• The presence of food in the stomach, especially if it is fatty, delays gastric emptying and the absorption of certain drugs; the plasma concentration of ampicillin and rifampicin may be much reduced if they are taken on a full stomach. More specifically, calcium, e.g. in milk, interferes with absorption of tetracyclines and iron (by chelation).

• Substituting protein for fat or carbohydrate in the diet is associated with an increase in drug oxidation rates. Some specific dietary factors induce drug metabolising enzymes, e.g. alcohol, charcoal grilled (broiled) beef, cabbage and Brussels sprouts.

Protein malnutrition causes changes that are likely to influence pharmacokinetics, e.g. loss of body weight, reduced hepatic metabolising capacity, hypo-proteinaemia.

Citrus flavinoids in grapefruit (but not orange) juice decrease hepatic metabolism and may lead to risk of toxicity from amiodarone, terfenadine (cardiac arrhythmia), benzodiazepines (increased sedation), Ciclosporin, felodipine (reduced blood pressure).

Alterations in drug action caused by diet are termed drug-food interactions

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