Can Medicines Be Taken With Milk or Other Dairy Products?

Updated on August 20, 2018
Sherry H profile image

Sherry Haynes is currently pursuing a PharmD degree and has experience in both the clinical and management sides of pharmacy.

Source

One of the most asked questions by patients is whether or not to take the meds with milk. The answer to this question depends on what exactly the medicine is. There are some medicines that should not be taken with milk the reason being, milk interacting with them, making them fail to work. When the term 'milk' is mentioned, most times not only is it milk that should be avoided but all the other dairy products like yoghurt, cottage cheese, butter milk and supplements containing calcium, magnesium, iron, and zinc.

When the presence of milk, food, herbs, or other drugs affects the action of a drug, it is called “interaction”. Drug-food interactions can cause changes in proportion of drug entering the circulation. This can influence the safety and efficacy of drug therapy, and may lead to treatment failure and in some cases, beneficial effects.

The drug-milk interactions are mostly pharmacokinetic interactions, since the milk affects the absorption and excretion of drugs. These types of interactions are usually moderate in severity as they cause a failure in treatment and need for additional treatment.

How does milk or other dairy products affect the action of medicines?

Some antibacterials e.g. tetracyclines can chelate with calcium present in the milk and other dairy products to form insoluble complexes that are poorly absorbed and have reduced antibacterial effects.

The same mechanism of interaction goes for other divalent and trivalent metallic ions, such as magnesium, aluminium, bismuth, zinc, and iron, present in many supplements and antacids. Most tetracyclines and related drugs come with a warning on the label to avoid milk and dairy products. The patients may often not realize that antacids, laxatives, and nutritional supplements should be shunned too. Many female patients take calcium pills to prevent osteoporosis. Most may also be taking vitamin and mineral supplements with iron, magnesium, and zinc. It might not sound very serious but dangerous situation could occur if a patient had rocky mountain spotted fever. This disease can be fatal if it is not treated quickly with antibiotic preferably tetracycline. Inactivation of this antibiotic by vitamin and mineral supplements could lead to tragedy.

In other cases, such as in laxatives containing bisacodyl that are coated with an intention to prevent their dissolution into the acid environment of the stomach, and cause them to go to intestine to dissolve there for the intended action. Milk lowers the stomach acidity and causes the drug to dissolve there instead of intestine, causing irritation in the stomach and hard stomach ache.

Separating the dosages of the meds and antacids or calcium supplements by 2 to 3 hours goes some way towards reducing the effects of this type of interaction.

Here is a list of drugs that should not be taken with milk

1. Tetracycline and Teracycline-like antibiotics

Tetracycline antibiotics are broad spectrum antibiotics that act by inhibiting the growth of bacteria. These are used for a large number of purposes from treatment of acne to malaria, brucellosis, chlamydia infection, and lyme disease.

Tetracycline can bind to calcium and iron present in the milk, forming insoluble chelates, and reducing its bioavailability. Milk can reduce the blood levels of tetracycline drugs by 50% or more. This much decrease in the bioavailability is enough to sabotage their impact.

Orange juice and coffee are calcium containing foods/drinks but do not interact with tetracyclines.

Tetracyclines include demeclocycline, methacycline, tetracycline, doxycycline, ocytetracycline, minocycline.

2. Quinolones - Ciprofloxacin, Norfloxacin, Gatifloxacin

Quinolones are another broad-spectrum antibiotics that act by killing the bacteria. These are often used for genitourinary infections such as pyelonephritis and sickle cell disease.

In the same way as in tetracycline antibiotics, calcium and caesium in milk and yoghurt or other dairy products combine with quinolone antibiotics to produce insoluble chelates.

Ciprofloxacin, norfloxacin, and gatifloxacin show reduced bioavailability when taken with milk. Whereas, xenoxacin, lomefloxacin, moxifloxacin, ofloxacin, and flevoxacin do not show such interaction.

3. Penicillins

In a study, the peak levels of oral Phenoxymethylpenicillin and oral Benzyl penicillin were reduced by 40-50% in children when they were given with milk. So, it is recommended that phenoxymethylpenicillin is taken 1 hour before food or on empty stomach to optimise the absorption. Due to poor oral absorption benzylpenicillin is given intramuscularly or intravenously which would be administered in the hospital.

4. Etidronate, Alendronate

Etidronate is a class of drug called bisphosphonates, prescribed for treating osteoporosis and bone pain from diseases such as metastatic breast cancer and Paget's disease. But, if calcium is consumed within 2 hours of taking the drug, it will be absorbed inadequately.

5. Laxatives

Laxatives are substances that loosen stools. Milk interferes with action of laxatives containing bisacodyl (Dulcolax). Normally laxatives containing bisacodyl are enteric-coated i.e., coating done to keep them from dissolving in the acid environment of the stomach, so that they go to work in the lower region of intestine. Drinking milk at the time of taking tablet may lower the stomach acidity enough that the coating dissolves there. This could result in stomach irritation and very bad belly ache.

6. Fleicainide

Fleicainide is an anti-arrythmic drug. It is used to restore normal heart rhythm and maintain a regular, steady heartbeat. It is also used to prevent certain types of irregular heartbeat from returning (such as atrial fibrillation).

In infants, the absorption of flecainide is reduced by milk.

7. Non-steroidal Anti-inflammatory Drugs (NSAIDS) - Nabumetome, Ketoprofen

NSAIDS are drugs prescribed to reduce fever, pain, and inflammation. These are most common drugs used. NSAIDs like ibuprofen, naproxen, and others can cause stomach irritation and thus they should be taken with food or milk

However, there are two drugs that show minor interaction with milk. Absorption of ketoprofen is reduced by milk. Whereas the absorption of another NSAID, Nabumetone is increased due to milk.

8. Trientine

It is used to treat Wilson's disease, a genetic metabolic defect that causes excess copper to build up in the body.

The drug should be taken 1 hour apart from milk. On theoritical grounds, Trientine can chelate with iron decreasing its absorption.

9. Paroxetine

It is an antidepressant drug, prescribed to treat mood and anxiety disorders. Very large amount of milk (as much as 1 litre) can cause 40% reduction in the absorption of paroxetine.

10. Strontium ranelate

Dairy products, Calcium compounds such as calcium containing antacids can cause marked decrease in the absorption of strontium ranelate. It is recommended to separate the administration of drug by at least 2 hours.

11. Ritonavir

Ritonavir is used in the treatment of HIV/AIDS. Milk and dairy products can increase the absorption of ritonavir by 13%.

12. Mercaptopurine

Mercaptopurine is used for cancers (acute lymphoblatic leukemia and chronic myelogenous leukemias). It is inactivated by an enzyme called xanthine oxidase (XO). Concurrent intake of substances containing XO may potentially reduce bioavailability of mercaptopurine. Cow's milk is known to contain a high level of XO which ay reduce the bioavailability of mercaptopurine. This interaction may be clinically significant. Therefore most patients should try to separate the timing of taking mercaptopurine and drinking milk.

13. Estramustine

It is an anticancer drug. Its absorption is reduced by milk, food and supplements containing calcium.

Steps to avoid such interactions

  • To avoid drug-milk interactions, take meds and milk at different times. Taking milk 2 or 3 hours before or after taking these meds is fine.
  • Take medicines with a full glass of water.
  • Read the prescription label on the container. If you do not understand something or think you need more information, ask your physician or pharmacist.
  • Read directions, warnings and interaction precautions printed on all medication labels and package inserts. Even over-the-counter medications can cause problems.
  • Make sure to follow all your doctor's dietary and medical instructions to make sure your treatment is working safely and effectively.

Disclaimer

This article is intended for informational purpose only. It should not take the place of advice from your doctor, pharmacist, or other health-care professionals. Always ask them if you have unusual symptoms, or any problem when you are using your medicines. This article may not cover all medicines or every type of medicines.

References

  1. Stockley, I. H., & Baxter, K. (2008). Stockley's drug interactions: A source book of interactions, their mechanisms, clinical importance, and management (8th ed.). London ; Chicago: Pharmaceutical Press.
  2. https://www.researchgate.net/publication/5801710_Interaction_between_mercaptopurine_and_milk [accessed Aug 18 2018].

Questions & Answers

    © 2018 Sherry Haynes

    Comments

      0 of 8192 characters used
      Post Comment

      • Sherry H profile imageAUTHOR

        Sherry Haynes 

        5 weeks ago

        Miebakagh- Thank you and you too!

      • Sherry H profile imageAUTHOR

        Sherry Haynes 

        5 weeks ago

        Hi, Liz. Thats true- alcohol interacts with a lot of drugs so its better to avoid it while using any type of medicine unless you are sure its otherwise.

      • Miebakagh57 profile image

        Miebakagh Fiberesima 

        5 weeks ago from Port Harcourt, Rivers State, NIGERIA.

        Hello Sherry, thanks for the answer. It is very useful and important as the question. Have a nice time hubbing.

      • Eurofile profile image

        Liz Westwood 

        5 weeks ago from UK

        This gives a useful checklist. Another relevant question is 'Can alcohol be consumed while taking a certain drug'? I have been told by a pharmacist in the past not to drink any alcohol when he has been dispensing a strong antibiotic.

      • Sherry H profile imageAUTHOR

        Sherry Haynes 

        5 weeks ago

        Hi, Miebakagh. Thank you for reading the article. Milk does interfere with drug absorption but it is because of three main reasons, not due to high content of saturated fats. (Meaning even low fat milk should be avoided for such drugs)

        1. Milk contains divalent cations like calcium, iron, caesium that form chelates with antibiotics like tetracyclines and some quinolones and become insoluble so that they are not absorbed as efficiently.

        2. Laxatives are enclosed in a capsule in such a way that they survive the acid environment of stomach and release the medicine in the intestine. But, because milk decreases the acidity of stomach the capsules release the medicine in the stomach itself causing irritaion and stomach ache.

        3. Xanthine oxidase is an enzyme that inactivates mercaptopurine (drug used in certain types of cancers) and reduces its proportion in the blood circulation. It is present in milk in high levels so it is recommended to avoid milk while using this drug.

        Meat is to be avoided for certain drugs because it contains high amount of tyramine. Drugs that interact with tyramine include Linezolid (an antibiotic), antitubercular drugs (ethambutol, pyrazinamide, rifampin, isoniazid) and antidepressant drugs ( phenelzine, tranycypromine).

        I am not aware of any drug interacting with coconut water but because it lowers blood pressure, it is better to avoid it while taking medicines that lower blood pressure (your regular antihypertensive/ BP lowering meds).

        Thank you so much for asking such important questions. I am planning to write more about foods and other drugs that interfere drugs action.

      • Miebakagh57 profile image

        Miebakagh Fiberesima 

        5 weeks ago from Port Harcourt, Rivers State, NIGERIA.

        Hi, Sherry, this is useful information. But specifically, since milk contained saturated fats, and interfere with drug absorption, what about products like coconut water or meat? I heard both can work against drug absorption. Thanks.

      working

      This website uses cookies

      As a user in the EEA, your approval is needed on a few things. To provide a better website experience, healdove.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

      For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://healdove.com/privacy-policy#gdpr

      Show Details
      Necessary
      HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
      LoginThis is necessary to sign in to the HubPages Service.
      Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
      AkismetThis is used to detect comment spam. (Privacy Policy)
      HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
      HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
      Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
      CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
      Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
      Features
      Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
      Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
      Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
      Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
      Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
      VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
      PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
      Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
      MavenThis supports the Maven widget and search functionality. (Privacy Policy)
      Marketing
      Google AdSenseThis is an ad network. (Privacy Policy)
      Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
      Index ExchangeThis is an ad network. (Privacy Policy)
      SovrnThis is an ad network. (Privacy Policy)
      Facebook AdsThis is an ad network. (Privacy Policy)
      Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
      AppNexusThis is an ad network. (Privacy Policy)
      OpenxThis is an ad network. (Privacy Policy)
      Rubicon ProjectThis is an ad network. (Privacy Policy)
      TripleLiftThis is an ad network. (Privacy Policy)
      Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
      Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
      Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
      Statistics
      Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
      ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
      Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)