“I hadn’t had anything to eat, so I figured that I could not take my medication until after I had had a meal…”. As a clinician, this is an explanation that I hear quite often from my patients in case of missed doses or sub-optimal adherence to medication. Rather than simply dismissing it as an `excuse, I find myself `adjusting my approach to adherence counselling. After all, the patient isn’t entirely wrong, nor have necessarily been intentionally negligent. Very often, patients have been instructed by a healthcare provider to take medication with food, or as it is commonly phrased, “after meals”, it is therefore understandable that some interpret this advice to mean medication should never be taken on an empty stomach. Many of us have heard similar instructions or warning “don’t take medication on an empty stomach”; “dont take tablets with alcohol instead of water”; “do not take tetracycline with milk”; or “if you have forgotten to take your birth control pill, take as soon as you have remembered”. These messages become part of everyday knowledge we carry about medicines.
With a background in healthcare and in studying medicines and how they work in the body, I am passionate about helping people understand their medicines and how to use them safely and effectively. In this blog, we will explore some common beliefs and the basis practices surrounding the intake of medication came from, whether they are supported by evidence and shed some light on how these can affect how well the medication will work for you.
Did you ever wonder why some pills say, “take with food”, while others say, “take on an empty stomach”? There is actually a good reason. When you take a pill with food, it can slow down or in some cases, speed up how quickly the drug gets absorbed. As most medications need to be absorbed before they are effective, some may work faster on an empty stomach, while others need a full stomach to be effective. In other cases, some medicines “react” with other medicines or minerals and that could lead to a reduction in the amount of medicine that reaches your blood, therefore making it less effective. This is why the instructions such as “take with a meal” or “take on an empty stomach” aren’t just simple suggestions. They are based on scientific evidence from years of research conducted by experts to make sure that you get the right amount of medicine to treat your condition and help you to receive the intended benefit from the treatment.
Have you ever stopped to think about why the same drug can come in so many different forms (a tablet, a capsule, a liquid, a patch, even a spray)? This is not only for convenience. The way a drug is presented and delivered, known as its “formulation”, can have an influence on how well it works. This is why changing from one formulation of a drug to another can sometimes make you feel different, even if it is the same medicine. For example, a tablet needs to break down in your stomach before your body can use it, while a liquid formulation gets absorbed almost right away. Some tablets are specially coated to release the medicine slowly over several hours, while others are designed to survive stomach conditions and dissolve further down in your digestive system so that they actually reach where they are needed and hence sometimes you will be instructed not to crush, break or chew them.
When it comes to your medication, timing can make or break how well it works. Some drugs need to maintain a certain concentration in your body to do their job, which is why antibiotics are prescribed to be taken at regular intervals. If you skip a dose, prolong or shoten dosing intervals, or take more than prescibed, that may cause disruption of this required amount of medication in your body and could affect the effect of the drug. On the other hand, taking too much of the drug leads to amounts in your blood that are too high and may cause any harm or side effects. Another important example is with HIV and antiretroviral drugs (ARVs). These need to be taken at roughly the same time every day to keep enough of the drugs in your system. Missing doses or taking them irregularly can cause the virus to increase again and even become resistant to the treatment. On a different note, sometimes taking two medications too close together can weaken one of them. So those specific instructions about when to take your medicine are not random. They’re based on how your body and the drug interact over time.
So, there it is. Skipping your dose of medication because you haven’t eaten yet might seem like no big deal, but it says a lot about how much we still don’t know about the “rules” of taking medication and the general beliefs influence the way we take them. The truth is that your medication doesn’t work in a vacuum. What you eat, what else you’re taking, how the drug is formulated, and when you take it all can influence how it works in your body. And while it’s easy to brush off instructions like “take with food” or “take at the same time daily” as optional, they are actually worth paying attention to. They’re the difference between a treatment that works and one that quietly fails you. The good news is that you don’t have to figure this out alone. Your pharmacist or doctor is there to answer your questions. Ask your pharmacist, doctor or another qualified healthcare professional – because the more you understand about what’s happening between that medication and your body, the better equipped you are to make it work for you, and not against you.
Written by SUPPORT fellow Vivian Mumbiro