How do you take your pills? If you are like most people you barely give it a moment’s thought. After all, the instructions on your medication bottle may be vague: “Take 1 (one) tablet by mouth every day.” Does it matter whether you swallow your tablets and capsules with juice in the morning during breakfast? Should those pills be taken on an empty stomach or with food? Do they work better if you take them at bedtime? Such information is often lacking.
Check Your Pill Bottles!
Do you take any medications? What about vitamins, minerals, herbs or other dietary supplements? Chances are good that precise instructions are lacking.
Don’t believe us? Take a moment to retrieve some of your bottles. We’ll wait. What do you see? Typical labels often say unhelpful things like:
“Take 1 capsule daily”
“Take one pill daily with food or as directed by a healthcare practitioner”
“Take 1 capsule three times a day between meals”
“Take before meals”
Why Are Such Instructions Worthless?
Does “before meals” mean 5 minutes, 30 minutes or an hour before eating? It could make a difference for some medications.
Does “with food” mean in the middle of a meal, after a meal or with a snack? How much food you eat and the kind of food you consume can impact drug absorption. A breakfast of eggs, sausage and toast with butter is quite different from a breakfast of bran buds, skim milk and blueberries. The amount of fat in the meal can impact how fast the drug gets into your bloodstream.
Some people swallow all their pills with a big glass of water. Others pop them down with a sip of coffee or tea. We have watched a tennis partner swallow “vitamin I” (ibuprofen) on the court without even a swallow of water.
How you take your pills can have a profound impact on how well they work or whether they will cause side effects. NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen or naproxen should never be swallowed without a big glass of water!
Info on How to Take Your Pills May be Lacking:
We hate blaming the victim. It seems like adding injury to insult. It’s not surprising that most patients are uncertain about the best way to take their medicine. Often, the only instruction they get is to take it once a day. Pharmacists and doctors rarely offer detailed guidance.
We should not blame health professionals either. There is often limited research on how you should take your pills when it comes to time of day, food or beverage. Even when there are data, they may not be widely communicated.
Should You Take Your Blood Pressure Pills at Night?
A recent study from Spain, for example, revealed the surprising information that drugs for blood pressure control work better if they are taken at bedtime rather than in the morning (European Heart Journal, Oct. 22, 2019). There were more than 19,000 people with hypertension in this randomized controlled trial.
Those taking their pills in the evening had better blood pressure control overnight without losing daytime effectiveness. In addition, during more than six years of follow-up, they were less likely to experience heart attacks, heart failure, strokes or other cardiovascular complications.
You can read more details about this research at this link:
Some people should not take their blood pressure pills at night:
Philip wrote that his ACE inhibitor ramipril made his cough worse at night:
“After taking my blood pressure medicine at bedtime, I found the coughing to be much worse during the night. It was so bad that I lost most of my sleep.”
We encouraged Philip to let his doctor know that coughs triggered by drugs like lisinopril or ramipril are a problem. There may be another BP medicine that is less likely to cause a cough. We are also concerned about ACE inhibitors and lung cancer, especially if people put up with a cough for years. There’s information at this link.
People should never change their medication regimen without checking first with the prescriber. Some BP meds contain diuretics. Taking them in the evening may lead to more trips to the bathroom during the night. That could be a problem for older people.
That is what JMR complained about:
“I would not want to take one of two BP meds at night primarily because it does have a diuretic compound. I have found that if I fail to take it in morning and take it towards evening, I have interrupted sleep. That’s because I need to go to the bathroom several times at night. It tires me out.”
George was pleased with the switch:
“I changed my time from morning to evening and noticed in a few days that the slight swelling in my lower legs is totally gone. I will continue at evenings and monitor that change. It might be that dosing in evenings and then lying flat that the body does not have as hard a time fighting gravity to return blood flow back to upper body. Taking BP pills in mornings may lead to fluid buildup during day. In my case the swelling was apparent by evening. This is just my personal observation.”
Statins: Should You Take Your Pills at Night?
Blood pressure pills are not the only medicines that might be better taken at the end of the day. For years, many doctors have recommended that their patients taking the cholesterol-lowering drugs lovastatin (Mevacor) or simvastatin (Zocor) take them in the evening, when they are most effective.
This recommendation doesn’t hold for all statins, though. Time of day doesn’t seem to make any difference for atorvastatin (Lipitor) or rosuvastatin (Crestor).
Thyroid: Take Your Pills at Bedtime?
People taking levothyroxine (Levoxyl, Synthroid) to treat hypothyroidism have long been admonished to take their pill immediately upon rising and hold off on coffee or breakfast for at least half an hour or preferably an hour. Some people find this impractical on a busy morning.
More recent research shows, however, that people who take levothyroxine at night get better results (Archives of Internal Medicine, Dec. 13, 2010). Ideally, this should be at least two or three hours after the last meal of the day, since food can interfere with the effectiveness of the hormone (Journal of Clinical Endocrinology and Metabolism, Oct. 2009).
Take Your Pills with Water or Juice?
What liquid do you use to swallow your pills? You may not think it matters, but you have doubtless heard or read that grapefruit juice can interact with certain medications. It can boost blood levels of medicines like felodipine (Plendil), nifedipine (Procardia), atorvastatin (Lipitor), simvastatin (Zocor), buspirone (BuSpar) or zaleplon (Sonata). Amiodarone is strongly affected by grapefruit juice, which could increase the risk of side effects.
You can learn more about grapefruit and drug interactions at this free link
Acid Beverages Could Spell Other Trouble:
Fruit and vegetable juice, soda and wine are all acid drinks. So is coffee. They may all reduce the effectiveness of antibiotics like ampicillin, penicillin or erythromycin (American Journal of Nursing, March, 1975).
Should You Take Your Pills with Milk?
Milk and dairy products in general are a bad idea with tetracycline-type antibiotics. The calcium can diminish absorption of the antibiotics into the blood stream and reduce effectiveness.
Milk is also a bad choice if you use bisacodyl laxatives (Bisacodyl, Dulcolax, Fleet Bisacodyl, etc). That’s because such drugs may not dissolve correctly if you create an alkaline environment in your stomach. The presence of the laxative in the stomach without the protective enteric coating may cause gastritis.
What About Water?
It is hard to go wrong with water. Just make sure that you drink enough while you are taking your pills. Too little liquid means that you may miss out on as much as half of the dose of an antibiotic like erythromycin (Postgraduate Medicine, July 1977). Trying to take your pills dry or with minimal water also means you run the risk of getting it stuck in your throat, where it could cause irritation.
Taking an NSAID like ibuprofen or naproxen without liquid could lead to digestive tract upset or even an ulcer. My tennis partner has been warned that swallowing his “vitamin I” without liquid is not a good idea.
The next time you get a prescription, be sure to ask the doctor and the pharmacist for specific instructions about the best way to take the pill. You can learn more about interactions with food from our free Guide to Drug and Food Interactions. You’ll find it in the Health Health Guides section:
You can also access our free Drug and Alcohol Interactions in our Health Guides Section.
How do you take your pills? Share your experience in the comment section below.