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Question: The doctor says I should take the medication three times daily after meals. However, I never eat three meals per day. Can I take the medication anyway?

Answer: Some medications need to be taken with or immediately after meals. There are scientific reasons for this instruction, and we will explore them in this article.

Some medications require food to be in the stomach for them to be absorbed properly. Food triggers the digestive system to start working. At this point, blood flow to the stomach increases, the stomach starts secreting acids, and all kinds of physiologic activities begin to happen to make digestion possible.

Actively engaged digestive system needed

Some medicines need the digestive system to be in full swing so they can be properly digested and absorbed into the body. If the medicine is taken on an empty stomach, where digestion is not actively taking place, the medicine will not be effectively digested and absorbed into the bloodstream to give the maximum effect. For example, the antibiotic Zinnat (Cefuroxime) is absorbed better after a meal when digestion is under way.

Acidic environment needed

Some medications need an acidic environment for absorption. During digestion the stomach produces acids, creating the ideal environment for the absorption of these medicines. Additionally, you can even drink acidic drinks such as cola to help create an even more acidic environment for these medications. For example, the antifungal medication Canditral (Itraconazole) needs an acidic environment for optimal absorption.

Fat needed

Some medications need fat to be absorbed properly, and you will be given the instruction to take the medication with a fatty meal. For example, Griseofulvin — used for treating fungal infections — is best absorbed when taken with a fatty meal.

To avoid exacerbated side effects

Other medications cause nausea and vomiting as side effects. These side effects are worse if the medication is taken on an empty stomach. The recommendation that you eat before taking these medications will ensure that you do not suffer severe nausea and vomiting during the course of your treatment. For example, the popular diabetes medication Metformin is notorious for causing all kinds of tummy troubles such as nausea, vomiting, flatulence, and diarrhoea. Taking it after meals will help to minimise these side effects.

To protect the stomach walls

Other types of medications affect the walls of the stomach, causing irritation, inflammation, indigestion, or ulcers. If these medications are taken without eating there will be nothing to cushion their effects on the stomach. If, however, there is food in the stomach, this will inhibit the medications from acting directly on the walls of the stomach and causing damage. Pain medications, such as Advil (Ibuprofen), Cataflam, and Voltaren, need to be taken with or immediately after meals for this reason.

To better relieve an active problem

Antacids are medications used to treat heartburn, reflux, or indigestion. These medications have to be taken when the problem is present in order to relieve it. The cause of heartburn is the excessive production of stomach acids when we eat. Hence, antacids need to be taken after meals or when the heartburn appears, to quell the effects of the stomach acids. Otherwise, they will not be as effective.

To avoid washing away drugs

Specific types of medications have to be taken after meals to ensure they do not get washed away by food. Nystatin for oral thrush or mouth ulcers is an example of such a drug. It is important not to eat or drink for 30 minutes after taking this medication, so it is actually best if you eat before taking it.

To help body process meal

Finally, some medications help the body process the meal. For example, diabetes medications help the body to process all the carbohydrates eaten at mealtime. It is very important to pay attention to the instructions given by your pharmacist for these medications to ensure that they can work effectively on the carbohydrates consumed, and reduce blood sugar spikes. Some diabetes medications should be taken with or immediately after meals, such as Glyburide or Amaryl (Glimepiride). Glucobay should be taken with the first bite of the meal. Taking these medications with or immediately after meals increases how efficiently they work, and it also lowers the risk of hypoglycaemia (low blood sugar), which is a common side effect of diabetes medications.

The answer is yes

So, back to the question at hand. Do you really need to eat before taking certain medications? The answer is yes. For some medications, you do need to eat when taking them. The directive to take medications with or after meals is so that you can get the most effective therapy and/or reduce side effects. You don’t necessarily have to have a full meal to take the medications — a light snack is quite fine. Just ensure that your stomach is not empty when taking these medications.

Novia Jerry Stewart, MSc, RPh, is a pharmacist who specialises in ophthalmic care. She earned a Bachelor of Pharmacy degree at the University of Technology, Jamaica and a Master of Science in General Management at Walden University in Minnesota, USA. She also has a Certificate in Diabetic Retinopathy Grading from the University of Melbourne, Australia, and a Diploma in Opticianry from the University of Central Florida. She may be contacted at novia_jerry@yahoo.com.