Medications and Food

The staff at Vivian Pharmacy are passionate about Pharmaceutical Care. Our mission is to provide our patients with the best pharmaceutical service by ensuring they are well supported in taking their medications effectively and safely.We have a team of clinically orientated pharmacists and pharmacy technicians who are always happy, in addition to medication supply, to answer drug questions, counsel patients and provide medication education. Over the next few months we will be writing a series of articles that show you how interesting and often complex it is to ensure safe and effective pharmaceutical care.

With food or on empty stomach?

Just like food, drugs taken by mouth must be absorbed through the lining of stomach and the small intestine to enter the blood stream. Because drugs are swallowed and end up in the same digestive tract as the whatever you had for lunch, it makes sense that we need to have an awareness of the possibility of the impact of food on drugs. After eating, several things happen in the gut – increased blood flow to the area, bile is released from the gall bladder, and the cells of the stomach lining release hydrochloric acid to digest food. These changes may impact on drug therapy.

Drugs to be taken with or after food

Many of the drugs that we dispense need to be taken with or after food. The reasons for this includes the reduction of the side effects of stomach irritation (indigestion or ulcers) or to reduce nausea or vomiting. Some drugs require food in the gut for the body to absorb them properly. Also, medicines for diabetes, if taken by mouth, should usually be taken around meal times to reduce blood sugar levels after eating, and to avoid a very low blood glucose (hypoglycaemia). Enzyme supplements, which can be used to help people with chronic pancreatitis, should also be taken with food to help the body digest the meal. Yet other drugs dissolve well in fats or bile, and are therefore also best taken with food.

Example:
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). This medicine works by reducing substances in the body that cause pain and inflammation. This is because NSAIDs blocks the body’s production of prostaglandins – compounds that promote inflammation. Unfortunately, prostaglandins in the gut also protect the stomach lining from stomach acid. So, this drug that prevents this protective function can lead to stomach irritation, particularly with regular use. Taking NSAIDs with a cushioning meal helps to avoid this problem.

Drugs that need to be taken “before food” or “on an empty stomach”.

Some drugs need to be taken “before food” or “on an empty stomach”. This is because food and certain drinks can affect the way these drugs work. Taking some drugs at the same time as eating may prevent absorption of the drugs, making it less effective. The term ‘empty stomach’ with regards to medication usually means at least an hour before a meal, and at least 2 hours after one. The reason for this direction is it may be the drug easily degrades in an overly acidic environment. Alternatively, the drug might be affected by the presence of calcium, or iron, or some other nutrient. In other cases, there is a special coating (enteric coating) on the tablet that does not dissolve until it gets into the intestine, so if taken with a big meal it can take many hours to start working

Example:
Levothyroxine is a thyroid medicine that replaces a hormone normally produced by thethyroid gland to regulate the body’s energy3 and metabolism. Levothyroxine is given when the thyroid does not produce enough of this hormone on its own. The dose must be individualized based on clinical response and biochemical tests and so accurate dosing is essential. This drug should be taken in the morning on an empty stomach with water.

For specific information about the best way to take your drug, especially if food affects its absorption or action, ask your pharmacist.

 

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