Getting the most out of your medicines while minimizing side effects

IT IS IMPERATIVE that you fully appreciate the do’s and don’ts of any medicine that you may use; both prescription and over-thecounter. Irrespective of the route that the medicine is administered or used, a medication needs to be taken correctly for it to be maximally effective and to minimize its potential side effects.

Correct way of taking the most commonly used pain medicines

• Non-steroidal anti-inflammatory drugs (NSAIDs): Examples of NSAIDs include aspirin, diclofenac, ibuprofen, Voltaren, Cataflam, Ponstan, Naprosyn, naproxen, Aleve, indomethacin, Celebrex, Mobic, etc. In order to reduce the chances of stomach irritation, stomach ulcers, and stomach bleeds these should always be taken with a meal and must never be taken on an empty stomach.
• Paracetamol: Many foods, in particular foods high in pectin (e.g. guavas, plums, citrus fruits, and apples), carbohydrates (e.g. bread, pasta, macaroni, ground provisions), and cruciferous vegetables (e.g. callaloo, cabbage, broccoli, cauliflower, kale, watercress, Brussel sprouts, Chinese cabbage, and others) can interfere with paracetamol’s absorption. So it is highly recommended that paracetamol or any of its forms, (e.g. Panadol, Tylenol, or acetaminophen) be taken on an empty stomach.

Medicines That Should Be Taken On An Empty Stomach 

For the best results, the following commonly taken medicines should be ingested on an empty stomach: amlodipine, ampicillin, azithromycin, bisacodyl, captopril, cloxacillin, ciprofloxacin, Floxin, levothyroxine, loratadine, metoclopramide, propranolol, proton pump inhibitors (e.g. Nexium, omeprazole, pantoprazole, lansoprazole), sotalol, sucralfate, sulfonamides (e.g.Bactrim, Septra, sulfatrim, etc.), tetracycline.

Medicines That Should Be Taken With Food 

These are some medicines that are best taken with food to improve their effectiveness and, or, to reduce their side effects: allopurinol, amiodarone, antacids, augmentin, bromocriptine, carbamazepine, CBD, carvedilol, Daonil, dexamethasone, Diamicron, digoxin, erythromycin, glipizide, Januvia, ketoconazole, mebendazole, metformin, nitrofurantoin, potassium, prednisone/ prednisolone, metronidazole, nifedipine, sodium valproate, spironolactone, zinc.

Alcohol needs to be avoided if taking any of the following medications

• Paracetamol.
• Sleep medications e.g. Ambien.
• Anti-anxiety medications – Ativan, lorazepam, Valium, diazepam, Xanax, alprazolam.
• Antidepressants/ antipsychotics.
• ADHD medications – Adderal, Ritalin, Methylphenidate.
• Certain antibiotics – Azithromycin, Erythromycin, Metronidazole, Sulfonamides.
• Opioid pain medicines.
• NSAIDs.
• Diabetes medications.
• Warfarin (Coumadin).
• Over-the-counter cold and flu medications.
• Erectile dysfunction medicines – Viagra, Levitra, Cialis.

Grapefruit and its juice need to be avoided if you are taking

• Amlodipine, nifedipine, buspirone, Cilias, Levitra, Viagra, amiodarone, Allegra, verapamil, rosuvastatin, simvastatin, and atorvastatin.

Dairy products should be avoided if you are taking

• Dairy products (e.g. milk, yogurt, or cheese) reduce the absorption of iron supplements, Fosamax, and certain antibiotics – cipro/ ciprofloxacin, levofloxacin, and tetracyclines (e.g. minocycline, doxycycline). Dairy products could reduce the efficacy of antacids.

If taking warfarin (coumadin) the following must be absolutely avoided

• Callaloo, spinach, parsley, cabbage, lettuce, kale, broccoli, green onions, cauliflower, Chinese cabbage, cranberry juice, alcohol, ginseng, ginkgo, seaweed, soy, chamomile tea, green tea, grapefruit juice, and NSAIDs.

Medications that are most effective if taken at night

• Blood pressure medicines
• Cholesterol-lowering medicines

Other important points regarding the taking of medicines

• Let your doctor and pharmacist know about any allergies.
• For the rapid onset of a medicine’s action (e.g. pain relief, erectile dysfunction), you should lie on your right side for 30-45 minutes immediately after taking it.
• One can become dependent on benzodiazepines (e.g. alprazolam, diazepam, lorazepam) in as little as 3 weeks.
• Patients with liver or kidney disease should ask their doctor if their medication’s dose needs to be adjusted.
• Report immediately suspected medication side effects to your doctor and or pharmacist.
• Medicines should be taken exactly as prescribed.
• Some generic brands of medications are substandard.
• Store your medicines properly and out of the reach of children.
• Check for the expiration date for any medication that you are taking
• When taking multiple medications it is best to get all your medicines from one pharmacy to minimize the chances of drug interactions.
• If on many different types of medication, getting a pill organizer is recommended.
• You should check with your doctor or pharmacist before stopping any medication.
• Check with your pharmacist to see if there is a less expensive but similarly effective alternative to the original brand.