MURITHI KATHARE: Why mixing ARVs with food could be bad for you

There are three categories of drugs. Those that you take without food – usually one hour before you eat.

There are those you take with food. This means you take a few spoons of food, then the drug, and then you continue to eat.  This is usually to prevent drug-induced nausea.

The other category you take after food, usually two hours after food.

Now, there is a problem when people indiscriminately mix food with drugs. Someone might have good intentions, but they have no knowledge of what might happen when the drug mixes with food.

They have no knowledge of which type of food can affect drugs and which cannot. The outcome may not be what you intend.

Some ARVs are not taken with any food. For instance, Efavirenz should be taken on an empty stomach - at least 30 minutes before or two hours after food.

If you take it with food, the concentration will be very high and the patient will feel weak and unproductive.

Atazanavir can be taken with food. But it depends on which food. Some foods contain zinc oxide and some vitamins which may accelerate metabolism of the drug and its concentration becomes less in the body. This means it therefore cannot fight the percentage of virus it’s supposed to fight.

Therefore the normal dose expected is not achieved and this is not because of the drug, but food-drug interaction.  After one year, this patient will be changed into another regimen. The doctor will think the drug is not working for the patient.

Grapefruit juice interacts with all drugs. It prevents the drug from getting distributed into the system. What might reach the body is 50 per cent and the rest is consumed by the juice. The virus becomes resistant to the drug because it's not dying and is multiplying slowly.

So, we don’t say that you don’t mix. But the caregiver should be trained by a pharmacist on medication therapy management.

Paediatric HIV medication is where we have the biggest problem. The problem is in HIV clinics no one teaches people about the medication use process.

I have several patients I’m handling because caregivers mixed drugs with food and the patients are getting worse.

Medication therapy management specialist and vice president of practice, Pharmaceutical Society of Kenya