Cheese is a versatile and beloved food enjoyed worldwide. However, it can interact with certain medications and supplements. These interactions are not always well-known but can have serious consequences. Understanding these interactions ensures safe and effective use of medications while enjoying cheese.
Monoamine oxidase inhibitors (MAOIs)
Aged cheeses like Cheddar, Parmesan and blue cheese contain high levels of tyramine. This compound forms when proteins break down during ageing.
MAOIs, used to treat depression or Parkinson’s disease, inhibit the enzyme monoamine oxidase. This enzyme normally breaks down tyramine in the body. When MAOIs are taken with aged cheeses, tyramine levels can spike.
- Mechanism: Excess tyramine causes a rapid release of norepinephrine, a stress hormone. This can lead to dangerously high blood pressure, known as a hypertensive crisis.
- Examples: Common MAOIs include phenelzine (Nardil), tranylcypromine (Parnate) and selegiline (Emsam).
- Advice: Avoid aged cheeses like Cheddar, Parmesan and blue cheese while taking MAOIs. Fresh cheeses like Ricotta or Mozzarella are safer alternatives.
Tetracyclines and Quinolones (antibiotics)
Some antibiotics, particularly tetracyclines and quinolones, can interact with cheese. These drugs are used to treat bacterial infections.
- Mechanism: Calcium in cheese binds with antibiotics in the gut, forming insoluble complexes. These complexes cannot be absorbed, reducing the drug’s effectiveness.
- Examples: Tetracyclines like doxycycline (Vibramycin) and minocycline (Minocin or Minomycin) or quinolones like ciprofloxacin (Cipro) and levofloxacin (Levaquin).
- Advice: Avoid consuming cheese two hours before or after taking these antibiotics. This ensures proper absorption of the medication.
Bisphosphonates (osteoporosis)
Bisphosphonates, like alendronate, treat and prevent osteoporosis by improving bone density. Calcium-rich foods, including cheese, can interfere with these medications.
- Mechanism: Calcium competes with bisphosphonates for absorption in the gut. This reduces the medication’s bioavailability.
- Examples: Common bisphosphonates include alendronate (Fosamax) and risedronate (Actonel).
- Advice: Take bisphosphonates on an empty stomach with water. Avoid cheese and other calcium sources for at least two hours.
Levothyroxine (thyroid hormone replacement)
Levothyroxine treats hypothyroidism by supplementing thyroid hormones. Its absorption can be affected by dietary calcium.
- Mechanism: Calcium in cheese binds to levothyroxine in the gut. This reduces the amount of medication absorbed into the bloodstream.
- Examples: Levothyroxine is available under brand names like Synthroid, Euthyrox, Levothroid and Oroxine.
- Advice: Take levothyroxine on an empty stomach. Wait four hours before eating cheese or other calcium-rich foods.
Lithium (bipolar disorder)
Lithium, commonly used to treat bipolar disorder, does not have a direct interaction with cheese in most cases. However, certain aspects of diet, including sodium and hydration, can influence lithium levels in the blood. Cheese, particularly aged and processed varieties, may indirectly affect lithium therapy due to its sodium content.
Mechanism of interaction
- Sodium Levels: Lithium and sodium are processed similarly in the kidneys. High-sodium foods, including salty cheeses like Parmesan, Roquefort and Feta, can increase sodium levels in the body. When sodium intake rises, the kidneys may excrete more lithium, reducing its therapeutic effect.
- Dehydration: A diet high in sodium, often paired with insufficient water intake, can cause dehydration. Dehydration may lead to a concentration of lithium in the blood, increasing the risk of lithium toxicity.
Potential risks
- Reduced Efficacy: Excess sodium can lower lithium levels, making it less effective for mood stabilization.
- Toxicity: Conversely, rapid changes in sodium levels or dehydration may cause lithium levels to rise dangerously, leading to side effects such as tremors, confusion, or even kidney damage.
Advice for Lithium users
- Moderate Sodium Intake: Avoid excessive consumption of salty cheeses like blue cheese or processed varieties.
- Stay Hydrated: Drink plenty of water to maintain proper hydration and stable lithium levels.
- Consistent Diet: Maintain a stable sodium intake daily, as sudden dietary changes can disrupt lithium balance.
- Monitor Levels: Regular blood tests are essential to monitor lithium levels and ensure they remain within the therapeutic range.
If you’re on lithium therapy, it’s always best to consult with a healthcare provider about your diet, including cheese consumption.
Iron supplements
Cheese is a significant source of calcium. Consuming it with iron supplements can reduce their absorption.
- Mechanism: Calcium competes with iron for absorption in the intestines. This interaction reduces the effectiveness of iron supplements.
- Examples: Common iron supplements include ferrous sulfate, ferrous gluconate and ferrous fumarate.
- Advice: Space iron supplements from cheese consumption by at least two hours.
Integrase Inhibitors (HIV management)
Integrase strand transfer inhibitors (INSTIs), such as dolutegravir, bictegravir and raltegravir, can interact with calcium.
- Mechanism: Calcium in cheese binds to INSTIs in the gastrointestinal tract, forming insoluble complexes. This reduces drug absorption and efficacy. Hard cheeses like Parmesan and aged Cheddar are particularly high in calcium.
- Advice: Avoid consuming cheese two hours before or after taking INSTIs. If consuming cheese, consider spacing it apart from your medication doses.
Sotalol (heart)
Sotalol is a beta-blocker commonly prescribed to treat irregular heart rhythms (arrhythmias) such as atrial fibrillation. While there is no direct interaction between cheese and sotalol, certain components in cheese, like calcium and sodium, can indirectly affect how the medication works.
Calcium in cheese and sotalol absorption
Calcium-rich cheeses, such as Parmesan, Cheddar and Swiss, can interfere with sotalol absorption if consumed around the same time as the medication.
- Mechanism: Calcium binds to sotalol in the gut, forming insoluble complexes. This reduces the amount of sotalol absorbed into the bloodstream, potentially decreasing its effectiveness in managing arrhythmias.
- Advice: Avoid consuming calcium-rich cheeses within two hours of taking sotalol. If cheese is part of your diet, schedule it away from your medication times.
General tips for patients on sotalol
- Time Cheese Consumption: Avoid eating cheese, particularly calcium-rich varieties, close to your medication time.
- Choose Low-Sodium Options: Stick to cheeses with less sodium to support cardiovascular health.
- Monitor Electrolytes: Sotalol can affect potassium and magnesium levels, so balance your diet accordingly.
- Stay Consistent: Maintain a regular diet and medication schedule to ensure stable sotalol levels in the blood.
Always consult your healthcare provider for specific advice on your diet and medication. By understanding potential interactions, you can enjoy cheese while effectively managing your heart health.
Deferasirox (iron overload treatment)
Deferasirox is an oral iron chelator used to treat iron overload in conditions like thalassemia or sickle cell disease. It works by binding excess iron in the body, which is then excreted via the stool.
Interaction with dairy and supplements
Deferasirox requires special consideration because calcium in dairy products and other minerals can interfere with its effectiveness.
- Mechanism: Deferasirox binds to calcium and other minerals, reducing its ability to chelate iron effectively. The presence of calcium, magnesium, or aluminium in the stomach can lower the drug’s bioavailability.
- Advice: Avoid dairy products, antacids, and mineral supplements two hours before and after taking deferasirox. Take deferasirox on an empty stomach with water or a small non-dairy snack for better absorption.
- Common Dairy Products to Avoid: Milk, cheese, yoghurt and cream. Calcium-fortified plant-based milks (check labels for added calcium).
By following these guidelines, patients can ensure optimal iron chelation and avoid reducing the drug’s efficacy. Always consult your doctor or pharmacist for personalised advice.
Ursodeoxycholic acid (gallstones)
Ursodeoxycholic acid (UDCA) is used to treat gallstones and liver conditions such as primary biliary cholangitis.
Interaction with dairy and supplements
- Mechanism: UDCA’s absorption relies on bile salts. High-fat meals, including some cheeses, can enhance bile secretion and improve UDCA absorption. However, antacids containing aluminium hydroxide or calcium carbonate can bind to UDCA in the gut, reducing its effectiveness.
- Advice: While dairy (including cheese) doesn’t directly interfere with UDCA, antacids and calcium supplements should not be taken at the same time. If taking antacids or calcium supplements, space them out by at least two hours from UDCA to ensure proper absorption.
- Practical Tips for Patients: UDCA is usually taken with food to enhance bile secretion and absorption. If prescribed antacids or supplements, discuss timing with your doctor or pharmacist.
While cheese and dairy products are generally safe with UDCA, careful scheduling of other medications can help optimise treatment outcomes.
Conclusion
Cheese is a delicious and nutritious food, but it can interact with various medications and supplements. The calcium, sodium, and other compounds in cheese are the main culprits. To avoid complications, understand how cheese interacts with your medications.
Consult your healthcare provider for tailored advice. By planning your diet wisely, you can enjoy cheese safely while maintaining your health.
References
- Gül, N. (2020). “Drug-food interactions: A focus on calcium-rich foods.” Journal of Clinical Pharmacy and Therapeutics. DOI: 10.1111/jcpt.13204
- Kellie, D., & Lambert, S. (2018). “Understanding tyramine and its effects with MAOIs.” Journal of Mental Health Practice. Retrieved from mentalhealth.org
- Dorrington, C., et al. (2017). “The impact of dietary calcium on antibiotic efficacy.” Pharmacological Reviews, 69(2), 154–163.
- American Thyroid Association. (2023). “Levothyroxine and dietary considerations.” Retrieved from thyroid.org
- National Heart, Lung, and Blood Institute (NHLBI). (2022). “Managing cholesterol with statins and diet.” Retrieved from nhlbi.nih.gov
- Young, L. J. (2019). “Calcium-zinc competition: Implications for supplementation.” Nutrition Insights, 34(6), 124–130.
Consult these sources or your healthcare provider for further details about drug-cheese interactions and safe dietary practices.
Cheese lover. Scientist. Created a website and a Youtube channel about cheese science because he could not find answers to his questions online.
