SODEXHO USA FOOD & NUTRITION SERVICES
Operational Standard:
2.4.17.1
FOOD & DRUG INTERACTION
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EFFECTIVE DATE: PAGE:
2
DATE OF REVIEW: 8/00, 8/01, 6/02, 6/03, 2/04, 2/05, 3/06 REV. NO.:
REVIEWED BY: Rebecca Brody, MS, RD, CNSD APPROVED BY:
ATTACHMENTS: Newark Beth Israel Medical Center Policy 2.4.17– Food Drug Interactions (FDI)
POLICY:
There is a multi-disciplinary policy and procedure addressing patient education of potential food and
drug interactions (Policy 2.4.17). The Registered Dietitian educates patients on significant food and
drug interactions.
PURPOSE:
To reduce the risk of food and drug interaction.
PROCEDURE:
1. The Newark Beth Israel Medical Center multidisciplinary policy for Food Drug Interactions is
followed.
2. The food and drug interaction list is reviewed by pharmacy, nursing, and nutrition services and
updated, as needed, annually.
3. On a daily basis, the Pharmacy Department will fax a list to the Department of Food and
Nutrition Services of all inpatients receiving targeted medications.
4. The Registered Dietitian staff will review the FDI list daily and educate patients who are taking
the following drugs:
4.1 Atovaquone (Mepron) - Educate patient on consumption of > 23 g fat per meal.
Modify cardex to reflect FDI.
4.2 Linezolid (Zyvox) – Educate patient on avoidance of tyramine containing foods.
Modify cardex to reflect FDI.
4.3 Warfarin (Coumadin) – Educate patient on maintenance of consistent levels of
Vitamin K.
4.4 Eskalith (Lithium) – Educate patient on consistent sodium intake.
4.5 MAO Inhibitors Isocarboxazid (Marplan), Phenelzine (Nardil), Tranycypromine
(Parnate) – Educate patient on avoidance of tyramine containing foods. Modify cardex
to reflect FDI.
4.6 Cyclosporin, Tacrolimus (Sandimmune, Neoral, Prograf) – Educate patient to
avoid grapefruit juice. Grapefruit juice is not available on the patient menu.
5. Education will be documented in the medical record in accordance with the Nutrition
Assessment and Reassessment policy 2.4.10 and on the interdisciplinary patient education
record.
6. The Registered Dietitian, Pharmacist, MD, RN or other pertinent health professional will
identify patients at risk for Dilantin(Phenytoin)/enteral feeding interaction.
6.1 The interaction results in significantly decreased absorption of oral Phenytoin,
thus decreased Phenytoin concentrations which may lead to poor therapeutic response.
6.2 If patients are to receive continuous enteral feeds, it is recommended that IV phenytoin
be administered, where appropriate, to avoid drug/nutrient interaction.
6.3 If the patient can receive intermittent feedings, or in situations where patient is able to
receive only oral Phenytoin, then oral Phenytoin should be given at least two hours
following a feeding and the next feeding be held until at least two hours after oral
Phenytoin is given. For patients receiving Phenytoin suspension through a feeding tube,

the tube should be flushed with water following Phenytoin administration. Serum
Phenytoin levels should be monitored, and the dosage should be adjusted accordingly.
EXCEPTIONS:
None.