Emerald Charity Bilbrew; Jody Vogelzang; Kelli Whittington

Learning Outcomes

By the end of this section, you should be able to:

18.3.1 Identify drug–food interactions for their impact on treatments used for gastrointestinal disorders.
18.3.2 Identify treatments and medications that can cause nutritional deficiencies in clients with gastrointestinal disorders.

Drug–Food Interactions Related to Treatments for Gastrointestinal Disorders

Medications used to treat Crohn’s disease and UC are in the anti-inflammatory and immunosuppressant classes. The most frequently used medications for Crohn’s disease treatment are azathioprine and mercaptopurine. A client with UC is most often prescribed balsalazide, mesalamine, olsalazine, or sulfasalazine. For diverticulitis, antibiotics are needed; the most commonly used are ciprofloxacin plus metronidazole, trimethoprim-sulfamethoxazole plus metronidazole, amoxicillin-clavulanate, and moxifloxacin.

Drug–food interactions are a concern when prescribing these drugs, so clients must be educated about specific interactions to avoid adverse effects (Table 18.4).

Food	Food Interaction
Azathioprine	Avoid raw or half-cooked foods (can cause foodborne illness).
Mercaptopurine	Take 1 hour before or 2 hours after ingestion of milk or dairy products (reduces absorption when taken with food).
Balsalazide	Swallow right away if taken with food as an open capsule (mixing with food can cause staining of the tooth enamel). Review medication insert for information on mixing medication with applesauce.
Mesalamine	Take this medication on an empty stomach—at least 1 hour before meals or 2 hours after meals when taking specifically the Asacol HD version of this medication.
Olsalazine	Drink plenty of water with this medication to protect the kidneys. Avoid smoking (decreases medication effectiveness).
Sulfasalazine	Avoid alcohol and spicy foods (increases risk for indigestion).
Metronidazole	Avoid alcohol during and 24 hours before and after treatments (can cause serious adverse effects).
Sulfamethoxazole-Trimethoprim	Avoid alcohol (can cause serious adverse effects).
Amoxicillin- Clavulanate	No interactions.
Moxifloxacin and Ciprofloxacin	Avoid dairy products (can make less effective). Avoid vitamins containing iron, magnesium, calcium, or zinc within 4 hours before and after taking this medicine (can make the drug and the vitamins less effective).

Table 18.4 Foods to Avoid When Taking Certain Drugs (sources: Cancer Research UK, 2022; Mayo Clinic, n.d.; Mayo Clinic, 2023; NHS, 2021; Offices of Disease Prevention and Health Promotion, 2023; PeaceHealth, 2023)

Treatments and Medications That Can Cause Nutritional Deficiencies

Avoiding certain foods is not the only concern that needs to be addressed regarding treatments. Many of the medications already described can also cause nutritional deficiencies. The client must know which foods they can increase in their diet to prevent deficiency (Table 18.5).

Drug	Nutrient Deficiency	Foods to Replace Nutrients
Azathioprine	Niacin (vitamin B₃)	Red meat, poultry, fish, brown rice, nuts, seeds, legumes, bananas
Mercaptopurine	Hypoglycemia in children younger than 6 years old when administered in a liquid form	Complex carbohydrates, along with monitoring of glucose levels
Balsalazide Olsalazine Sulfasalazine Mesalamine	Folic acid can reduce adverse effects of the medication	Dark green leafy vegetables, beans, peanuts, sunflower seeds, whole grains, liver
Ciprofloxacin Moxifloxacin	Bifidobacterium bifidum Lactobacillus acidophilus Biotin Folic acid Inositol Vitamin B₁ (thiamin) Vitamin B₂ (riboflavin) Vitamin B₃ (niacin) Vitamin B₆ (pyridoxine) Vitamin B₁₂ (cobalamin) Vitamin K	Kefir, sourdough bread, sauerkraut, kimchi, other fermented vegetables Milk enriched with acidophilus, yogurt containing live L. acidophilus cultures, miso, tempeh Legumes, egg yolks, organ meats, nuts, seeds, mushrooms, avocados, sweet potatoes Dark green leafy vegetables, beans, peanuts, sunflower seeds, whole grains, liver Whole-grain bread and bran, prunes, cantaloupe, citrus fruits, beans, peas, almonds, peanut butter, liver Fortified breakfast cereals, pork, fish, beans, lentils, green peas, enriched cereals, breads, noodles, rice, sunflower seeds, yogurt Dairy milk, yogurt, cheese, eggs, lean beef and pork, organ meats (beef liver), chicken breast, salmon Red meat, poultry, fish, brown rice, nuts, seeds, legumes, bananas Fish, beef liver and other organ meats, potatoes and other starchy vegetables Fish, meat, poultry, eggs, dairy products Kale, collard greens, broccoli, spinach, cabbage, lettuce
Metronidazole	Calcium Carbohydrates Beta-carotene Fats Folic acid Iron Magnesium Potassium Sodium Vitamin A Vitamin B₁₂ (cobalamin) Vitamin D Vitamin K	Dairy products, soybeans, dark green leafy vegetables, calcium-fortified foods, canned salmon, figs Grains, fruit, dairy products, legumes Yellow, orange, and green fruits and vegetables Fish, avocados, seeds, nuts, olive oil, eggs Dark green leafy vegetables, beans, peanuts, sunflower seeds, whole grains, liver Nuts, dried fruits, iron-fortified breads and cereals, legumes, oats, tofu Smoked, cured, salted, or canned meat, fish, or poultry; frozen breaded meats; frozen processed foods such as burritos and pizza; canned entrees (like canned pasta in tomato sauce); salted nuts Leafy green vegetables, orange and yellow vegetables, tomatoes, red bell peppers, cantaloupes, mangos, beef liver, fish oils, milk, eggs Fish, meat, poultry, eggs, dairy products Cod liver oil, salmon, swordfish, tuna, sardines, beef liver, vitamin D–fortified orange juice and dairy and plant milks Kale, collard greens, broccoli, spinach, cabbage, lettuce
Sulfamethoxazole-Trimethoprim	Vitamin K Calcium Magnesium Vitamin B₁₂ (cobalamin)	Kale, collard greens, broccoli, spinach, cabbage, lettuce Dairy products, soybeans, dark green leafy vegetables, canned salmon, figs Pumpkin seeds, chia seeds, almonds, boiled spinach, cashews, peanuts, soy milk Fish, meat, poultry, eggs, dairy products
Amoxicillin- Clavulanate	Vitamin K Vitamin B₁₂ (cobalamin) Folic acid Potassium Vitamin B₂ (riboflavin)	Kale, collard greens, broccoli, spinach, cabbage, lettuce Fish, meat, poultry, eggs, dairy products Dark green leafy vegetables, beans, peanuts, sunflower seeds, whole grains, liver Dried fruits, beans, lentils, potatoes, winter squash (acorn, butternut), spinach, broccoli, beet greens, avocados Fish, meat, poultry, eggs, dairy products Milk, yogurt, cheese, eggs, lean beef and pork, organ meats (beef liver), chicken breast, salmon Kale, collard greens, broccoli, spinach, cabbage, lettuce

Table 18.5 Nutritional Deficiencies Caused by Pharmacologic Therapies and Foods to Replace Those Nutrients (sources: Kaiser Permanente, 2015; Mayo Clinic, 2023; Naeini et al., 2021; Peace Health, 2015; Prescott et al., 2018; Ratajczak, et al., 2021)

18.3 Treatments and Nutrition

Learning Outcomes

Drug–Food Interactions Related to Treatments for Gastrointestinal Disorders

Treatments and Medications That Can Cause Nutritional Deficiencies