Pill for dinner
Photo: Jens Mortensen
Medicines come with seemingly simple directives like “Take on empty stomach.” You might assume that means: Swallow the pill just before a meal. You’d be mistaken. If you eat within an hour, your body may not fully absorb the medication. After a meal, wait at least two hours before taking your pill.

“The misunderstanding isn’t about people’s inability to follow directions, but the lack of communication between health professionals and their patients,” says Rima Rudd, senior lecturer at the Harvard School of Public Health and committee member for the 2007 Joint Commission report, What Did the Doctor Say? Improving Health Literacy to Protect Patient Safety. To help guarantee that your meds work as they should, we’ve decoded some common prescription perplexities—from what to do about missed doses to the safe disposal of pills.

In the Doctor’s Office
When you’re handed a prescription, talk with your doctor about the medications you’re already taking. Tell her if you are on oral contraceptives, since certain drugs like Valium and some antibiotics can interfere with their effectiveness. Make sure she knows about any over-the-counter pills you take, such as aspirin and especially acetaminophen—many prescriptions contain high concentrations of it, and you may be at risk for an unintended overdose, says Sandra Kweder, MD, deputy director of the FDA’s Office of New Drugs.

Timing at Home
If the drug needs to be taken several times a day, ask your doctor about the best times. But there’s usually no need to set an alarm for the middle of the night: If you take four doses a day, you can have one when you wake up, midmorning, mid-afternoon, and at bedtime. Mealtimes can serve as a reminder if you need three pills a day. But don’t down two at once if you miss a pill—skipping a dose typically isn’t a big problem. “Take the medicine as soon as you remember, and then resume the normal schedule,” Kweder says. Never stop a medication midway through its course unless you have an allergic reaction (itchiness, rashes)—in which case, cease immediately and notify your doctor, says Michael Cohen, president of the Institute for Safe Medication Practices.

At Mealtimes
Pills meant to be taken with food should be swallowed at the table after a balanced meal. Steer clear of grapefruit and its juice while on medication: Substances in the fruit can drastically increase how much of a medication your body absorbs, and the effect may occur with more than 20 different types of drugs. Caffeine can interfere with theophylline, a drug used to treat wheezing and shortness of breath from asthma, bronchitis, and other lung conditions. And generally, alcohol is a no-no. “Alcohol can alter the rate at which the stomach empties itself, affecting the absorption of certain drugs,” says B. Joseph Guglielmo, PharmD, chair of clinical pharmacy for the University of California, San Francisco, School of Pharmacy. “It can also cause the liver to metabolize some medications more rapidly. Plus, it can increase the sedative effect of medications such as antihistamines and antidepressants.” If your prescription is for only a couple of weeks, you may want to avoid alcohol for the duration. If you’re treating a chronic problem, discuss the best approach with your doctor.

Disposing of Drugs Safely
The best and most environmentally sound way is to see if your pharmacy or local hazardous waste facility will do it for you (find out about take-back programs at Teleosis.org), says Janet Silvester, RPh, president of the American Society of Health-System Pharmacists.

As a reminder, always consult your doctor for medical advice and treatment before starting any program.


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