Medication and baverages

Proper co-ingestion of oral medications with an appropriate beverage is crucial to ensure their efficacy and safety. However, studies have shown that most patients do not take their medications with water as recommended, but instead use other drinks such as tea, fruit juices, or alcohol. This practice can lead to clinically significant drug interactions. These interactions most commonly arise from the inhibition of transporters such as OATP1A2 and OATP2B1, or the CYP3A4 enzyme, resulting in decreased or increased bioavailability of medications. For example, green tea, grapefruit juice, or orange juice may reduce the absorption of fexofenadine, lisinopril, or celiprolol by up to 99 %, or conversely significantly increase the systemic exposure of drugs metabolized by CYP3A4, such as simvastatin. This review summarizes the mechanisms underlying these interactions, the results of clinical and preclinical studies, and highlights the need for better patient and healthcare professional education regarding the importance of choosing an appropriate beverage when taking medications.

Keywords: medication co-ingestion, drug interactions, transport systems, OATP1A2, OATP2B1, PEPT1, CYP3A4, green tea, grapefruit juice, bioavailability, pharmacokinetics.