When you take a medication can change everything. Some medications become more effective when swallowed on an empty stomach, others protect the stomach better when taken with food. Dr. Gérald Kierzek, emergency physician and Medical Director of True Medical, details precisely when and how to take them, explaining why the right timing is so important and what to do if you forget.
Medications to take on an empty stomach
Dr. Kierzek points out that certain treatments are more effective if they are taken away from meals. Certain medications must be taken”fasting (2 hours before or after a meal)” and their instructions for use can be very strict:
-
Levothyroxine (thyroid), bisphosphonates (osteoporosis), certain antibiotics:
This allows for better absorption of the medication, as food slows or blocks the intestinal passage and reduces effectiveness; - Thyroid hormones and anti-migraine medications for rapid action: this makes it possible to avoid food enzymatic interactions;
- Oral bisphosphonates are preferably taken in the morning upon rising, at least 30 minutes before the first meal of the day. They should be swallowed while sitting or standing with a large glass of still, lightly mineralized water (such as tap water) to facilitate their passage to the stomach and reduce the risk of esophageal damage. It is important not to go back to bed or lie down for 30 minutes after taking it. The only exception: gastro-resistant risedronate (Actonel®️) can be taken immediately after breakfast.
Dr. Kierzek insists: “This taking on an empty stomach is essential to ensure good absorption of the drug, because the presence of food or other drinks (such as coffee or orange juice) can significantly reduce the effectiveness of the treatment by reducing the bioavailability of the active ingredient.“.
Medications to take with meals
Other medications benefit from being taken with food, particularly to limit digestive irritations. The doctor indicates that some are to be taken during meals such as “NSAIDs (ibuprofen, naproxen) and metformin to protect the stomach against irritation, ulcers, nausea, diarrhea, reflux or vomiting“.
He also emphasizes that the fat-soluble vitamins A, D, E, K see their “absorption optimized by dietary fats“. Generally speaking, it sums up that eating at the same time “will reduce the side effects of the drug“.
What to do if you forget a socket?
It can happen that you forget a take. Faced with this, Dr. Kierzek warns against a common mistake: “never double the dose to compensate“. He recommends “always consult the instructions, your pharmacist or doctor before taking action, and resume the usual schedule the next time you take it“.
When a forgetting occurs, it describes the procedure to follow depending on the time of forgetting:
- If the forgotten dose is noticed within 1-2 hours following the scheduled time: take the forgotten dose as soon as possible if it does not overlap with the next one (especially for stable chronic treatments), respecting dietary constraints (on an empty stomach or with a meal);
- If more than 2-3 hours have passed or if the next dose is approaching: skip the missed dose and resume normally, without catching up.
Depending on how the medication is taken:
- On an empty stomach: if forgetfulness is noticed near the meal, skip it to avoid reduced absorption. Resume on an empty stomach the next hour. Delay may reduce effectiveness but is not critical for a single dose;
- During/with meals: if forgetting is noticed after the meal, resume if possible with a light snack to limit gastric irritation. Otherwise, skip it if the risk of side effects is too bothersome.
Finally, more generally, he encourages checking the recommendations for each molecule: “Always check the package leaflet or consult a pharmacist, as interactions vary per molecule.”. Finally, our expert reminds us of an often forgotten instruction: “And you have to remember to take them at set times too, especially hormones“.
