By Barbara Bronson Gray, RN, MN
You'd think it would be easy, taking the drugs your doctors have prescribed. You read the label, and you do what it says, right?
Well, it's a little more complicated. The instructions are not always that clear. And the best, most effective way to spread out the doses or ensure that food doesn't interact with the pills can be a little more nuanced.
Here are a few basic tips you should remember:
Before meals:If you're supposed to take a drug "before meals," that usually doesn't mean right before. Typically there's the expectation that you'll take the pill on an empty stomach between 30 minutes and 2 hours before you eat. It's important to know the amount of time that is recommended for the pill you're taking.
On an empty stomach: This means the drug needs to be alone in the stomach when you take it, (water is usually OK), usually to help ensure the medication has a chance to be well absorbed. Generally that means either taking the drug a few hours after dinner (before bed) or 30 minutes to an hour before breakfast.
With meals: Many of the medications that should be taken with a meal can irritate your gastrointestinal system, so the idea is that if you mix them in with other food, you'll have less of a problem. With drugs that can sometimes make you a little sick to your stomach, or nauseated, it's amazing what taking them with food can often do to prevent or reduce this annoying side effect. It's best to eat about 25% of your meal and then take the pill. What about taking the medication with a snack? That can also work, but make sure it's a substantial enough snack -- not just a piece of fruit or a bag of chips -- to ensure your stomach has something else to work on other than the pill.
Twice a day: The goal with timing medications is to space them out so that you can have as continuous and even a blood level of the drug in your bloodstream as possible. Generally it's best to set times that are about 12 hours apart and that are convenient for you, based on your routine, commitments and lifestyle. For many people, taking two doses at something like 8 a.m. and 8 p.m. works well. Twice a day is often prescribed as "b.i.d."
Three times a day: Check with your healthcare provider or pharmacist on the specific timing for your medication, but generally you simply take your pills about six hours apart, so say something like 8 a.m., 2 p.m. and 8 p.m. Three times a day is sometimes prescribed as "t.i.d."
Four times a day: Generally, this means something like with meals and at bedtime. Four times a day is written as "q.i.d." on a prescription.
Once a day: This sometimes comes with other rules, like taking 30 minutes before breakfast. Some drugs are considered best taken at night. But in general, it's the simplest kind of prescription because you have some choice about when to take it. If you have the latitude to pick the time you'll take your medication, go with something that is convenient for you, especially when you're away from home or traveling. And stick to the time. If you vary it, you're more likely to forget or even accidentally take a double dose one day.
Food restrictions: Some drugs don't play well with certain others. For example, many antibiotics shouldn't be taken several hours before or after ingesting milk products. It's important to follow those restrictions. Recently I was on an antibiotic that couldn't be taken close to drinking or eating milk products, and I had to ditch my beloved morning cereal (with milk) and have eggs and toast. Some drugs don't play well with coffee, either.
Medication Combos: If you take more than one drug, your best bet is to take your complete list of medications to your physician or pharmacist and be sure you have a medication schedule that helps you avoid taking certain medications together.
If you're taking several drugs a day, you may want to have a drug organizer to help you keep track of things. You can get a pill organizer that has dividers for a.m. and p.m. medicine, for example. And any time you have new symptoms -- such as a rash, difficulty breathing, a rapid heart rate or extra beats, for example -- contact your doctor. Drug and food interactions can occur at any time and your healthcare providers may want to change or stop a medication.
Be aware that over-the-counter drugs, supplements, vitamins and other non-prescription medications can also affect the way your prescription drugs works. Be sure your pharmacist and physicians know anything you're taking.
You can visit a website called "adverse events" to learn more about possible side effects or problems that could be associated with the medications you're taking.
Barbara Bronson Gray, RN, MN, who writes the blog bodboss.com, is an award-winning writer and a nationally recognized health expert. She's a regular contributor to HealthDay.com, preparedpatientforum.com and thirdage.com. Barbara has worked in hospitals, as a nurse and as an administrator, led a major healthcare magazine, created a website for WebMD, and served as a leader of global communications for Amgen, the world's largest biotech company. She continues to write and speak about healthcare and has a communications consultancy. Follow her on Twitter: @bbgrayrn.