabbage 菠菜 spinach 蘆筍抗凝血劑 ( 例如 :Warfarin) asparagus 萵苣 lattuce 深綠色蔬菜 dark green vegetables 綠茶 green tea 人蔘 ginseng 等富含 tyramine 之食物 : 魚干 air-dried or cured meats 味增湯紅酒生啤酒 draft beers 酪梨香蕉酵母乳酪 cheese 起司醬油 soy sauce fava 蠶豆優格酸奶油醃漬品精緻肉品如香腸 sausages 燻肉醃肉 cured meats 培根等葡萄柚汁 Grape juice 高纖維食品 Food with fiber MAOI 類抗憂鬱藥 ( 例如 :Selegiline 等 ) alcium channel blocker 類降壓藥院內現有藥品 : Nifedipine Felodipine Amlodipine Verapamil iltiazem(*1) HMG-oA Reductase inhibitor 類降血脂藥院內現有藥品 :Simvastatin Atorvastatin(*2) Azole antifungal 類抗黴菌藥院內現有藥品 : 飯前 1hr 或飯後 2hr 服用鈣質與藥物結合成複合物, 干擾藥品之吸收, 降低藥品療效服藥前 2hr 或服藥後 6hr Administration with iron or 再食用 Avoid or take ciprofloxacin 2 hours calcium may decrease drug before or 6 hours after antacids, dairy absorption products, or calcium-fortified juices alone or in a meal containing >800 mg calcium, oral multivitamins, or mineral supplements containing divalent and/or trivalent cations 因含維他命 K 的食物會拮抗 warfarin 的抗凝血作用, 使療效降低 The anticoagulant effects of warfarin may be decreased if taken with foods rich in vitamin K 抑制 tyramine 的代謝, 容易造成高血壓的危象 may cause sudden and severe high blood pressure (hypertensive crisis or serotonin syndrome) 葡萄柚汁中含類黃酮, 會抑制肝臟內的重要的代謝酵素 (YP3A4), 使藥物延緩代謝, 會增加副作用 Increased drug concentrations resulting in therapeutic and vasodilator side effects, including severe hypotension and myocardial ischemia Fluconazole Itraconazole resulting in decreased Voriconazole antifungal effects 鎮靜安眠類藥物院內現有藥品 : iazepam Midazolam Triazolam Estazolam (*3) igoxin 避免大量食用, 如需併用嚴密監測藥物效果 Maintain a consistent diet; consult prescriber before making changes in diet. Take warfarin at the same time each day 避免服用含 tyramine 的食物 Avoid tyramine-containing foods 葡萄柚汁中含類黃酮, 會抑制肝臟內的重要的代謝酵服藥期間需避免飲用大素 (YP3A4), 使藥物延緩量的葡萄柚汁代謝, 會增加副作用 Avoid concurrent intake Simvastatin serum of large quantities of concentration may be grapefruit juice ( >1 quart increased when taken with 夸特 (473ml) / day) grapefruit juice 降低藥品療效 Grapefruit juice may impair the absorption of itraconazole capsules, 使藥品作用的時間延後 Grapefruit juice may increase drug serum concentrations 減少藥品的吸收 may decrease oral 風險分級 (Risk Rating) (Nifedip ine) (Felodip ine Amlodipi ne) (Verapa mil iltiazem )

4 absorption of digoxin 咖啡因 ( 咖啡巧克力可樂等 ) caffeine Quinolones 類抗生素院內現有藥品 :iprofloxacin 會造成心悸手抖興奮等作用如果發現有中樞神經過度剌激的情形, 咖啡的攝取需減量 Restrict caffeine intake if excessive cardiac or NS stimulation occurs 含鐵之維他命或飲食 ( 例如 : 黑糖 brown sugar 黑芝麻 black sesame seeds 紅莧菜 red amaranth 紅豆 red beans 黑豆 black beans 動物肝臟 livers 瘦肉 lean meat 黃豆 soybean 菠菜 spinach 雞蛋 eggs 蝦 shrimp 紫菜 laver 海帶 kelp 黑木耳 black fungus 等 ) 紅麴 (Red yeast rice) Quinolones 類抗生素 ( 例如 :iprofloxacin Tetracyclines 類抗生素 ( 例如 : oxycycline) HMG-oA Reductase inhibitor 類降血脂藥院內現有藥品 : Simvastatin Atorvastatin Fluvastatin, pitavastatin pravastatin rosuvastatin 降低藥物的吸收. iprofloxacin serum levels may be decreased if taken with divalent or trivalent cations. 降低藥物的吸收 Administration with iron or calcium may decrease doxycycline absorption 增加藥物毒性 : 肌痛橫紋肌溶解 Red yeast rice contains an estimated 2.4 mg lovastatin per 600 mg rice 飯前 2hr 或飯後 6hr 服用 Avoid or take ciprofloxacin 2 hours before or 6 hours after antacids, dairy products, or calcium-fortified juices alone or in a meal containing >800 mg calcium, oral multivitamins, or mineral supplements containing divalent and/or trivalent cations. 服藥期間需避免食用 Avoid concurrent intake *1: Lacidipine 未查到 *2: Exceptions :Fluvastatin(lexscol), pitavastatin(livalo), pravastatin, and rosuvastatin---low risk *3: Exceptions :Lorazepam(Ativan)--- are probably unaffected by grapefruit juice,alprazolam and lonazepam is unlikely to be increased by grapefruit juice because of their high oral bioavailability. 許多藥品與酒精 ( 未列上 ) 皆有嚴重交互作用, 建議服藥期間不宜飲酒, 若必須飲用, 請先洽藥師 Reference: UpToate Lexi-Interact Online Risk Rating Action escription A 無已知的交互作用 No Known Interaction 臨床証據顯示在藥效學和藥動學方面沒有交互作用存在 ata have not demonstrated either pharmacodynamic or pharmacokinetic interactions between the specified agents B 不需採取其它的動作 No Action Needed 臨床証據顯示併用時交互作用發生的可能性很小 ata demonstrate that the specified agents may interact with each other, but there is little to no evidence of clinical concern resulting from their concomitant use. 監測療效及副作用 Monitor Therapy 臨床資料顯示併用時可能會有明顯的交互作用, 需要時可能要調整劑量及適當監測副作用的發生 ata demonstrate that the specified agents may interact with each other in a clinically significant manner. The benefits of concomitant use of these two

5 medications usually outweigh the risks. An appropriate monitoring plan should be implemented to identify potential negative effects. osage adjustments of one or both agents may be needed in a minority of patients. 考慮用藥和治療選擇的調整 onsider Therapy Modification 臨床資料顯示併用時可能會有明顯的交互作用, 需依病人差異性評估併用是否有利益, 必要時需持續監測調整劑量, 或改用其它藥品 ata demonstrate that the two medications may interact with each other in a clinically significant manner. A patient-specific assessment must be conducted to determine whether the benefits of concomitant therapy outweigh the risks. Specific actions must be taken in order to realize the benefits and/or minimize the toxicity resulting from concomitant use of the agents. These actions may include aggressive monitoring, empiric dosage changes, choosing alternative agents. 避免併用 Avoid ombination 臨床資料顯示併用時有明顯的交互作用, 且風險大於可獲得的利益, 兩者併用列為禁忌 ata demonstrate that the specified agents may interact with each other in a clinically significant manner. The risks associated with concomitant use of these agents usually outweigh the benefits. These agents are generally considered contraindicated.

Microsoft Word - 20140116012.doc

Microsoft Word - 20140116012.doc 淺談食物與藥物交互作用食物真得會影響藥物的作用嗎? 李雅琪藥師新聞曾報導過, 降血脂藥加上紅麴膠囊, 容易導致肝腎的損傷食物和藥物不當的組合會傷身, 兩者之間到底是如何互相影響呢? 食物對藥物的影響不外乎在干擾吸收分