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Table 2 Effect of fasting on the pharmacokinetics and pharmacodynamics of immunosuppressants and manufacturer recommendations for their consumption

From: Islamic fasting and multiple sclerosis

Drug Circadian variations in pharmacodynamics and pharmacokinetics Manufacturer recommendations
Azathioprine   Take after meals or in divided doses for reducing the risk of stomach upset.
Cyclophosphamide   On an empty stomach with a glass of water or juice or with food.
Tablets are not scored and should not be cut or crushed. Do not take tablets at bedtime to minimize the risk of bladder irritation.
Methotrexate Peak serum levels of methotrexate may be decreased if taken with food. Milk-rich foods may decrease methotrexate absorption. On empty stomach with plenty of water.
Limit or avoid caffeine intake. Avoid drinks (e.g., coffee, tea, cola), foods (e.g., chocolate) or diet pills that contain caffeine.