Before, with or after the meal? (2023)

introduction

In general, only some medicines should be taken with or without food for specific reasons. For most of them it is not a problem. Taking a drug on an empty stomach is often defined as taking the drug half an hour (up to 1 hour) before eating or two hours after eating.

A drug should be taken with food because

Foods reduce gastrointestinal side effects, such as allopurinol, NSAIDs
to reduce the riskhypoglycemic episodes, such as sulfonylureas
to increase the extent of absorption of a drug such as itraconazole, griseofulvin

A drug should be taken without food because

Food can delay or reduce the absorption of a drug and thus reduce its effectiveness, e.g. B. flucloxacillin, rifampicin
to reduce side effects by reducing the absorption of a medicine such as efavirenz

NOTE:There are instances where we know that a drug is best taken on an empty stomach for better efficacy, but to reduce GI burden it can be taken with food (e.g. frusemide). Another interesting systematic review will followEffects of food on the pharmacokinetics of oral immediate-release formulations of aspirin, dipyrone, paracetamol and NSAIDs. More examples are discussed inPart 2.

With a clear understanding of the reasoning behind it is easier for us to persuade patients to follow the advice given.Because it's actually easier to consistently take medications after meals (for better compliance), we tend to specify the need for some medications to be taken on an empty stomach and advise patients to take the remaining medications after meals.

When I got a call from a patient he asked if it was okay to take amoxicillin syrup with empty food because the pharmacist in the ER told him to take it after eating but he forgot to do so . So what do you think of this case?

(Video) Insulin Before or After Meals? And Other Do’s and Don’ts

(Video) Should you eat fruits before or after a meal?

Reference

Advice on oral administration can be obtained in a number of ways, e.g

product brochure
Dictionary: under the category "Administration: Oral"
Micromedex Medication Reference: under the “Administration” category
British National Formulary70+: under the Management Guide category
MIMS pre- and postprandial counseling: available in MIMS Gateway under "MIMS Clinical Table"

Below I have compiled a short list of medications that should be taken before or after meals or on a regular basis. Surely,the list is not complete.

List of medications that should be taken before meals

Abirateron
Swallow tablets whole. Do not take abiraterone with food as this can increase the risk of serious side effects. Take it at least 2 hours after eating and then wait at least 1 hour before eating again.
Afatinib
Absorption decreased with high-fat meals. Take at least 1 hour before or 3 hours after meals.
Alendronate
Each oral tablet should be taken with at least 180 mL (6 oz) of plain water (no coffee, juice, mineral water, or milk) in the morning at least 30 minutes before consuming any food, supplement, or medication. The patient should remain upright (sitting). or standing) for at least 30 minutes.
Amisulpirid
Preferably taken before meals.
Ampicillin
Take 1 hour before or 2 hours after meals. Ampicillin can be administered orally, but less than half the dose is absorbed, and absorption is further reduced by the presence of food in the gut.
Benserazide + Levodopa (Standard Capsule, HBS Capsule, Dispersible Tablet)
It is best to take at least 30 minutes before or 1 hour after meals whenever possible. Gastrointestinal symptoms, which occur mainly in the early stages of treatment, can be controlled by taking it with food or liquid, or by slowly increasing the dose.
Bilastin
Administer 1 hour before or 2 hours after food intake. Food reduces bioavailability by 33%.
Cabozantinib
Take on an empty stomach. Do not eat anything 2 hours before and 1 hour after taking the tablet.
Captopril
Administer 1 hour before meals.
Carbidopa + Levodopa
Can be taken with meals if GI discomfort occurs.
Chlorambucil
Absorption is reduced when taken with food. Administer preferably on an empty stomach.
Cilostazol
Take on an empty stomach (half an hour before or 2 hours after a meal) as food can increase the likelihood of side effects.
Cloxacillin
Administer with water 1 hour before or 2 hours after meals.
Didanosine Kapsel
Administer on an empty stomach at least 30 minutes before or 2 hours after a meal. Food decreases AUC and Cmax.
Domperidone
For gastrointestinal dysmotility, administer 15 to 30 minutes before meals and, if necessary, at bedtime.
Efavirenz
Administer on an empty stomach. Bedtime dosing is recommended to limit central nervous effects. Tablets must not be broken.
Entecavir
Take entecavir on an empty stomach as it is better absorbed that way.
Erlotinib
Food increases bioavailability. Take at least 1 hour before or 2 hours after food on an empty stomach.
Etopos
Swallow the capsules whole on an empty stomach.
ferrous fumarate
Iron salts are best absorbed when taken on an empty stomach 1 hour before or 2 hours after a meal. If it upsets your stomach, it can be taken with or just after a meal. Avoid taking with tea or coffee.
Gemfibrozil
This medicine is best absorbed if you take it half an hour before eating. However, if it upsets your stomach, take it with meals.
ibandronic acid
The tablets should be swallowed whole with plenty of water while sitting or standing; taken on an empty stomach at least 30 minutes (for most ibandronic acid tablets, 50 mg) or 1 hour (for Bonviva® tablets, 150 mg) before the first food or drink (other than water) of the day or any other oral medicine; The patient should stand or sit upright for at least 1 hour after taking the tablet.
Imidapril
Administer about 15 minutes before meals. Meals high in fat reduce the absorption of imidapril significantly.
Isoniazid
It is best absorbed if you take it on an empty stomach (1 hour before or 2 hours after a meal).
Itoprid
Administer before meals.
Itraconazole oral liquid
Take on an empty stomach at least 1 hour before a meal.
Ixazomib
Take at least 1 hour before or at least 2 hours after eating. High-fat meals decreased AUC by 28% and Cmax by 69%.
Lapatinib
Administer once daily on an empty stomach 1 hour before or 1 hour after a meal at the same time each day. The systemic exposure of lapatinib is increased when taken with food (AUC three to four-fold higher).
Lercanidipin
This medicine is best absorbed if you take it at least 15 minutes before a meal.
Levothyroxine
Consistently give in the morning on an empty stomach, at least 30 to 60 minutes before eating. Alternatively, it can be consistently administered at night 3 to 4 hours after the last meal. Do not administer products containing calcium or iron within 4 hours.
Mebeverine
Administer tablets about 20 minutes before eating. Tablets should not be chewed because of the unpleasant taste.
Melphalan
Take the tablets on an empty stomach at least half an hour before or 2 hours after a meal.
Mercatopurine
This medicine is best absorbed if taken on an empty stomach 1 hour before or 2 hours after a meal. However, it can be taken with food if necessary.
methotrexate
Peak serum methotrexate levels may be decreased when taken with food. Dairy-rich foods can decrease methotrexate absorption. Management: Administer independently of food.
Metoclopramide
Administer 30 minutes before meals and at bedtime.
Nilotinib
Do not take nilotinib with food as this can increase the risk of serious side effects. Take it at least 2 hours after eating and then wait at least 1 hour before eating again.
Pazopanib
The systemic absorption of pazopanib is increased when taken with food (AUC two-fold higher with a high-fat [~50% fat] or low-fat [~5%] meal). Have a good meal.
Perindopril
Administer before a meal. The concentration of the active metabolite of perindopril may be reduced when taken with food.
Phenoxymethylpenicillin
Administer around the clock to promote less fluctuation in peak and trough serum levels. Take on an empty stomach 1 hour before or 2 hours after meals to improve absorption.
Propranolol
Propranolol serum levels may be elevated when taken with food. Protein-rich foods can increase bioavailability; Dietary changes from high-carb/low-protein to low-carb/high-protein may result in increased oral clearance. Management: Tablets (immediate release) should be taken on an empty stomach. Capsules (retard-retard) can be taken with or without food, but are consistent about food.
Protonenpumpenhemmer (z. B. Omeprazol, Esomeprazol, Pantoprazol, Lansoprazol)
All PPIs are most effective when taken about 30 minutes before a meal, since they only inhibit actively secreting proton pumps, and meals are the main stimulus of proton pump activity.
Repaglinid
Repaglinide AUC is decreased when taken with food. Taking medication without eating can lead to hypoglycemia. Management: Administer within 30 minutes before a meal. If a meal is missed, skip the dose for that meal.
Rifampicin
Rifampicin is best absorbed if you take it at least half an hour before a meal.
Riluzole
A high-fat meal decreases the absorption of riluzole (reduction in AUC by 20% and maximum blood levels by 45%). Management: Administer at the same time each day, at least 1 hour before or 2 hours after a meal.
Risedronat
Take in the morning at least 30 minutes before eating or drinking with a full glass of plain water. Stay upright during this time and until after you eat. Do not take antacids, calcium, iron or mineral supplements within 2 hours of risedronate as these may interfere with absorption.
Strontium
This medication is best taken at bedtime, at least 2 hours after eating, as food and drink (especially calcium-rich items like milk) can decrease absorption. Mix the granules with water and drink immediately.
Sucralfat
Administration of sucralfate and enteral feeding should be spaced 1 hour apart, and for oral administration, sucralfate should be administered 1 hour before meals.
Sulodexid
Admin siter without food.
Temozolomid
Administer consistently with respect to food (either consistently fasted or not fasted). Administer on an empty and/or before bedtime to reduce nausea and vomiting.
Tetracyclines
This medicine is best absorbed if you take it 1 hour before or 2 hours after a meal. Take it with a large glass of water and remain upright (do not lie down) for an hour after taking a tetracycline. This is to prevent pills or capsules from getting stuck on their way into your stomach and causing painful damage to the lining of your throat.
Thalidomide
Take at least 1 hour after eating and preferably at night to avoid drowsiness during the day.
Trospium
Administer on an empty stomach with water at least 1 hour before meals. Taking it with meals containing fat reduces the absorption and bioavailability of trospium.
Voriconazol
Take voriconazole either 1 hour before or 1 hour after food.

(Video) What Time is Best to Take Diabetes Medication? Before or After Food ? Dr Ravi Shankar E | HealthTips

List of medications to be taken before or with a light meal

Deferasirox-Filmtablette
Take on an empty stomach or with a light meal (contains <7% fat content and ~250 calories)
Felodipine
swallow tablet whole; The tablet should not be divided, crushed or chewed. Can be given without food or with a small low-fat, low-carbohydrate meal. When taken after a high-fat or high-carbohydrate meal, maximum plasma concentrations of felodipine are increased up to two-fold compared to the fasted state.
Quetiapin
ER tablet: Administer without food or with a light meal (≤ 300 calories), preferably in the evening. swallow tablet whole; do not break, crush or chew.
Sorafenib
Bioavailability decreases by 29% with a 900 calorie high-fat meal, 50% of which is from fat (bioavailability is similar to that in the fasted state when administered with a moderate-fat meal). Management: Administer without food, at least 1 hour or 2 hours after a meal.

List of drugs that should be taken with food

Acarbose
The tablets should be chewed with the first bite of a meal or swallowed whole with some liquid immediately before a meal. Acarbose's mechanism of action is actually to delay the digestion and absorption of starches and glucose.
Acetazolamide
Take tablets with meals to reduce the risk of an upset stomach. However, it can lead to taste changes, especially in carbonated drinks.
Acitretin
This medicine is best absorbed when taken with food (preferably the main meal of the day). ~72% absorbed when given with food.
Alectinib
Administer with food. A high-fat, high-calorie meal increased the combined exposure of alectinib plus its active metabolite M4 by 3.1-fold.
Alfuzosin
For optimal absorption, take immediately after a meal. Under fasting conditions, absorption is reduced by 50%.
Allopurinol
Take this medicine with or just after a meal to reduce the chance of an upset stomach.
all-trans retinoic acid
This medicine is best absorbed when taken with food.
Alpelisib
Administer with food at approximately the same time each day.
Amantadin
Take with food to reduce stomach upset.
Amiloride
Administer with food or meals to avoid GI upset.
amoxicillin and clavulanic acid
Administer with food to increase absorption and reduce gastrointestinal discomfort.
artemether and lumefantrine
Administer with a full meal for optimal absorption.
Atazanavir
Administer with food to improve absorption.
Bedaquiline
Administer with food. Ingestion with a standard meal (~22g fat; 558 calories) increases bioavailability approximately 2-fold.
Bezafibrat
Take with or immediately after a meal.
Bromocriptine
Administer with food to reduce GI disorders.
Cabergolin
Take with meals to reduce the risk of nausea or stomach upset.
Capecitabin
Administer within 30 minutes after a meal. Food reduced the rate and extent of capecitabine absorption.
carbamazepine
Take with food to prevent stomach upset and serum carbamazepine levels may be increased when taken with food and/or grapefruit juice.
Cefuroxime
Bioavailability: tablet: fasting, 37%; After food, 52%. The cefuroxime axetil suspension is less bioavailable than the tablet (91% of the AUC for tablets).
Ceritinib
Administer with food. NOTE: It was previously recommended that ceritinib be administered at a higher dose on an empty stomach, but now it should be taken once daily with a meal of 450 mg.
Cinacalcet
Administer with food or shortly after a meal. Food increases bioavailability.
Cyproteronacetat
Take this medicine after a meal.
Clomipramine
Administer with meals to reduce gastrointestinal side effects.
Dapson
Administer with meals if gastrointestinal disturbances occur.
Kortikosteroid (z. B. Dexamethason, Hydrocortison, Prednisolon)
Administer with meals to prevent GI disorders.
Episodes
Administer after meals.
Etravir
Uptake increased by 50% with food. Administer after meals.
Exemestane
Administer after a meal. AUC and Cmax increased by 59% and 39%, respectively, when exemestane was co-administered with a high-fat breakfast.
Griseofulvin
Administer with a fatty meal to increase absorption.
Hydroxychloroquin
Take with food or a glass of milk to reduce stomach upset.
Imatinib
Administer with a meal and a large glass of water.
Isotretinoin
Administer with a meal. Absorption is enhanced with a high-fat meal.
Ivabradin
Administer with food. Bioavailability: ~40%; AUC increased by 20% to 40% with food.
Lithium
Administer with meals to reduce GI disorders
Moclobemid
Moclobemide is best taken with or just after a meal.
Metformin
Administer with a meal to reduce GI upset.
Methoxsalen
To reduce nausea, capsules should be administered with food or milk.
Metoprolol
Food increases absorption. Metoprolol serum levels may be increased when taken with food. Treatment: Take immediate-release tartrate tablets with food; Extended-release succinate can be taken with or without food.
Nitrofurantoin
Administer with meals to improve absorption and reduce side effects.
NSAIDs (eg, diclofenac, ibuprofen, indomethacin, ketoprofen, mefenamic acid, naproxen, piroxicam)
Administer with food to reduce GI upset, but food may reduce effectiveness.
Orlistat
Administer during or up to 1 hour after each fatty meal; separate dose of at least 2 hours form multivitamin with fat-soluble vitamins. Skip dose if meal is skipped or contains no fat.
Pancreatin
Administer with meals or snacks and swallow whole with plenty of liquid.
Pentoxyfillin
Take with food to reduce stomach upset.
Phosphatbinder (z. B. Lanthanum, Sevelamer)
Take with meals. If you skip a meal, skip your dose.
Piribedil
Should be taken with food; take at the end of a main meal.
Posaconazol-Suspension
The suspension must be administered with or within 20 minutes of a full meal. Increased bioavailability when taken with a meal.
potassium chloride
Oral dosage forms should be taken with meals and a full glass of water or other liquid to minimize the risk of gastrointestinal irritation.
Probenecid
Administer with food to minimize GI effects.
Rivaroxaban
Taking rivaroxaban 15 mg or 20 mg tablets with a meal.
Rivastigmin
Administer with meals. Food delays absorption by 90 minutes, decreases Cmax by 30% and increases AUC by 30%.
Sodium valproate
Take with food to reduce stomach upset.
Sulfasalazine
Take tablets with food to reduce stomach upset.
Sulfonylharnstoffe (z. B. Glibenclamid, Gliclazid, Glimerpirid, Glipizid, Tolbutamid)
Take with food to minimize the risk of hypoglycemia.
Tenofoviralafenamid
Administer with food.
Ticlopidine
The bioavailability of ticlopidine may be increased (20%) when taken with food. High-fat meals increase absorption, antacids decrease absorption. Take with food to reduce stomach upset.
Valganciclovir
Co-administration with a high-fat meal increased AUC by 30%. Treatment: Valganciclovir should be taken with meals.
Venlafaxine
Administer with food.

List of medications that should be taken consistently with or without food

Aliskiren
Administer at the same time daily with or without food, but consistent administration with meals is recommended; high-fat meal reduces absorption.
Amiodarone
Administer consistently with meals. Take in divided doses with meals in case of gastrointestinal disturbances or when taking a large daily dose (≥1000 mg). If GI intolerance occurs with single dose therapy, use twice daily dose.
Cyclosporin
Administer this medication consistently regarding time of day and meals.
Danazol
Consistently administer with food; either always administer with food or administer on an empty stomach. Food delays time to reach peak levels. A high-fat meal increases plasma concentration and availability.
Digoxin
Consistently administer in relation to meals; Avoid co-administration (i.e. digoxin 1 hour before or 2 hours after) with meals high in fiber or pectin and with drugs that decrease oral absorption of digoxin.
Everolimus
Can be taken with or without food; To reduce fluctuations, eat food consistently.
Labetalol
Administer without regard to food; However, the absolute bioavailability of labetalol is increased when taken with food. Administer consistently in relation to meals.
Paliperidon
Do not cut, crush or chew tablets; swallow them whole. Take them the same way every day (always with food or always on an empty stomach).
Propranolol
Propranolol serum levels may be elevated when taken with food. Protein-rich foods can increase bioavailability; Dietary changes from high-carb/low-protein to low-carb/high-protein may result in increased oral clearance. Management: Tablets (immediate release) should be taken on an empty stomach. Capsules (retard-retard) can be taken with or without food, but are consistent about food.
Sirolimus
Ingestion with high-fat meals lowers peak concentrations but increases AUC by 23% to 35%. Management: Take consistently (either with or without food) to minimize fluctuations.
Spironolactone
Administer with or without food; however, administer consistently in relation to food. Food increases the bioavailability of unmetabolized spironolactone by ~90% to 95%.
Tacrolimus
Administer with or without food; be consistent in timing and composition of meals when GI intolerance occurs and administration with food becomes necessary.
Temozolomid
Administer consistently with respect to food (either consistently fasted or not fasted). Administer on an empty and/or before bedtime to reduce nausea and vomiting.
Theophylline
Extended Release: Consistently administered with or without food (to maintain constant drug levels); Do not chew or crush tablets; may split tablet if scored. An intact matrix tablet can be excreted in the stool.

Relevant Links

Time of medication (morning, afternoon or night)will be discussed in a separate post.