When we begin to consume any medication or supplement, it is common for the specialist to detail whether it should be taken before, after, or outside of eating hours. It is also frequent that we ourselves spontaneously make the intakes coincide with the times of the main meals, since there are many that are prescribed every 8 hours, it is easy to balance them with our breakfast, lunch and dinner routines. It is not always a good idea, since not all foods should be taken with meals, so the specialist who has prescribed it should be in charge of precisely transferring the consumption patterns.
“The answer to whether you should take medication before meals is that it depends on the type of medication. There are some that can be taken before or after because they do not interact with food, but there are others that in combination with food may see their absorption reduced. On the contrary, there are some whose effects are enhanced when combined with certain foods”, explains the head of the Pharmacy service at Hospital Vall d’Hebron, in Barcelona, ​​Maria Queralt.
This brings us to another issue, which is that in no case should we self-medicate if it is not under a medical prescription, since by not knowing all these details it is easy to be nullifying the effects of a medication or, worse, giving rise to the appearance of side effects. for not following the proper guidelines.
But this is not all, since sometimes you also have to look at which foods are being combined with the drug in question. “There are medications that interact with the calcium present in dairy products, for example, so that they cannot be taken together, while others may see absorption enhanced if they are consumed with certain foods,” explains the specialist. Some examples? Some antifungals, such as griseofulvin, or supplements such as vitamin D, are better absorbed if they are accompanied by a low-fat meal, while phenytoin, which is used to treat some arrhythmias and epilepsies, is more effective if taken with rich foods. in calcium (for example, accompanied by a glass of milk). In the case of iron supplements, it is recommended to take them with drinks rich in vitamin C, such as orange or grapefruit juice, since its absorption is much better, but without solid food.
There are other medicines that it is recommended to always take with food, not because they will improve their absorption, but to avoid possible gastric problems derived from prolonged consumption. This is the case of non-steroidal anti-inflammatory drugs, some antibiotics such as amoxicillin or certain oral contraceptives during the first weeks of use.
“In the case of drugs that are prescribed during meals, we should not worry about whether we take them before, during or after, since the effect will be exactly the same because there will be food in the stomach at all times,” explains Queralt. One of the most frequent doubts among patients is whether alcohol can be included in these food intakes. There are organizations, such as the National Institute on Alcohol Abuse and Alcoholism in the United States, that strongly discourage it: “There are some medications, including many more widely used pain relievers and cough, cold, and allergy remedies, that contain more of a chemical compound that could interact negatively with alcoholâ€, he points out. In addition, he remembers that alcohol consumption can cause drowsiness, lethargy and dizziness, as well as certain medications, so all these symptoms could be intensified.
In the case of some specific medication, such as antidepressants, alcohol consumption is absolutely discouraged, since “drinking alcohol can counteract the benefits of the antidepressant medication and make it difficult to treat the symptoms,” explains Daniel K. Hall-Flavin, a specialist in Psychiatry from the American Mayo Clinic. “If these antidepressants are combined with other drugs, such as those used to treat anxiety, sleep medications and pain relievers, as well as alcohol, the side effects could be triggered,” Hall-Flavin says. In the case of certain drugs, such as monoamine oxidase inhibitors (MAOIs), there can be “a sudden increase in blood pressure that could have serious consequences.”
For its part, the General Council of Official Colleges of Pharmacists, points out that “the consumption of foods rich in tyramine, such as cured cheeses, fermented drinks and tofu, can cause hypertensive crises known as “reaction to cheese” in patients treated with MAOIâ€.
In fact, this organization has just published, in collaboration with Editorial Médica Panamerica, the guide Interactions between food and medicines, aimed at health professionals, in which it details some specific examples of drugs that may see their absorption rate reduced in combination with certain food. According to this publication, one of the most frequent cases is metformin, which is administered to patients with type 2 diabetes mellitus, who must ensure a diet with the correct level of fat, since otherwise adverse effects may occur at the gastrointestinal level. . Another example is that of sodium levothyroxine, for the treatment of hypothyroidism, which is always recommended to be administered on an empty stomach and avoiding foods rich in fiber, soybeans and their derivatives, coffee and fruit juices, among others.
