A patient at a rehabilitation center is prescribed erythromycin. The nurse is reviewing the patient's medication list, checking to see if there are medications that should not be taken with this antibiotic. One medication is found. What medication should not be taken with erythromycin?

1. Do not have to demonstrate effectiveness:

This statement is generally true under DSHEA regulations. Unlike pharmaceutical drugs, dietary supplements are not required to undergo rigorous testing to demonstrate their effectiveness in treating, preventing, or curing specific health conditions before they are marketed. However, manufacturers are prohibited from making unsubstantiated claims about the effectiveness of their products.

B. Are determined to be safe before being placed on the market:

Under DSHEA regulations, dietary supplement manufacturers are responsible for ensuring the safety of their products before they are marketed. However, unlike pharmaceutical drugs, dietary supplements do not undergo premarket approval by the Food and Drug Administration (FDA) to verify their safety and efficacy. Instead, manufacturers are required to notify the FDA of their intent to market a new dietary ingredient (NDI) and provide evidence of the ingredient’s safety.

C. Are checked for label accuracy:

The FDA regulates dietary supplements to ensure that their labels are accurate and truthful. However, the extent of label accuracy checking varies, and the FDA does not routinely test every dietary supplement product on the market. Instead, the FDA relies on postmarket surveillance, consumer complaints, and other mechanisms to identify and address inaccuracies or violations of labeling regulations.

D. Are tested prior to marketing:

Unlike pharmaceutical drugs, dietary supplements are not required to undergo premarket testing to demonstrate their safety or efficacy before they are marketed. While manufacturers are responsible for ensuring the safety of their products, there is no formal premarket testing requirement under DSHEA regulations.

A. Chocolate:

Chocolate contains tyramine, a substance that can interact with certain medications like monoamine oxidase inhibitors (MAOIs) to increase blood pressure. While isoniazid itself does not directly interact with tyramine, it is often recommended to avoid tyramine-rich foods to prevent potential interactions with other medications or to minimize potential risks. Therefore, clients taking isoniazid are advised to avoid consuming chocolate to reduce the risk of adverse effects.

B. Aged cheese:

Aged cheeses, such as cheddar, Swiss, and blue cheeses, are high in tyramine. Tyramine levels increase as cheeses age, and consuming aged cheeses can lead to tyramine buildup in the body, potentially causing hypertensive crisis when combined with certain medications like MAOIs. While isoniazid is not an MAOI, the cautionary advice to avoid tyramine-rich foods is often extended to individuals taking isoniazid to minimize potential risks.

C. Bananas:

Bananas contain tyramine, although in lower amounts compared to some other foods. However, it is still advisable for individuals taking isoniazid to avoid consuming bananas and other tyramine-rich foods to reduce the risk of potential interactions or adverse effects.

D. Red meat:

Red meat is not typically high in tyramine compared to other foods like aged cheeses, certain processed meats, and fermented foods. While some sources suggest limiting consumption of aged or fermented meats, fresh red meat is generally considered safe to consume while taking isoniazid.

E. White wine:

While red wine is more commonly associated with tyramine content, white wine can also contain tyramine and other biogenic amines. Like other tyramine-rich foods, white wine consumption should be limited or avoided by individuals taking isoniazid to minimize the risk of tyramine-related interactions or adverse effects.