Drug-nutrient interaction

Levodopa/Carbidopa

Duopa, Inbrija, Parcopa, Rytary, Sinemet, Sinemet CR, Stalevo

Levodopa is absorbed in the same part of the gut as protein in food. Taking levodopa at the same time as eating protein (meat, fish, cheese, beans or nuts) may mean less medication is absorbed. If levodopa doesn’t work as well as you would like — it doesn’t kick in quickly or it wears off before the next dose is scheduled — consider separating it from meals. Swallow your pill, for example, 30 to 60 minutes before or after you eat. (If this causes nausea, combine it with a low- or no-protein snack, such as crackers, dry toast or oatmeal.) Or, save higher amounts of protein for dinner and eat more vegetables and carbohydrates during the day when it’s important for medication to work well.

Dopamine agonists

Mirapex (pramipexole), Neupro (rotigotine) and Requip (ropinirole)

This class of drugs does not compete with dietary protein for absorption like levodopa does, so here are no specific dietary restrictions. But each individual has different medication responses and side effects. If symptoms are generally poorly controlled, your doctor may recommend you take the drug on an empty stomach. If, on the other hand, the medication causes a side effect such as nausea, your doctor may suggest taking it with food.

MAO-B inhibitors

Azilect (rasagiline), selegiline, Xadago (safinamide)

These medications increase a substance called tyramine. When mixed with foods high in tyramine, the combination could significantly raise blood pressure. People who take these drugs should be aware of the potential for this rare but serious interaction. You don’t have to avoid tyramine-containing foods completely, but eat them in moderation.

Foods high in tyramine:

• Alcohol: tap beer, wine, vermouth

• Aged cheese: blue cheese, Camembert, Swiss

• Cured, fermented or air-dried meat: mortadella, salami

• Fermented cabbage: kimchi, sauerkraut

• Pickled fish: herring, lox

• Soybean products: miso soup, soy sauce, tofu