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Psychiatrists should be vigilant of patient dietary habits, potential drug-food interactions

Routine inquiry about dietary habits and supplements and increased monitoring for potential drug-food interactions is an essential component of psychopharmacological practice, according to a recent review.

“Although drug-food interactions involving psychotropic drugs are common, most are not associated with serious adverse effects. On the other hand, some drug-food interactions involving psychotropic drugs can lead to potentially catastrophic outcomes, such as hypertensive crisis, drug/nutrient toxicity, or treatment failure,” Andrew D. Carlo, MD, and Jonathan E. Alpert, MD, PhD, of Massachusetts General Hospital, wrote.

Researchers explored clinically significant drug-food interactions in psychiatry, including those associated with hypertensive crises with monoamine oxidase inhibitors and the absorption of medications such as levothyroxine, ziprasidone and lurasidone.

They assessed effects of co-administration with food and the excretion of lithium and other medications within dietary changes.

Further, they analyzed the impact of grapefruit juice, St. John’s wort, cruciferous vegetables, charbroiled meats, dietary supplements and alcohol on drug metabolism.

“Although many drug-food interactions are clinically insignificant, some may have a major effect on efficacy and risk. Greater awareness of key drug-food interactions, routine inquiry about changes in dietary habits, and use of supplements is likely to contribute to safer prescribing and monitoring as well as to earlier recognition of significant interactions when they occur,” the researchers concluded. – by Amanda Oldt

Disclosure: Alpert reports receiving consultant fees from Luye Pharmaceuticals and a royalty from Belvoir Publications Inc. Carlo reports no relevant financial disclosures.