Ask Dr. H: Dairy products can inhibit drug intake

Question:

I've heard that calcium can interfere with the absorption of certain prescription medications. Does that include almond milk, yogurt, and cheese, too?

Answer: Dairy products and calcium can bind up certain medications in the stomach, reducing their absorption and efficacy.

Almond "milk" is not actually a dairy product, however, so it does not have this effect.

Medications whose absorption can potentially be reduced by the dairy products or calcium supplements include: Levaquin and Cipro antibiotics; iron supplements; osteoporosis drugs like Fosamax and Actonel; Synthroid (levothyroxine) for hypothyroidism; tetracycline and minocycline; and calcium-channel blocker blood pressure medications like verapamil or Norvasc. Taking calcium supplements or consuming dairy products either one hour before or two hours after taking these medications will help reduce interaction issues.

Sometimes drugs can increase or decrease blood levels of calcium, rather than the other way around. Estrogen (e.g., Premarin or birth control medication) and the water pill hydrochlorothiazide (e.g., Dyazide for hypertension) may have that effect. On the other hand, Lasix and the antiseizure medications Dilantin, phenobarbital, Tegretol, and primidone can all lower serum blood calcium levels. Keep this in mind when taking calcium supplementation.

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Q:

I am 76 years old and have been afflicted with an embarrassing condition for several months. Often, after having a bowel movement and wiping myself thoroughly, I find excrement in my underwear later. What could be causing that?

A: What you're describing sounds like "anal seepage."

There a number of possible causes. First, there may be a weakening of the anal sphincter muscle tone. To help with that, I'd recommend Kegel exercises that focus on contracting the anal sphincter and improving muscle tone. I recommend 300 or more short contraction exercises per day, each contraction lasting a few seconds. It sounds like a lot of effort, but you can do them throughout the day while sitting on the sofa or chair, waiting for a traffic light while in the car, etc. Next, I'd suggest that you add lots of extra fiber to your diet to bulk up your stools. Probiotics (healthy bacteria) in the form of Activia yogurt or Align probiotic supplements may also help.

If you have an itchy bottom, that's a medical condition called "pruritus ani," well known to cause stool stains in underwear. Moistened baby wipes and anal creams that contain a steroid and numbing medication help relieve symptoms.

The next thing to try is removing, one at a time, certain foods and drinks from your diet to see if your symptoms improve. Dietetic cakes and candies, coffee, the Alli diet pill, snack foods that contain Olestra/Olean, and mineral oil can all cause anal seepage.

If these suggestions don't help, I'd see a gastroenterologist for evaluation.