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Chapter 1: About Drugs in General    
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Drug Effects on Nutritional Status Dietary Recommendations
Methotrexate (cancer) Diarrhea, GI bleeding, nausea or vomiting. Reduces folic acid. Poor absorption of B12. Loss of appetite, sore mouth and throat, altered taste. Increase water intake.
Avoid alcohol.
Mineral Oil
(laxative)		 Flatulence, nausea, vomiting. Reduces absorption of vitamins A, D, E, K. Loss of appetite and weight loss. Hypokalemia (low potassium) Take 2 hrs before a meal. Increase fat-soluble vitamin intake.
Penicillamine
(antiarthritic)		 Diarrhea, nausea, vomiting. Reduces copper, zinc, and iron. Altered taste and loss of appetite. Take with water. Take on empty stomach. B6 and trace mineral supplementation.
Phenolphthalein
(laxative)		 Reduced absorption of vitamin D, calcium, and other minerals. Hypokalemia (low potassium). Take on empty stomach.
Chew well.
Phenylbutazone
(anti-inflammatory)
Steroids		 Constipation, diarrhea, heartburn, fluid retention, and weight gain.Bloating, indigestion, nausea. Fluid and sodium retention. Reduced absorption of vitamin D. Osteomalacia. Take with food. Avoid alcohol.
Take with food or low-sodium snack. Sodium-restricted diet.Increase potassium.
Steroids (anabolic) Nausea, vomiting, fluid retention, edema,
and weight gain. 		 
 
Sulfasalazine
(anti-inflammatory)		 Diarrhea, stomach distress, nausea, vomiting. Reduces absorption
offolic acid. Loss of appetite.		 Take with water.
Increase water intake.
Increase folic acid-rich foods.
Source: David Heber, op.cit.

The Effects of Food on Absorption and Action of Medications
Food Drug Action
Coffee/tea Neuroleptic agents Reduces drug absorption
  Theophylline Increases drug side effects
Citrus Quinidine Increases blood levels of drug
Fiber (bran, Pectin) Digoxin Reduces drug absorption.
Food/meals Chlorothiazide Increases drug absorption
  Propranolol Increases drug absorption
  Nitrofurantoin Increases drug effectiveness
  Cimetidine Delays drug absorption
  Aspirin Reduces drug absorption
  Tetracycline Reduces drug absorption
High-fat foods Griseofulvin Increases drug absorption
High-protein foods Levodopa, methyldopa Reduces drug absorption
Licorice Antihypertensive Induces hypokalemia and drugs sodium retention
Milk Tetracycline Reduces drug absorption
Meal with Milk Methotrexate Reduces drug absorption
Salty foods Lithium Reduces drug effectiveness
Vegetables (dark green) Warfarin Reduces drug effectiveness
Source: David Heber, op.cit.


X. Effect of Long-Term Use

Many diseases/disorders require long-term drug treatment either to control the symptoms or to prevent them for occurring again, for example, patients with Insulin-dependent Diabetes have to take Insulin regularly for all their whole life. There are certain other diseases/disorders which take a long time to cure, for example, Tuberculosis requires at least six months treatment with drugs.

Certain drugs cause adverse effects, especially on long-term use. If you are regularly taking a drug for a long time, you should know the possible long-term adverse effects of the drug which you should expect. As soon as any of them occur, you should report to the doctor immediately. One must never stop using the drug without consulting the doctor just because of the appearance of adverse effects. Doing so may cause worsening of the symptoms which can sometimes prove more dangerous than the adverse effects of the drug.

The possible adverse effects that may occur on long-term use as well as any specific warning pertaining to long-term use of the drug are mentioned in this column of the drug profile wherever necessary.

Any changes in the patients' health must be reported to the doctor, for example, if the patient gets pregnant, it is important to ask her doctor if it is proper to continue the drug in pregnancy or change the drug. Similarly if one contracts a new disease/disorder, for which other drugs are prescribed, the doctor must know about it. The doctor must be informed, in case s/he does not know about the regular long-term drug you are using, when you consult him/her for another new disease/disorder. It is also advisable to carry a warning card mentioning that you are using a particular drug regularly along with you as it may prove useful in case of emergency, such as an accident.
Try to take the drug at the same time every day to avoid the chances of missing any dose. Certain long-term use drugs may require the patient to go to the doctor for regular check-ups, for example, blood-pressure measurement, blood count, certain blood tests, etc.

It is often thought that regular long-term use of certain drugs may result in reduced effectiveness of the drug or dependence of the patient on the drug. Now, this is true only for a few drugs and not for most of the other drugs. Besides, a drug if taken for few weeks may not cause such problems.

Annexure 1 is a brief discussion of some of the more commonly used drug groups. Annexure 2 is about poisoning, including drug poisoning, and its treatment.

     
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