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Table 1 Circadian variations in pharmacodynamics and pharmacokinetics as well as drug–food interactions of commonly prescribed MS drugs

From: Islamic fasting and multiple sclerosis

Drug Food–drug interaction Recommendation
Baclofen No effect [37].  
Dantrolene No effect [38].  
Pregabalin Consuming with food decreased Cmaxby 25–30% and delayedtmaxby ≈3h [39].  
Tizanidine Simultaneous food intake with a tizanidinecapsule reduced Cmaxand AUCo–t by <20% and extendedtmax from 0.75 h to 1.5 h. Extent of absorption is increased ≤20% relative to administration of the tizanidine capsule under fasted conditions.
In contrast,simultaneous food consumption with a tizanidinetablet increased Cmax and AUCo–t by22.6% and 45.2%, respectively [40]. The dosage forms of the tablet and capsule were not bioequivalent if administered with food.
Food increasedthe tmax and the extent of absorption for the tablet and capsule. However, the Cmaxvalues of tizanidine achieved if administered with food were increased by 30% for the tablet but decreased by 20% for the capsule. Under fed conditions, the capsule was ≈80% bioavailable relative to the tablet.
Using tizanidine together with caffeine is, in general, not recommended. Combining these medications may significantly increase the blood levels and effects of tizanidine.
Gabapentin High-protein food increased the AUC and Cmaxby 26% and 32%, respectively [41]. Take extended release tablet with evening meal. Swallow whole; do not chew, crush, or split.
No significant effects on the rate or extent of absorption of the immediate-release tablet were noted. The rate and extent of absorption of the extended-release tablet was increased.
Carbamazepine Serum levels of carbamazepine may be increased if taken with food and/or grapefruit juice. Extended-release tablets should be administered with meals; swallow whole, do not crush or chew.
SSRIs Paroxetine: peak concentration is increased, but bioavailability is not significantly altered by food.  
Sertraline: average peak serum levels may be increased if taken with food.
  1. AUCo–t, area under the curve from administration (0) to last observed concentration at (t), Cmax, maximum concentration, tmax, time after administration of a drug when the maximum plasma concentration is reached.