Your Guide to Food and Drug Interactions

Patients on certain medications may be advised to avoid taking the drugs with certain foods to avoid unwanted interactions. For instance, some drugs may lose their effectiveness if taken with citrus fruits, while others may cause unpleasant side effects if taken with alcohol. It’s important to speak with the care team about potential interactions between the patient’s medication and any foods or beverages. Patients may also find it useful to review the following list of possible food and drug interactions.

Drugs and Their Food Interactions

Alendronate (Fosamax®)

Take with 6-8 ounces of plain water on an empty stomach at least 30 minutes before eating or drinking (including other medicines). Swallow tablets whole. Do not lie down for at least 30 minutes after taking a dose. Include high calcium foods in the diet. 

Cyclosporine (Gengraf®, Neoral®, Sangcya®)

Avoid grapefruit and grapefruit juice when taking this medication. Include high magnesium foods in the diet.

Itraconazole (Sporanox®)

Take capsules with a full meal to increase absorption. Take liquid formulations on an empty stomach to increase absorption. Avoid taking antacids, calcium or magnesium supplements, and Pepcid within two hours of this medication. Avoid grapefruit and grapefruit juice. 

Levofloxacin (Levaquin®)

Best if taken on an empty stomach with a large glass of water. Avoid taking antacids, sucralfate, dairy products, and iron and zinc supplements within two hours of taking this medication. 

Levothyroxine (Levoxyl®, Synthroid®) 

Take levothyroxine on an empty stomach with a full glass of water at least 30-60 minutes before breakfast. Take four hours apart from antacids, and iron and calcium supplements.

Linezolid (Zyvox®)

Avoid alcohol and foods high in tyramine when taking this medication.

Posaconazole (Noxafil®)

Shake well. Take suspension with a full meal (high fat meals are best) to increase absorption. Avoid taking antacids, calcium or magnesium supplements, or Pepcid within two hours of this medication. Avoid grapefruit and grapefruit juice.

Prednisone (Deltasone®, Orasone®)

Best if taken with food or milk. Avoid alcohol. Limit high sodium foods (see below for a list of them). Include high calcium foods in the diet.

Procarbazine (Matulane®)

Avoid alcohol and foods high in tyramine. 

Sirolimus (Rapamune®) 

Avoid grapefruit and grapefruit juice when taking this medication.

Sucralfate (Carafate®)

Best if taken at least one hour before meals or at bedtime. Limit caffeine. Avoid alcohol. Avoid taking antacids within 30 minutes of this medication.

Tacrolimus (Prograf®)

Avoid taking with grapefruit and grapefruit juice. Include high magnesium foods in the diet.

Warfarin (Coumadin®)

Your intake of foods high in vitamin K should remain the same from day to day. Avoid alcohol.

Foods High in Calcium

  • Baked beans
  • Bok choy
  • Broccoli
  • Cheese**
  • Cottage cheese
  • Custard**
  • Fruit juices** (fortified with calcium)
  • Ice cream
  • Kale
  • Milk**
  • Mustard greens
  • Pancakes
  • Pudding**
  • Salmon (canned with bones)
  • Sardines** (canned with bones)
  • Spinach
  • Tofu
  • Turnip greens
  • Waffle (homemade)
  • Yogurt**

**Most notable sources

Low Tyramine Diet

The amount of tyramine increases as foods age and spoil. Eat foods as fresh as possible. Keep foods fresh by properly storing them and observing expiration dates. Prepared foods should not be stored longer than 48 hours. Cooking does not destroy tyramine content.

Foods to Avoid

  • Aged cheese* (e.g., cheddar, Swiss, bleu, gouda, parmesan, feta)
  • Aged meats (curing process for steaks)
  • Air-dried meats (e.g., salami)
  • Brewer’s yeast supplement
  • Broad beans, fava beans
  • Concentrated yeast extract spreads (e.g., marmite, vegemite)
  • Fermented products (e.g., fish sauce, tofu, miso)
  • Sauerkraut, kimchi
  • Soy sauce, teriyaki sauce
  • Tap and imported beers

* May use cream cheese, cottage, ricotta, processed American and mozzarella cheese

Foods to Use with Caution

Limit to one to two servings per day

  • Peanuts (1/4 cup)
  • Wine (4 ounces)
  • Domestic bottled/canned beer, alcoholic or nonalcoholic (12 ounces)
  • Caffeine (1 cup coffee)
  • Chocolate (1 ounces)
  • Pickled herring (3 ounces)

Foods High in Vitamin K

Very High Sources (200-550 mcg/Serving)

  • Beet greens: 1/2 cup cooked
  • Collard greens: 1/2 cup cooked
  • Kale: 1/2 cup cooked
  • Mustard greens: 1/2 cup cooked
  • Spinach: 1/2 cup cooked
  • Swiss chard: 1/2 cup cooked
  • Turnip greens: 1/2 cup cooked

Moderately High Sources (less than 150 mcg/Serving)

  • Broccoli: 1/2 cup cooked
  • Brussels sprouts: 1/2 cup cooked
  • Cabbage: 1/2 cup cooked
  • Lettuce (green leaf): 1 cup raw
  • Okra: 1 cup cooked
  • Parsley: 1 tbsp.

Foods High in Potassium

  • Apricots
  • Artichokes
  • Asparagus
  • Avocados
  • Bananas
  • Brussels sprouts
  • Cantaloupe
  • Celery
  • Chocolate
  • Corn
  • Dates
  • Dried beans
  • Dried fruit
  • Figs
  • Greens
  • Honeydew
  • Milk
  • Orange juice
  • Oranges
  • Potatoes
  • Prune juice
  • Prunes
  • Pumpkin
  • Raisins
  • Rhubarb
  • Spinach
  • Squash
  • Tomato juice
  • Tomatoes
  • V8 juice

Foods High in Magnesium

  • Almonds
  • Artichokes
  • Baked potato
  • Beets
  • Blackberries
  • Bran cereals
  • Cashews
  • Chocolate
  • Collard greens
  • Crab
  • Dried beans
  • Dried fruits
  • Fish
  • Green peas
  • Kiwi
  • Lobster
  • Mandarin oranges
  • Milk
  • Okra
  • Oysters
  • Peanut butter
  • Peanuts
  • Persimmon
  • Plantain
  • Raspberries
  • Rye crackers
  • Shredded wheat
  • Shrimp
  • Spinach
  • Strawberries
  • Summer squash
  • Tofu
  • Tuna
  • Watermelon
  • Yogurt

Foods High in Sodium

  • Bacon
  • Bouillon
  • Cheese:
    • American
    • Bleu*
    • Cottage
    • Feta
    • Parmesan
    • Processed
    • Roquefort*
  • Corned Beef
  • Dried meat or fish
  • Fish or meat canned with salt
  • Frankfurters
  • Frozen dinners
  • Ham
  • Instant hot cereal
  • Luncheon meats
  • Olives and pickles
  • Packaged or canned soups
  • Pickled vegetables
  • Pretzels
  • Salt, salt substitute mixtures
  • Salted crackers and chips
  • Salted popcorn
  • Salted meat tenderizers
  • Salted spices (garlic salt, onion salt, seasoned salt)
  • Sauerkraut
  • Sausages
  • Soy sauce
  • Teriyaki sauce
  • Vegetable juice (canned)
  • Vegetables with seasoned sauces

* These items may pose a high risk for developing foodborne illness in certain individuals, including pregnant women and their fetuses, young children, older adults, people with weakened immune systems and individuals with certain chronic illnesses.