Which medicines should be taken with food and which should be taken on an empty stomach?

Q: Dear Dr., I’m taking paracetamol and baby aspirin; must I take these with food?

A: Introduction: Food can affect a medication’s absorption by prolonging stomach emptying time, altering the stomach and intestinal acidity/ pH, stimulating bile production, increasing intestinal blood flow, or physically binding with medications. Hence it is important to know how your medicines should be taken relative to a full or empty stomach as well as the type of meal eaten. By taking your medicine correctly, you can improve the effectiveness of the medicines as well as reduce some of the side effects.

• Low Dose (Baby) Aspirin And Food: Baby aspirin, also known as low dose aspirin, generally comes in 79mg and 81 mg formulations. Like all forms of aspirin, including NSAIDS (e.g. diclofenac, ibuprofen, voltaren, cataflam, Naprosyn, etc.), it should always be taken with meals.

For if taken on an empty stomach it may not only result in an upset stomach, but can cause ulcers of the stomach and stomach bleeds. And taking low dose aspirin with food does not dimmish the effectiveness of the aspirin.

• Paracetamol And Food: Many foods, in particular foods high in pectin (e.g. apples, guavas, plums, and citrus fruits), carbohydrates (e.g. bread, pasta, macaroni, ground provisions), and many types of cruciferous vegetables (e.g. cabbage, broccoli, cauliflower, kale, watercress, Brussel sprouts, Chinese cabbage and others) can interfere with paracetamol’s absorption. So it’s best to take paracetamol or any of it’s forms, (e.g. Panadol, Tylenol, or acetaminophen) on an empty stomach and with lots of fluids. It should also be noted that paracetamol when taken on an empty stomach, is quite an effective pain reliever for mild to moderate pain, including osteoarthritis pain.

• Medicines That Should Be Taken On An Empty Stomach: For the best results the following commonly taken medicines should be taken on an empty stomach: amlodipine, ampicillin, azithromycin, bisacodyl, captopril, cloxacillin, ciprofloxacillin, floxin, levothyroxine, loratadine, metoclopramide, propranolol, proton pump inhibitors (e.g. omeprazole, pantoprazole, lansoprazole), sotalol, sucralfate, sulfonamides (e.g. bactrim, septra, sulfatrim, etc.), tetracycline Medicines That Should Be Taken With Food: These are some medicines that are best taken with food in order to improve their effectiveness and or to reduce their side effects: allopurinol, amiodarone, augmentin, bromocriptine, carbamazepine (Tegretol), carvedilol (Coreg), daonil, diamicron, digoxin, erythromycin, glipizide, ketoconazole (e.g. Nizoral), mebendazole, potassium, prednisone/ prednisolone, metronidazole (e.g. flagyl, fasigyn), nifedipine, sodium valproate, spironolactone, zinc.

Other medicine/ food interactions which you need to be aware of:

• Paracetamol should not be taken with alcohol because of the potential of liver toxicity.

• Dairy products (e.g. milk, yogurt, or cheese) reduce the absorption of certain antibiotics – cipro/ ciprofloxacin, levofloxacin, and tetracyclines.

• Amlodipine, nifedipine, simvastatin and atorvastatin should not be taken with grapefruit or its juice.

• Alcohol should not be used with metronidazole.

• If taking the blood thinner warfarin, the following foods and beverages should be avoided – spinach, parsley, cabbage, lettuce, kale, broccoli, cauliflower, cranberry juice, alcohol, green tea and grapefruit juice.

• Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)

Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.