AIDS Treatment Update, Issue 58, October 1997
Keith Alcorn
This chart summarises the advice for the commonest drugs; first the anti-HIV agents, then drugs used to treat or prevent opportunistic infections. Dietary guidelines that are vital to maximise the effects of the drug are described as `essential'.
NB. see print or web editions for fully formatted tables.
>>Anti-HIV drugs
Drug
Food
Drink
May be taken with or without food
No interference
AZT (Retrovir)
May be taken with or without food. Try taking with food if nausea is a problem
No interference
May be taken with or without food
No interference
ddC (Hivid)
May be taken with or without food
No interference
ddI (Videx)
Essential to take it on an empty stomach (half an hour before or two hours after eating) to maximise absorption
Apple juice or ice cold water may disguise taste. Acidic drinks such as orange juice or cola will interfere with absorption
May be taken with or without food. Take at least two hours apart from ddI or antacids Tablets can be dissolved in water
Essential to avoid large or fatty meals for two hours before and one hour after taking it.Indinavir can be taken with a light low-fat meal e.g. bread, toast, jam, cereal, skimmed milk. High fat, high protein or high sugar foods will decrease absorption e.g. eggs, full fat milk, yoghurt, meat at breakfast, ice cream, chocolate.
Essential to take it at least one hour apart from ddI Essential to drink at least 1.5 litres of water daily - and more in hot weather or if you have also been drinking alcohol - to help prevent kidney stones.Grapefruit juice reduces absorption.
Loviride
May be taken with or without food
No interference
Nelfinavir (Viracept)
Take with food to maximise absorption
No interference
Nevirapine (Viramune)
May be taken with or without food
No interference
May be taken with or without food. Taking it with a substantial meal will improve absorption and may reduce side-effects Food supplements such as Fortisip or milky drinks may mask tastes and aid absorption
Essential to take it within two hours after eating a substantial, balanced meal (i.e. not low fat or just a light snack)
Fresh grapefruit juice containing pith (not pink juice) increases absorption;
Del Monte is the only brand tested
>>Drugs for opportunistic infections
Drug
Food
Drink
May be taken with or without food
No interference
Atovaquone (Mepron)
Essential to take it with fatty food to maximise absorption
Milky drinks and food supplements such as Fortisip may aid absorption
Azithromycin (Zithromax)
Take at least one hour before or two hours after food, ddI or antacids
No interference
May be taken with or without food
Essential to receive adequate liquids before and during infusions, and drink plenty during the 48 hours after each infusion
Ciprofloxacin (Cipro)
Take four hours apart from ddI, antacids or mineral supplements
Drink plenty of fluids
Clarithromycin (Klaricid)
Try taking with food to reduce nausea. Take at least two hours apart from ddI or antacids
No interference
Co-trimoxazole (Septrin)
Try taking with food to reduce nausea.
Drink plenty of fluids
Dapsone (Maloprim)
May be taken with or without food. Taking with food may reduce nausea. Take at least two hours apart from ddI or antacids No interference
Fluconazole (Diflucan)
May be taken with or without food
No interference
Foscarnet (Foscavir)
May be taken with or without food
Essential to drink plenty of fluids before intravenous infusions and ensure adequate liquids during infusions
Ganciclovir capsules (Cymevene)
Essential to take it with food
No interference
Isoniazid
Take at least one hour before or two hours after food or antacids
No interference
Itraconazole liquid (Sporanox)
Take on an empty stomach
No interference
Itraconazole capsules (Sporanox)
Take immediately after a meal for best absorption. Take at least two hours apart from ddI or antacids Acidic drinks like cola maximise absorption
Ketoconazole (Nizoral)
Take immediately after a meal for best absorption. Take at least two hours apart from ddI or antacids Acidic drinks like cola maximise absorption
Pyrimethamine (Daraprim)
Try taking with food to minimise stomach upsets
No interference
Rifabutin (Mycobutin)
Try taking with food to minimise stomach upsets
No interference
Rifampicin (Rifadin, Rimactane)
Take immediately after a meal for best absorption. Take at least two hours apart from ddI or antacids No interference
>>Alcohol
Alcohol itself is not known to affect the uptake of medications in the gut (although the acid in some alcoholic drinks may). However, alcohol-induced liver damage may affect the way the body processes drugs, resulting in higher or lower blood levels. Alcohol may also increase the risk of drug-related pancreatitis.
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