The rules for taking medications, which directly translate into obtaining the optimal therapeutic effect, are always included in the leaflet. - Take your medications down with water. Why not juice, not milk, not coffee, not tea? When drinking them, for example, with juice, the acidity is much higher and the tablet is in an environment other than it should. The acids in the juice react with the active substance and can, for example, counteract its effect, says Rafał Janiszewski.
Anna Tłustochowicz: A person swallowing a handful of different drugs at once - it's not such a rare sight. And yet the time of day and whether we take medication with or without food: it all matters!
Rafał Janiszewski:Definitely yes. The rules for taking medications, which directly translate into obtaining the optimal therapeutic effect, are always included in the leaflet.
I talked to Artur Fałek about the fact that it is worth and even necessary to read it.
Today we need to appeal to our readers again to read the leaflets. Medicines have various recommendations for taking them, both in terms of what time to take them - in the morning, afternoon or evening - and how to take them: on an empty stomach or with food? It all depends not only on the group of drugs, i.e. on what active substances they consist of, but also on the form: syrup, drops, tablets, capsules or suppositories. Not only that: tablets can be divided into coated and not.
Why does the character matter?
In the group of oral medications it is often important insofar as, for example, if the drug is in the form of a capsule, it usually does not dissolve - i.e. the active substance does not enter our digestive tract - earlier than in the intestine . This is because the capsule is made of a material that dissolves only behind the stomach. The same is the case with tablets, which are coated precisely so that they do not dissolve in the mouth and the initial part of the gastrointestinal tract. The form of the drug will therefore affect whether the drug is taken on an empty stomach, during or after a meal. Of course, the active substance contained in the drug is also of great importance. A large group of drugs used inWhen treating high blood pressure, swallow on an empty stomach. Right after waking up!
Why?
The idea is to get this drug to work ASAP! That it would be absorbed as soon as possible. And of course, in the case of the above-mentioned drugs for hypertension - as with all other drugs - indications as to when and how to take them will be found in the leaflet. We will also receive such instructions from a doctor who, when prescribing a specific drug, for the best effect of its use, recommends that we take it at a specific time of the day, e.g. on an empty stomach.
Can we group the medications into those we should take in the morning, afternoon and evening?
Oh no! It cannot be said that we take this group of drugs in the morning, in the afternoon, and in the evening. It is impossible. However, I understand your intentions! Probably you and I now have a small box for drugs at the back of our heads that so many patients use …
Exactly! Just described: morning, afternoon, evening!
Everything is correct. And now patients - most often elderly people, but not necessarily, because also chronically ill patients - most often in the early morning take all the medications they have prescribed and put the pills in specific compartments. Of course, it happens that there are several of these drugs in one compartment.
Dangerous?
It could be dangerous. As I have already sensitized many times: not only can drugs interact with each other, but they can also cancel each other out.
It is extremely important that there are drugs that, when taken together with others, may simply not work at all! And you have to be aware of this. Therefore, it is extremely important that when we receive another drug from the doctor, we tell him exactly about all the substances we are already taking and decide whether we can take these drugs together and how to take them.
It happens that between one drug and another one has to take an hour or two off, right?
Interval, yes. And then we take both drugs, for example in the afternoon, but not simultaneously, so that each of them has a chance to work properly. Of course, it also happens that we buy drugs without a prescription, but then we should simply use the information contained in the leaflets. Drug interactions with each other are always described there.
And now there is no doubt that - going back to my first question - you shouldn't take a handful of drugs! Of course, without first making sure that they are not interacting with each other.
Me oftenduring my lectures I show examples of such anti-drug kits. Let's say a patient who is taking a preparation with a low dose of salicylic acid for the heart, is also taking some painkiller from the group of non-steroidal anti-inflammatory drugs, e.g. containing ibuprofen.
Risky?
Yes, because the two drugs are from the same group, so accumulating them over a short period of time may increase the risk of side effects. It may be damage to the gastrointestinal mucosa or, for example, bleeding, as these drugs act as anticoagulants. It is also often the case that the patient is taking counter-drugs at the same time! For example, increasing and lowering blood pressure.
How's that? It makes no sense?!
Does it unconsciously, of course. For example, he is taking a drug that has a supplementary effect on one of the electrolytes, but - by the way! - causes an increase in pressure, and at the same time takes a drug aimed at lowering the pressure. Here we have a meatball!
Remember that each drug, apart from its main area of action, also has side effects. This is a big oversight when we only remember about the indication of the drug for which we are taking it, and forget about checking what else it causes. I mentioned some popular NSAIDs that contain ibuprofen. We know them as painkillers, but they're also anti-inflammatory. They affect our blood clotting.
Since we already know that we have to be careful about which drugs we can swallow together, now let's figure out: what to drink them with?
The easiest way to answer this question is. Of course with water! Drugs should be washed down - most often - with plenty of water. Why not juice, not milk, not coffee, not tea? Because we should remember that the assumption of the drug form is such that such form enters the natural environment of the gastrointestinal tract. And now if we sip this drug with juice, is it happening? This acidity is much higher! Thus, for example, a tablet is in an environment different from what it should be. The acids in this juice react with the active substance and may, for example, counteract its effect.
Supposedly, it is especially dangerous to wash down some medications with grapefruit juice. That's true?
Grapefruit juice contains furanocoumarin, a derivative of coumarin, which inhibits the breakdown of some drugs in the digestive tract before they even enter the bloodstream. It applies to all medications, not just antibiotics.
Drugs are washed down with water and full stop. I have encountered some doubts once: but what about medications that should be taken in the environmentfats? There are, for example, fatty vitamins in capsules, right? Vitamin A, Vitamin E. Ladies and Gentlemen: This capsule is filled with a little bit of fat to help you absorb this vitamin, and that's it! We really shouldn't take such drugs with broth or oil. Drugs are washed down with water.
Please tell us about a special group of drugs, which are antibiotics. Is it true that it is absolutely forbidden to drink alcohol then, but it is worth adding yogurt to your diet?
With alcohol, it is not exactly like that, but when it comes to taking antibiotics, the most important thing is a very strict regimen of the time of taking them. I mean the dose interval. If it has to be: every 8 hours, then it has to be 8 hours with a watch in hand! This is very important because it translates directly into the effectiveness of the treatment.
Sometimes these 8 hours can happen in the middle of the night.
Maybe you have to wake up and take an antibiotic! The idea is to ensure that the level of the antibiotic in the body is as even as possible. If it's supposed to be 6 a.m., it's supposed to be 6! And not "somehow in the morning"! Because "somehow in the morning", it can also be good 6, 7, 8 but also 10, right?
Yes.
That is why it is necessary to maintain a strict time interval between successive doses. By treating the matter lightly - I would say recklessly - we can not only lead to a disruption of the antibiotic's action, and thus reduce its effectiveness, but we even risk antibiotic resistance, i.e. a situation when a microorganism that should be sensitive to a given antibiotic ceases to be sensitive to it.
What about alcohol?
As a rule, it is not recommended to drink alcohol not only during antibiotic therapy, but also chronic treatment with other drugs. However, it must be honestly said that not all antibiotics interact with alcohol. Does a specific antibiotic interact? We will certainly find this information in the leaflet. And it may happen that we read that there is no data on this subject. And since the antibiotic does not interact with alcohol, it means that alcohol consumption will not reduce its effectiveness. However, this does not mean that it is safe to drink alcohol while taking this antibiotic.
Why?
Because alcohol is a heavy burden on metabolic processes, and we need metabolic strength when taking antibiotics! They are absorbed, metabolized and excreted, so it is important that the whole process runs smoothly. And if we overload the liver with alcohol, we will certainly reduce the metabolic capacity of the body. In sum:alcohol should not be drunk while taking antibiotics but also other medications, and at least drinking should be moderate.
Jogurcik?
And yogurt is recommended because antibiotics have an antimicrobial effect, destroying all bacteria that are sensitive to this antibiotic, but also affect the bacterial flora of the gastrointestinal tract, especially the intestines. How? By simply destroying it, which can disrupt the digestive tract and cause diarrhea, for example. That is why yoghurts should be included in the diet during antibiotic therapy, because they contain live bacteria and are useful in restoring our bacterial flora.
Finally, I will ask about a common dilemma of parents: can drugs that do not taste good to a child, for example, be given along with his favorite meal? Bread with nutella?
These approaches aren't always good because, as we've already talked about, we're changing the environment in which the drug begins to work in the body. However, if a given drug can be taken with a meal, there is nothing to prevent a child from eating their favorite sandwich, but I hope it is obvious that dissolving the syrup in Coca-Cola will not help this syrup ?!
And coca - cola generally does not serve a child? In this topic, you must first of all use common sense. I always recommend looking for a medicine for your child in a form that is acceptable to the child. Often, the form of the suspension is extremely intolerable by children - the reaction is even vomiting - so another form of the drug should be considered. This is especially important in the case of an antibiotic, because this - I will emphasize once again - should be taken in the entire recommended dose and at the specified time.
You mentioned vomiting. What to do if a child or adult patient vomits after taking the drug?
Difficult situation. Management depends on the type of medication, so it is best to consult your doctor and agree whether the dose should be repeated or skipped.
Can't decide to take the next dose yourself?
Generally, you shouldn't do this because you never know exactly how much of this drug you returned. What if the dose we are entrusted with is the maximum? It is then that by swallowing another pill, we risk overdosing and poisoning the body. Of course, information on what to do in case of vomiting is also included in the leaflets, so at the end I urge you to read them again. I would also like to say that pharmacists in our pharmacies are really knowledgeable people.
It's always worth buying drugsask if they can all be taken together at the same time. Of course, it is also worth asking the same question to the doctor who prescribed our medications. The doctor should clearly write down the dosage not only on a piece of paper, but in the system! So, if we only have IKP - and I strongly encourage you to set up accounts - then we can enter our profile and check the dosage of drugs at any time.
Rafał Janiszewski, owner of the Advisory Office providing services in the field of he althcare organization to he althcare entities
Speaker, organizer of many trainings and conferences on he alth protection and patient rights. In the years 1998-1999 an employee of the Office of the Government Plenipotentiary for the Implementation of the General He alth Insurance. Author of over 20 books on he althcare organization and he alth care financing standards. In 2005-2007, he was an expert of the Presidium of the Parliamentary He alth Committee, as an advisor on he alth services. Co-author of the general study as part of the Pharmaceutical Pricing and Reimbursement project for the European He alth Commission.
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