How to take pills with meals. The art of being healthy. Dependence of taking certain drugs on biological rhythms

Colds, flu, sore throat, whooping cough - in winter, and at any time of the year, you can get sick without leaving the couch. And always, even at the first symptoms of the disease, we begin to stuff ourselves with pills. We would like to warn you against the most common misconceptions associated with taking medications and tell you how to take them correctly.

If there are no other instructions in the instructions or in the doctor's prescription, it is better to take medications on an empty stomach 30 minutes before meals, since interaction with food and digestive juices can disrupt the absorption mechanism or lead to changes in the properties of the medications.

Take on an empty stomach:

- all tinctures, infusions, decoctions and them similar drugs made from plant materials. They contain the amount active ingredients, some of which are influenced of hydrochloric acid stomach can be digested and turn into inactive forms. In addition, under the influence of food, the absorption of individual components of such drugs may be impaired and, as a result, insufficient or distorted effects;

- all calcium supplements , although some of them (for example, calcium chloride) have a pronounced irritant effect. The fact is that calcium, when bound with fatty and other acids, forms insoluble compounds. Therefore, taking drugs such as calcium glycerophosphate, calcium chloride, calcium gluconate and the like during or after meals, according to at least, useless. To avoid irritating effects, it is better to take such drugs with milk, jelly or rice water;

- medications that, although absorbed from food, for some reason have an adverse effect on digestion or relax smooth muscles . An example is a drug that eliminates or weakens smooth muscle spasms ( antispasmodic) drotaverine (known to everyone as No-shpa) and others.

-tetracycline , since it dissolves well in acids. But you should not drink it (as well as doxycycline, metacycline and other tetracycline antibiotics) with milk, as it binds with calcium, which is quite abundant in this product.

Take all multivitamin preparations during meals or immediately after meals.

Immediately after eating it is better to take drugs that irritate the gastric mucosa: indomethacin, acetylsalicylic acid, steroids, metronidazole, reserpine, cardiac glycosides (lily of the valley tincture, digitoxin, digoxin, cordigit, celanide).

Diuretics(diacarb, hypotheazide, triampur, furosemide) - only after meals.

Antihypertensive drugs(adelfan, brinerdine, clonidine, renitek, papazole, raunatin, reserpine, triresitol K, enalapril, enap) can be taken before and after meals, morning and evening.

Means that improve cerebral circulation (cavinton, instenon, tanakan, trental, stugeron (innarizin), nootropil) are taken regardless of when you sat down at the table.

Antiulcer drugs(denol, gastrofarm) should be taken half an hour before meals. They should be washed down with water (not milk).

Laxatives(Bisacodyl, Senade, Glaxena, Regulax, Gatalax, Forlax) are taken before bed and half an hour before breakfast.

Antacids(almagel, phosphalugel, gastal, maalox) and antidiarrheals (imodium, intetrix, neointestopan, smecta) - half an hour before meals or 1.5-2 hours after.

Bronchodilators(berodual, broncholitin, ventolin, salbutamol) - regardless of food.

Take 10-15 minutes before meals choleretic drugs, so that they get into duodenum before food and stimulated the process of bile secretion by the time food enters the intestines.

All medications whose dosage time is not indicated in the instructions or prescription should be taken on an empty stomach (3-4 hours after meals or 30-60 minutes before meals).

Drink water while standing.

A special group consists of medications that should act directly on the stomach or on the digestion process itself. So, acid reducers gastric juice (antacids), as well as means that weaken the irritating effect of food on a sore stomach and prevent copious discharge gastric juice, usually taken 30 minutes before meals. 10-15 minutes before meals, it is recommended to take drugs that stimulate the secretion of the digestive glands (bitterness), andcholeretic agents . Gastric juice substitutes are taken with meals, and bile substitutes (for example, Allochol) at the end or immediately after meals. Preparations containing digestive enzymes and promoting the digestion of food (for example, Mezim forte), usually taken before meals, during meals or immediately after meals. Drugs that suppress the secretion of hydrochloric acid into gastric juice, such as cimetidine, should be taken immediately or shortly after meals, in otherwise they block digestion at the very first stage.

Not only the presence of food masses in the stomach and intestines affects the absorption of drugs. The composition of food can also change this process. For example, with a diet rich in fat, the concentration of vitamin A in the blood plasma increases (the speed and completeness of its absorption in the intestine increases). Milk enhances the absorption of vitamin D, the excess of which is dangerous, first of all, for the central nervous system.

A protein diet or consumption of pickled, sour and salty foods impairs the absorption of the anti-tuberculosis drug isoniazid, while a protein-free diet, on the contrary, improves it.

I hope that the examples above have given you general idea about how the properties of a particular medicine can change depending on the diet and time of administration.

It is very important to take the drug at the time indicated by the doctor or recommended in the instructions. Otherwise, the medicine may simply become useless, or even cause harm.

Of course, there are drugs that act “regardless of food intake,” and this is usually indicated in the instructions.

The method of taking the medicine is also of great importance.

Remember that it is better to take the medicine orally while standing, in as a last resort- sitting, but not lying down! After taking it, you should not lie down for 2-3 minutes, otherwise the medicine will “stick” to the inner surface of the esophagus and after 10 minutes it may completely collapse without reaching the stomach and intestines. When several drugs are prescribed at once, an interval of 10-15 minutes is required between taking each of them.

It's supposed to be washed down warm water. Tea, especially strong tea, is not suitable for this, since the tannin it contains forms with many medicinal substances insoluble and therefore non-absorbable compounds. Tannin is especially active in binding papaverine, amidopyrine, cardiac glycosides, enzymes, and active ingredients in herbal infusions and decoctions.

Who just prescribed you a course of treatment that includes several medications, do you completely forget how and when to take them? If you forgot, you are not alone. These are the majority. Result: medications do not help and even cause harm. If you want the pills to provide health benefits, take them correctly.

1. Accept different tablets separately, and not all at once in one go. This way you will avoid many side effects.

2. Check medications for compatibility. For example, if a therapist prescribed you one medicine, a urologist prescribed another, a cardiologist prescribed a third, and a gastroenterologist prescribed a fourth, be sure to return to the therapist or consult a pharmacist. This way you will prevent their contradictory interaction by replacing the medicine with a safe analogue.

3. Do not expect instant results from drugs and do not take them without waiting for them. double dose. Most tablets begin to work within 40-60 minutes.

4. Do not swallow medications while lying down. Otherwise, they may begin to decompose in the esophagus, leading to heartburn, nausea and vomiting.

5. Do not chew or twist capsules. The gelatinous shell ensures the “delivery” of the medicine to its intended purpose - to the gastrointestinal tract. In addition, many of the capsules are so-called extended-release products that no longer need to be taken several times a day. The shell provides a slow release of the drug and should not be damaged.

Cautions for each drug

Aspirin. This medicine should be taken only after meals. Soluble tablet dip in exactly the amount of water indicated in the insert, and it is better to crush or chew an ordinary tablet and wash it down with milk or mineral water: then it will get into the blood faster and will not unnecessarily irritate the mucous membranes gastrointestinal tract.

Sulfonamides. They should be washed down with a glass of mineral water. These drugs often cause kidney problems, and drinking plenty of alkaline fluid will relieve the problems.

Oral contraceptives. These pills should not be taken with tea, coffee, or Coca-Cola. If this recommendation is not followed, hyperactivity and insomnia may occur because contraceptives reduce the body's ability to break down caffeine.

Antibiotics. They should be taken half an hour before meals. And wash them down better water, and not milk, since what is contained in milk reacts with antibiotics (especially tetracycline) and forms poorly soluble compounds.

Nitroglycerin, glycine. They must be dissolved without drinking anything.

How to take your pills

Boiled water at room temperature is the best drink for most tablets.

Grapefruit juice. It cannot be combined with drugs that lower blood cholesterol, immunosuppressants, erythromycin, oral contraceptives, some antitumor drugs, Viagra (and its analogues). Grapefruit juice does not remove drugs from the body. The result is an overdose.

Cranberry juice. Anticoagulants - drugs that reduce blood clotting - cannot be combined with it. Otherwise, bleeding may occur in the gastrointestinal tract.

Alcohol. The annotation for many tablets contains a warning about incompatibility with alcohol. Thus, the combination of alcohol with antihistamines, insulin, tranquilizers and tablets that lower blood pressure, will lead to increased drowsiness, which is especially dangerous for motorists. Antibiotics, when mixed with alcohol, will cause a rush of blood to the head, dizziness and nausea. Nitroglycerin under the influence of alcohol changes its effect and will not bring much-needed relief to the heart. Antipyretic tablets combined with alcohol will cause a massive blow to the mucous membranes of the stomach.

How to take medications

Enzyme preparations that improve digestion should be swallowed directly during meals.

Do not mix aspirin with spicy food and citrus fruits an hour before and after taking the pills, so as not to irritate the stomach and intestines.

It is better to take antidepressants on a diet that excludes foods such as cheese, yeast, soy sauce, fish roe, and avocado. Otherwise, severe drowsiness and high blood pressure will ruin your day.

Hormonal drugs require mandatory proximity to protein foods. Vitamins require fats for good absorption.

Drugs that regulate digestion, on the contrary, with fatty foods don't match.

Time to take medications

Heart and asthma medications are taken closer to midnight.

Medicines for ulcers - early in the morning and late in the evening to prevent hunger pains.

Of course, you yourself know very well about all this. But... they forgot. Print this leaflet if you take any medication regularly for a medical condition. And you don’t have to bother remembering.

When prescribing certain medications, the doctor gives certain recommendations - "Twice a day after meals", “Not on an empty stomach, but on an empty stomach!”(these are different things, by the way!), “Chew, do not swallow!”, etc. The instructions also always indicate the specifics of reception.
"Who cares? - you ask, - after all therapeutic effect The prescribed medications will still work!”.
And yet, there is a difference. And today we will devote an article to nine important points when taking medications.

1. FREQUENCY OF DOSING IS THE KEY TO EFFECTIVENESS
Our body, unlike us, works around the clock. 24 hours a day the heart beats, the lungs breathe, the liver and kidneys work. And that is why, when prescribing us to take medicine twice a day, the doctor does not mean the 15-16 hours that we are awake. He means all 24 hours.

This means that taking the medicine should be divided into equal periods of time - for example, with a double dose, the interval between each dosage should be 12 hours, three times - 8, four times - 6. Of course, jumping out of bed in the middle of the night to take a pill is not the best best idea. Therefore, the timing should be calculated taking into account your daily schedule.
Why is it important? Imagine a pill antimicrobial action. It is active for a certain period of time. After the interval specified in the instructions, it simply stops protecting you from the growth of bacteria inside the body. And the longer you wait to take the next dosage, the more chances your illness has to take power back over your body. Do you want an effective and quick cure? Set an alarm clock with reminders and take your medications at the intervals specified by your doctor or instructions.

2. FOLLOW THE PRESCRIBED TREATMENT REGIME
If the medications are prescribed for a week of daily use, then problems usually do not arise. But during long courses of treatment, the situation when the patient forgot to take a pill, or, on the contrary, drank an extra one, is not uncommon. Even doctors who know how important it is to follow the prescribed dosage regimen, like all people, have noted the effect of this “forgetfulness” when it comes to dreary long-term treatment.
Why is it important? If you forget to take your pill on time, you essentially interrupt your treatment for a day. And then drink two in a row - in best case scenario is useless, and at worst (if the drug is potent) it is fraught with toxic damage to the liver, stomach, intestines….
To prevent such “sclerosis” when long-term use medications are possible different ways– celebrate taken pill ticking a chart or calendar, storing medications in a visible (but out of reach of children!) place, or setting reminders on your phone for the right time.

3. AFTER A MEAL OR ON AN EMPTY STOMACH – THIS IS IMPORTANT!

Taking pills varies in relation to meals: “before”, “after” and “independently”. It would seem, “just think, what a difference it makes!”, but the problem is not only that. It often happens that in the minds of the doctor, the patient eats regularly, and does not indulge in tea or cookies during breaks, but the patient may not have breakfast in the morning, have lunch with compote, or eat a cutlet at three o’clock in the morning while awake - and all this also contributes to the incorrect use of medications and a decrease in the effectiveness of treatment.
Why is it important? Some medications are only absorbed if they are not interfered with digestive process, gastric juice or acidic environment. Therefore, the instructions for them indicate "before meals". This means that if you take such a pill even after a small snack, you are essentially throwing money away - the active substances simply will not be absorbed by the body. "While eating" It is often recommended to take those medications that require, for example, fats from food to dissolve and assimilate. "After meal" medications are taken that irritate the gastric mucosa or are intended to normalize the digestion process. Moreover, in all three cases, “meal” does not necessarily mean a three-course meal. An eaten banana is also a meal. Always check with your doctor for any dosage recommendations and what they mean by them.

4. ON AN EAST STOMACH AND ON AN HUNGRY STOMACH ARE DIFFERENT THINGS!
Many people think that these two terms mean the same concept. However, this is not so, and there is a significant difference between these concepts in the state of the body. An empty stomach (or on a lean stomach) is the time without food or drink between the end of sleep and the first breakfast, but no later than 10 am.
If even after 10 o’clock in the morning a person has not eaten or drunk, then this state is already called “on an empty stomach.”
Why is it important? The fact is that “on an empty stomach” the body treats the lack of food easily, but “on an empty stomach” the mechanism of “self-feeding” of the body is activated due to internal reserves, and if they are not there, then due to cell loss internal organs, acidity in the stomach increases, the medicine is absorbed completely differently.

5. NOT ALL MEDICATIONS CAN BE TAKEN AT ONCE!
You should almost always take medications separately, unless otherwise agreed with your doctor. Of course, in real life this is not always convenient, but it is better to make an effort and make a schedule for taking it if you do not want to get an unpredictable effect already on initial stage.
Sometimes the patient, having decided that the medicine prescribed by the doctor has a bad effect, for example, on the liver, begins to take the pill with an additional vitamin or hepatoprotector. And in vain! After all, even natural preparations- these are still medications that may turn out to be completely incompatible with the prescribed treatment, neutralize it, or even worse - aggravate the disease. And that is why, if you are being treated by several specialists for different reasons, they must know about each other’s prescriptions!

6. NOT ALL TABLETS CAN BE DIVIDED IN HALVES

Some tablets can be broken to give multiple doses, but not all. And even more than that: some tablets are coated, damaging which can affect the properties of the medicine. For example, some drugs are coated with a coating that is insoluble in the stomach due to the fact that they are absorbed only in the intestines. But if you remove this shell, the medicine simply will not reach the intestines. It will be digested in the stomach, without providing you with any benefit.

7. MOST TABLETS ARE TAKEN WITH WATER
No tea, no coffee, no juice or soda. For the same reasons why it is prohibited joint reception medicines. Any liquid has certain chemical properties, which affect the absorption of the drug. For example, if you take a calcium tablet with soda and an oral contraceptive with chamomile infusion with St. John's wort, the effectiveness of the tablet in both cases will be zero. And this is the most harmless outcome. Here's something to drink sedatives alcohol, or drugs that reduce blood clotting - sour juice - this means increasing their effect so much that possible consequences begin stomach bleeding, but end fatal. And this, imagine, is not a joke at all.

8. CHEWABLE TABLETS – CHEW!
On the contrary, you can’t bite into the jelly beans. The release form of the drug is also not chosen by chance.
Why is it important? A chewable (suckable) tablet that you swallow whole will take a different time to work or may not work at all. And the special coating on the tablet means it cannot be crushed, broken or cracked. Because this coating protects something: the active substance of the tablet from stomach acids or the stomach from the active substance, the esophagus or tooth enamel etc. The capsule form of release also says that the active substance should be absorbed only in the intestines and for a certain time, so capsules can only be opened as prescribed by a doctor, with an eye to the instructions.

9. EVERY RULE HAS AN EXCEPTION
Rare, but there. It happens that the treatment regimen, dosage and method of administration of drugs allows for adjustments for certain groups of patients, for example, if there are features in the patient’s anamnesis or medical history ( accompanying illnesses, individual reactions, etc.). Take the pills like any other medicines, it is necessary without initiative, all innovations must be agreed upon with the doctor.

Stay healthy and take your medications correctly!

Description of the question

No matter how much we monitor our health, unfortunately, each of us is sooner or later destined to take our dose of medicine. On the one hand, there is nothing complicated in taking pills: put it in your mouth, drink it and wait for a miraculous recovery. However, in practice everything is not so simple. After all, any medicine will begin to act only when it is in sufficient concentration in the tissues of the diseased organ. The path of the active substance to its destination is sometimes very complicated. Through the mouth you need to get into the stomach, from there to small intestine, then dissolve in its contents and at the same time avoid destruction due to the effects of hydrochloric acid of the stomach, enzymes and other food components. It is very important what time of day you take the medicine, do it before, during or after meals, what do you take with it, etc. You always really want the treatment to last a short time, to be effective against the disease and not to harm the rest of the body. For everything to be exactly like this, the pills must be taken correctly. The instructions for use, which you will find in the box with the medicine, will tell you in detail about the features of taking certain tablets. However, there are a number general advice, which are often not reflected in the insert, because are considered generally known. It's about them we'll talk below.

You will need

alarm clock or timer on your mobile phone
a special calendar where you can mark the fact of taking pills
instructions for use of the medicine

Step by step solution

note

Always strictly follow the instructions for use that come with any medicine. Never throw away the information leaflet after opening the package of tablets and briefly looking at this leaflet. It is very possible that you will need to re-read it later.
The best way to stay on schedule is to draw up a pill dosing plan and hang it in a visible place (on the refrigerator, on the door, etc.). And in order not to miss the time to take your medication, use a timer or alarm clock on your mobile phone.
Do not take advice on using pills from your friends. When a doctor prescribes you a medicine, he relies on medical knowledge, which at first glance is not always obvious to you. The instructions for use are compiled by specialists, and every word in it is the result of long and painstaking scientific research. Therefore, if your mother with hypertension took the same medications that were prescribed to you, according to a different regimen, this is not at all a reason to take them the same way. Do not engage in any activity when taking pills. If in any doubt, consult a doctor.

Why do medications prescribed by a doctor sometimes not give the expected effect? Why are medications that are very effective for one patient practically useless for another? Do not rush to blame the doctor for choosing the wrong one for you. remedy, which does not fully take into account your individual characteristics and previous diseases. Maybe it's all about you - that you're just taking your medications incorrectly?

Well, firstly, you need to follow the medication regimen and correct dosage. If you want to take them three times a day – this is actually three times a day, that is, one tablet every 8 hours. Not “morning, noon and evening” - this could be at “11 am”, “12 noon” and “5 pm” - but every 8 hours. For the most effective action In order for the medicine to be applied to the body, it is necessary to maintain a certain concentration in the blood.

This is especially important to consider when taking antibiotics. Otherwise, the medicine is unlikely to be able to cope with the microbes; rather, it will teach them to resist the drug.

Sometimes patients stop taking recommended medications - they say, “everything has gone for me,” “I feel sorry for the money, the pills are too expensive,” or if side effects suddenly begin to appear before the end of the course. Consult your doctor; sometimes you need to “endure” some inconveniences.

It is very important when you take your medications - “before meals”, “during meals” and “after meals”. Doctors emphasize: only timely use of medications ensures not only the maximum effect, but also, often, safety for your health.

Before meals: if gastric juice does not affect the medications, they are digested better and absorbed faster. They are recommended to be taken 30 minutes before meals. Such drugs include choleretic, antiulcer, and normalizing heart function. Often, during this half hour, do not even drink liquids, not even water, so as not to wash the remedy out of the stomach. Example: antacids /heartburn medications/.

Sometimes tablets “on an empty stomach” can severely irritate the mucous membranes. The same aspirin /acetylsalicylic acid/ should under no circumstances be taken before meals, only strictly after meals /!/, during meals it breaks down into acetic acid. Moreover, it is necessary to take aspirin tablets big amount water, a glass wouldn’t be amiss here. If the tablet does not have time to dissolve and for some reason lingers for a long time in the esophagus or sticks to the wall of the stomach, the formation of an ulcer is inevitable! Aspirin can even corrode the walls of blood vessels.

True, there is one exception: in the form effervescent tablets You can take aspirin before lunch: active substance has already dissolved, and gas bubbles will only speed up the absorption of the medicine.

While eating: medications that are recommended to be taken after the first spoons are the majority. These are drugs that improve digestion, diuretics, laxatives (not all!/). It is strictly forbidden to take antibiotics with food - their effect is completely neutralized by gastric juice.

After meal: most often, two hours after eating, as soon as the contents of the stomach are empty. This is done to ensure that the mucous membranes of the stomach and intestines are irritated as little as possible. Such medications include anti-inflammatory and painkillers, drugs that reduce acidity.

Regardless of meal medications are taken that improve blood circulation in the brain, bronchodilators and antihypertensive drugs - those that cause a decrease in blood pressure and are used mainly for pathological increase system pressure.

Under no circumstances should you take “handfuls” of medicine. If you need to take several medications, and the doctor has not given any recommendations, you should wait between taking different medications. take a 30-40 minute break . It is unlikely that even scientists will tell you how thousands of types of tablets, mixtures, powders are combined with each other - whether they will be absorbed by the body, whether they are easily excreted by the intestines, and in general - whether such an “assortment” will lead to any serious complications.

What should I take with my medications? The question is fundamental. For example, very healthy freshly squeezed grapefruit juice in combination with certain drugs can be life-threatening. Juices, like milk, generally have the ability to destroy the structure medicines. Even “simple” tea can form insoluble compounds in combination with some medications that are difficult to absorb by the body. And our beloved coffee has the ability to speed up the removal of drugs from the body - before they are absorbed.

So take your medications only with water. If the creators of the drug provide for taking a different liquid, this will be indicated in the instructions.

And anyway, Do not combine medications and alcohol ! Doctors say that these concepts simply do not go together, and the alcohol strength does not play any role. Alcohol combined with antibiotics will cause dizziness and nausea; with tranquilizers and antidepressants - will enhance their effect, with drugs that lower blood pressure - will cause drowsiness. Taking with aspirin will cause stomach ulcers, taking with paracetamol will cause stomach ulcers. toxic hepatitis, with insulin - hypoglycemic coma.

Most tablets, especially coated ones, cannot be chewed - only swallowed . They are designed this way - a special shell protects the drug from the acidic environment of the stomach. This is why you should not cut film-coated tablets in half. In addition, the active ingredient in the tablet itself is often coated with a flavoring agent to “neutralize” the unpleasant taste of the drug.

Well, and finally - on storage of medicines . Tip number 1: after the expiration date, which is certainly indicated on the packaging of the drug, it should be thrown away without regret. Although in fairness it should be noted that unopened packages and tablets in blisters can be stored without much concern long years. American researchers have found that more than 80% of drugs remain usable from 5 to 25 /!/ years after the expiration date, and the remaining part simply decreases in the amount of active ingredients. If you want to check this data and take a chance own health- can experiment on yourself.

But it is better to get rid of packages that have already been opened, even if the indicated expiration date has not yet expired. The reason is not only that the tablets dry out or, on the contrary, absorb moisture from the air - depending on storage conditions. That is, they spoil. The same Americans found that on the surface of drugs stored in an opened container, within a year salmonella, staphylococcus, coli and other microorganisms.

In general, don't get sick!

Read also on our website on the topic of “medicines”:

Nowadays you can often hear from doctors and pharmacists that when taking medications, you must strictly follow the instructions that come with them. Only in this case will the drugs help maximum benefit and there will be minimal amount side effects. However, some instructions contain non-specific wording, such as “before meals”, “after meals”, “during meals”, “before bed”, “at night”, etc. What does this mean?

If the instructions prescribe taking medications “on an empty stomach,” this means that you need to take the medications in the morning, but not immediately after waking up, but 30-40 minutes before breakfast.

If the accompanying instructions indicate that the drug should be taken “at night”, for example, sleeping pills, then this means that this medicine should be taken not before going to bed, but 25-30 minutes before.

If the instructions say that medications should be taken “before meals,” this means that they must be taken not before the first spoonful of food is put into the mouth, but 15-20 minutes before sitting down at the table, but best of all - 30 -40 minutes before the start of the meal process. When pharmaceuticals, such as Festal, Panzinorm, Pancreatin and others are prescribed to improve digestion, in which case they are taken during a meal, when half of the intended food has already been eaten.

If medications must be taken “after meals,” then for maximum therapeutic effect Most medications should not be taken immediately after the spoon is put aside, but not earlier than 1.5-2 hours after finishing the meal. However, if drugs have an irritating effect on the mucous membrane of the stomach and intestines (aspirin, butadione, voltaren and others), then they should be taken immediately after meals.

If there are no special instructions for taking medications, then it is most advisable to take them 15-20 minutes before meals or 1.5-2 hours after finishing the meal. It is better to take preparations containing calcium before meals, then it will almost completely bind with the acids of plant foods.

Only medications intended “under the tongue” (validol, nitroglycerin and others) do not have a dosage time. They are used every time an attack occurs.

If the instructions recommend taking a drug “three times a day,” this does not mean “breakfast, lunch, dinner.” Medicines must be taken every 8 hours to maintain a constant concentration in the blood.

In addition to the above, you need to remember about the compatibility of drugs. Experts have calculated that taking 3 drugs at once threatens the development of adverse reactions in 15-25 percent of cases. When to take 5-6 drugs at the same time without first consulting about their compatibility, then unwanted effects may occur in approximately 80 percent of cases.

Article prepared

As long as nothing hurts, you don’t think about pills. Meanwhile, each tablet has its own hour - time and order of administration. In a word, if you started to be treated with medications, then take into account all the subtleties!

Accept any medicinal medicine it is necessary strictly according to the rules and instructions attached to the medications, or the doctor’s instructions. The success of your treatment and your health depends on whether you know how to take this or that type of medication, the correct dosage, what it is incompatible with, what foods and medications.

In order for the drug to be fully effective and not cause side effects, you need to know how and when to take it and what it is combined with.

You can't drink it down antidepressants, sleeping pills and tranquilizers alcoholic drinks. In combination with alcohol, they enhance each other’s effects, which means that if you wash down a couple of tablets with a decent dose of alcohol, you risk waking up in intensive care. The combination of some antidepressants with cheese, yeast buns, soy sauce, fish roe, coffee, cream can cause severe headache and increase arterial pressure.

There is no point in taking any medications at the same time as drugs that coat the gastric mucosa (almagel or phosphalugel). True, this does not threaten resuscitation, but there is no point.

Antibiotics are not compatible with coffee, Pepsi and Coca-Cola, in combination with these drinks, antibiotics provoke nervous excitement and stomach irritation. By the way, if you take pills for stomach pain with the same drinks, the effect will be the same. Antibiotics are not at all easy and should only be taken as directed by a doctor. Because they act not only on the bacteria that caused the disease, but also on vitamins. So the jars in vitamin preparations can be postponed until later until the course of antibiotics is completed.

Tetracycline antibiotics(doxycycline, etc.) cannot be taken with milk and dairy products, since calcium ions, which milk is rich in, combine with tetracyclines, forming sparingly soluble compounds, and sharply reduce their activity.

Upon admission diuretics It is necessary to replenish potassium reserves in the body. They will help with this green pea, spinach, sorrel, potatoes, onion, carrots, beets, dried apricots, apples.

Grapefruit juice is also included in the list of products incompatible with medications.. It may reduce the effectiveness of medications prescribed to fight cholesterol. Those who take cyclosporine, which prevents the rejection of transplanted organs, should also forget about grapefruit juice, otherwise these people are at risk of losing their orientation. Research shows that grapefruit juice for unknown reasons) sharply increases the degree of absorption of drugs and contributes to their overdose.

Iron supplements, which are used in the treatment of anemia, are well absorbed when taken simultaneously meat products and are poorly absorbed if washed down with milk, coffee or undiluted fruit juices.

Reception hormonal drugs causes metabolic disorders. To prevent complications, you need to eat food rich in complete proteins, potassium salts, vitamins: cottage cheese and other dairy products, fish, dried apricots, raisins, pumpkin, berries.

Oral contraceptives Do not combine well with products containing caffeine. The fact is that contraceptives reduce the body's ability to break down caffeine, which can lead to hyperactivity and insomnia.

Fat-soluble vitamins A, D, E, F, K must be taken after meals, as well as with foods rich in animals and vegetable fats, which accelerate their absorption.

During treatment antitumor drugs eat foods that promote hematopoiesis: liver, fish, carrots, dill, pomegranates, black currants, strawberries. A mixture of honey, aloe and Cahors juice is very useful. equal parts.

Do not drink alcoholic beverages while taking any medications. This may cause side effects and reduce the effect of the drug. Especially not desirable simultaneous administration alcoholic beverages and drugs such as furazolidone, metronidazole, cephalosporin antibiotics. Possible Negative consequences: dizziness, nausea, irritation of the mucous membranes, drowsiness.

If possible, try to take only one or two medications. If different doctors have given you each a different prescription, be sure to tell them which medications you are already taking. Various drugs take separately.

A universal rule for taking almost all medications: take the tablet with half a glass ordinary water room temperature. Then the medicine will quickly dissolve in the stomach without irritating it.

Take before meals.

Most medications are taken 30-40 minutes before meals, when they are best absorbed. Sometimes - 15 minutes before meals, not before.

Half an hour before meals should be taken antiulcer drugs- DE-NOL, GASTROPHARM. They should be washed down with water (not milk).

You should also take it half an hour before meals. antacids(ALMAGEL, PHOSPHALUGEL, etc.) and choleretic agents.

Take with meals.

During meals, the acidity of gastric juice is very high, and therefore significantly affects the stability of drugs and their absorption into the blood.

Should be taken with food gastric juice preparations or digestive enzymes, as they help the stomach digest food. These include FESTAL, ENZISTAL, PANZINORM, MEZIM FORTE.

Take after meals.

If the medicine is prescribed after meal, then to get the best therapeutic effect, wait at least two hours.

Immediately after eating, they take mainly medications that irritate the mucous membrane of the stomach and intestines. This recommendation applies to such groups of drugs as:

diuretics- DIACARB, HYPOTHIAZIDE, TRIAMPUR, FUROSEMIDE (only after meals)

painkillers(non-steroidal) anti-inflammatory drugs - BUTADIONE, ASPIRIN, ASPIRIN CARDIO, VOLTAREN, IBUPROFEN, ASKOFEN, CITRAMON (only after meals).

cardiac glycosides- Lily of the Valley tincture.

sulfonamides- PHTHALAZOL, BISEPTOL; It is recommended to take these medications with an alkaline drink, for example, mineral water.

agents that are components of bile- ALLOCHOL, CHOLENZIM, etc.; taken after meals - required condition so that these drugs “work.”

Regardless of food.

Regardless of when you sit down at the table, take:
bronchodilators- BERODUAL, BRONCHOLITIN, VENTOLIN, SALBUTAMOL

Antihypertensive drugs can be taken during the day: before or after meals, morning and evening - ADELPHAN, BRYNERDINE, CLOPHELINE, RENITEK, PAPAZOL, RAUNATIN, RESERPINE, TRIRESIDE K, ENALAPRIL, ENAP N.

Take on an empty stomach.

Taking medication on an empty stomach is common in the morning 20-40 minutes before breakfast.

Medicines taken on an empty stomach are absorbed and absorbed much faster. Otherwise, the acidic gastric juice will have a destructive effect on them, and the medications will be of little use.

Take 2-3 times a day.

If the instructions indicate " three times a day", this does not mean breakfast - lunch - dinner. The medicine must be taken every eight hours so that its concentration is maintained evenly in the blood. It is better to take the medicine simply boiled water. Tea and juices - no the best remedy.

If it is necessary to resort to cleansing the body (for example, in case of poisoning, alcohol intoxication), usually used sorbents: ACTIVATED CHARCOAL, POLYPHEPAN or ENTEROSGEL. They collect toxins “on themselves” and remove them through the intestines. They should be taken twice daily between meals. At the same time, you need to increase your fluid intake. It is good to add herbs that have a diuretic effect to your drink.

Day or night.

Drugs with hypnotic effect need to be accepted 30 minutes before bedtime.

Laxatives- BISACODIL, SENAD, GLAXEN, REGULAX, GUTALAX, FORLAX - usually taken before bed or half an hour before breakfast.

Heart medications And asthma remedies accepted closer to midnight.

Remedies for ulcers taken early in the morning and late in the evening to prevent hunger pangs.

After inserting the suppositories, you need to lie down, so they are prescribed at night.

If there are no instructions in the instructions.

In the absence of any instructions in the package insert, the medicine should be taken 30 minutes before meals. This applies to the bulk of drugs.

If your appointment time is missed.

If you " we were late» for 1-2 hours, then the drug can be accepted, as usual. If the break is longer, you should skip the medication until the next one to avoid an overdose. After this, it is advisable to restore the medication dosage schedule.

You cannot take the drug in double dose just because you missed your appointment time - this may increase side effect medicines.

Hormonal And "heart" drugs, majority antibiotics should be taken strictly by the clock. The best thing is to draw up a reception diagram and hang it in a visible place (on the door, furniture, refrigerator, etc.).

In what order should I take the medications?

Many medications interact with each other, so try to accept medicines one by one.

Often incompatible there are antibiotics. They should not be unnecessarily combined with antipyretics, hypnotics, antihistamines. And, of course, in no case with alcohol.

The gastric mucosa will be safer if you take into account the specifics of taking vitamins. Fat-soluble vitamins(A, D, E, K) are more useful after meals, and water-soluble(C and group B) - before meals or during meals. Complex multivitamin preparations It is better to drink immediately after eating.

Pharmacists advise.

When visiting a doctor, it is advisable for patients write down recommendations. This is important to ensure your own safety, because medications are a delicate thing. As for foods, almost all of them can change the effect of the drug. Some (for example, fatty and sweet foods) delay and increase the absorption time of the drug components into the blood, while others increase the effect of the drug significantly, causing an overdose.

“Take these tablets one at a time 2 times a day after meals.” We've probably all heard this recommendation more than once. Now let's think about how accurate it is and whether it requires additional instructions. After all, when prescribing this or that, he expects that they will be used correctly.

Rule 1. Multiplicity is everything

When prescribing taking pills several times a day, most doctors mean a day - not the 15-17 hours that we are usually awake, but all 24. Because the heart and liver work around the clock, and, therefore, microbes work without a lunch break and dream. Therefore, taking tablets should be divided into equal intervals as much as possible, this especially applies to antimicrobial agents.

That is, with a two-time dose, the interval between taking each dosage should be 12 hours, three times - 8, four times - 6. However, this does not mean that patients should jump out of bed every night. There are not so many medications, the accuracy of administration of which is calculated minutely, and they are usually not prescribed in tablet form. But nevertheless, 2, 3, 4 times a day - this is not when it is convenient for the patient (“now and in an hour, because I forgot to drink in the morning”), but at certain intervals. To avoid interpretations when taking twice a day, for example, it is justified to prescribe exact time taking the pill: 8:00 and 20:00 or 10:00 and 22:00. It’s more convenient for the patient, and it’s impossible to understand in both ways.

Rule 2. Compliance, or commitment to acceptance

WITH short courses When taking pills, things are more or less normal: we usually don’t forget to take them for a couple of days. It gets worse with long courses. Because we are in a hurry, because we are stressed, because it just slipped our minds. There is another side to the coin: sometimes people take medicine mechanically, half asleep, and then forget about it and take more. And it’s good if it’s not a potent drug.

Among doctors, before grumbling about this to patients, they suggest testing it on yourself: take a dark glass jar with 60 harmless tablets (glucose, calcium gluconate, etc.) and take one daily. There were many experimenters, but there were only a few of those who, after two months, had 2 to 5-6 “extra” tablets left.

Everyone chooses ways to combat such “sclerosis” for themselves: someone puts medications in a visible place, ticks on the calendar help pedants, and alarm clocks, reminders on a mobile phone, etc. help those who are especially forgetful. Pharmaceutical companies even produce special calendars where you can mark each appointment. Not so long ago (though, as usual, not in Russia) hybrid alarm clocks and mini-first aid kits appeared, ringing and dispensing a tablet at a certain time.

Rule 3. Before or after eating - this is important

According to their relationship with meals, all tablets are divided into groups: “anyway”, “before”, “after” and “during meals”. Moreover, in the doctor’s mind, the patient eats strictly according to the schedule, does not snack during breaks and does not drink tea. But in the patient’s mind, an apple, banana and candy are not food, but food is borscht with a cutlet and compote with pies. Unfortunately, these beliefs also contribute to improper medication use.

"Before meals". To begin with, it’s a good idea to understand what the doctor means when he says “take 30 minutes before meals.” Does this mean that after taking the pill you need to eat a lot, or is the medicine just taken on an empty stomach?

In most cases, when prescribing medications “before meals”, the doctor means:

that you did not eat anything (nothing at all!) before taking the pill;
that at least for the specified period after taking the medicine, you will also not eat anything.

That is, this tablet should get into empty stomach, where she will not be disturbed by gastric juice, food components, etc. From our own practice, we can say that this has to be explained many times. Because, for example, the active ingredients of drugs from the macrolide group are destroyed acidic environment. In this case, eating candy or drinking a glass of juice two hours before taking the medicine or an hour after can dramatically affect the result of treatment. The same applies to many other drugs, and it’s not just about gastric juice, but also about the timing of the drug getting from the stomach into the intestines, absorption disorders, and simply the chemical reaction of the drug’s components with food.

There are, of course, exceptions to this rule when you need to eat exactly within the specified period after taking it. For example, for gastrointestinal diseases or endocrinopathies. Therefore, for your own convenience, it is better to clarify what exactly the doctor had in mind when prescribing the drug “before meals”.

"While eating": everything is clear here. Just again, check what to do and how much to eat with the pill, especially if you are organized according to the “Monday-Wednesday-Friday” principle.

"After meal" Significantly fewer medications are taken. As a rule, these include drugs that irritate the gastric mucosa or help normalize digestion. "Food" in this case often does not mean a three-course change, especially if the drug needs to be taken 4-5-6 times a day. A limited amount of food will suffice.

Rule 4. Not all tablets can be taken together

Most tablets should be taken separately, unless taking a “bulk lot” is specifically approved by your doctor. This is not very convenient, but it is impossible to conduct research on the interaction of all drugs in the world, and swallowing tablets by the handful can easily result in an unpredictable effect already at the initial stage. Unless otherwise stated, between doses various drugs at least 30 minutes should pass.

Now about compatibility. Patients often like to bring their own creativity to treatment. For example, “I’m taking the medicine prescribed by the doctor, and since it’s probably harmful, it’s a good idea to take some vitamins or something else at the same time.” And the fact that vitamins can neutralize the medicine or lead to unpredictable consequences while taking the main drug is not taken into account.

Hepatorotectors, vitamins, combined agents for colds and herbs, recommended by your beloved grandmother, can be taken during treatment only after consulting with your doctor. If you are being treated by several specialists for different reasons, they should know about each other’s prescriptions.

Rule 5. Not all tablets have fractional dosages

There are different tablets, and not all of them can be broken to divide into several doses. Moreover, some tablets are coated, damaging which can affect the properties of the medicine. Therefore, the absence of a “dividing strip” should be alarming - most often such a tablet cannot be divided. And dosages of one-fourth or even one-eighth of a tablet also raise questions - it is almost impossible to measure correctly in such cases. If such a prescription was made by a doctor, you can ask him what the consequences are. Well, let’s not even talk about self-medication again.

Rule 6. Medicines, with rare exceptions, are taken only with water.

Not tea-coffee, not juice, not, God forbid, sweet soda, but personalized water - the most ordinary and non-carbonated one. There are even separate studies devoted to this issue.

True, there is certain groups drugs that are washed down with sour drinks, milk, alkaline mineral water and other separately specified drinks. But these are exceptions, and they will definitely be mentioned when prescribing and in the instructions.

Rule 7. Chewable tablets are chewed, dragees are not crushed.

Direct prohibitions, as well as instructions on special ways usage, appear for a reason. A chewable or suckable tablet that you swallow whole will take a different time to work or may not work at all.

The release form of the drug is also not chosen by chance. If the tablet has a special coating, it should not be crushed, broken or bitten. Because this coating protects something from something: the active substance of the tablet from stomach acids, the stomach from the active substance, the esophagus or tooth enamel from damage, etc. The capsule form also says that the active substance should be absorbed only in the intestines and for a certain time. Therefore, capsules can only be opened as prescribed by a doctor, with an eye to the instructions.

Rule 8. There are special cases, but they must be assessed by a doctor

U different doctors We have our own treatment regimens that have been tested for years, and sometimes the dosage and method of taking the drugs may differ for different groups patients. In the same way, if there are characteristics of the patient (comorbidities, individual reactions, etc.), the prescription can be adjusted specifically for this case. At the same time, the choice of a drug and the method of its use are influenced by factors that are not always obvious to a person without medical education factors. Therefore, if your grandfather with hypertension took the same medications according to a different regimen prescribed by the best doctor in the world, this is not a reason to take them the same way. You need to take pills, like any other medicines, without doing anything on your own, and absolutely any innovations that have not been agreed upon with your doctor are unnecessary.

What should I take with my medications?

Grapefruit juice does not mix well with medications. Back in 2000, scientists proved that it should not be used simultaneously with heart medications. The fact is that grapefruit juice contains a substance that can interact with certain medications, increasing the rate of their absorption in the patient’s gastrointestinal tract.

This feature citrus drink It is especially dangerous for older people, who more often take heart pills and often drink calcium-fortified grapefruit juice. Excessive action of cardiac drugs can be fatal dangerous complications. In general, the interaction of grapefruit juice with medications intended for oral administration is unpredictable.

Name list

On the initiative of scientists, it was published in some American journals full list drugs that, in combination with grapefruit juice, can behave unpredictably. For example, women taking birth control pills and those who drink grapefruit juice may one day discover that they are a little pregnant, and those who take it - that they are not a little depressed. The range of “miracles” depends on the drug itself.

But the greatest danger is the combination of harmful juice and lipid-lowering drugs. While the liver is “busy” disassembling grapefruit ingredients into spare parts, drugs circulate throughout the body, their concentration in the blood increases, reaching dangerous level when all side effects appear at once. The main problems - as in the described case - are muscle damage and acute renal failure.

So, you will have to forget about grapefruit juice (especially freshly squeezed) if you take one of the following drugs(it should be noted that many of them are very popular in Russia):

Anxiolytics: alprazolam, buspirone, midazolam, triazolam
Antiarrhythmic: amiodarone, quinidine
: clarithromycin, erythromycin, troleandomycin
Antihistamines: fexofenadine
Anticoagulants: warfarin
Antiepileptic: carbamazepine
Beta blockers: carvedilol
Calcium channel blockers: diltiazem, felodipine, nicardipine, nifedipine, nimodipine, nisoldipine, verapamil
Hormonal preparations containing: , estradiol, methylprednisolone, progesterone, testosterone
Immunosuppressants: cyclosporine, sirolimus, tacrolimus
HMG-CoA reductase inhibitors (hypolipidemic): atorvastatin, fluvastatin, lovastatin, simvastatin
Serotonin reuptake inhibitors (antidepressants): sertraline, fluvoxamine
Xanthines: theophylline
Treatment benign hyperplasia prostate gland: finasteride
Opioid analgesics: alfentanil, fentanyl, sufentanil
Antiviral: amprenavir, indinavir, nelfinavir, ritonavir, saquinavir
Anthelmintic: albendazole
Antifungal: itraconazole
Antitussives: dextromethorphan
Antitumor: cyclophosphamide, etoposide, ifosamide, tamoxifen, vinblastine, vincristine
Reporters: sildenafil, tadalafil

It should be especially emphasized that listed active ingredients, and trade names of drugs can be very diverse. The name of the active substance is written on the packaging and indicated in the instructions for the drug.

Tea, coffee, Borjom

After reading this list, which included five dozen active ingredients (which is several hundred trade names), a logical question arises: what then can and should be taken with medications, if everything is so serious? What about mineral water, other juices, tea, coffee, milk?

There are a number of medications that should be taken not with water, but with a specific liquid - to achieve the desired effect.

For example, it is better to take erythromycin with any alkaline mineral water (Essentuki No. 4, No. 17) or milk. Alkaline mineral water will also be required if you are taking aspirin. It is also recommended to drink sulfonamides (biseptol, sulfalene, sulfodimethoxine). Mineral water also enhances the absorption of analgin, tetracycline, and sedatives.

Indomethacin or reserpine, due to chemical features active principle, it is recommended to drink it with milk. The same applies to fat-soluble vitamins(D, E, K, A) and iodine preparations.

But the same milk reduces the effectiveness of drugs similar in structure to proteins - cardiac glycosides, caffeine, antiulcer drugs (cimetidine, ranitidine). You should not drink it with it (pancreatin, mezim). Milk inactivates tetracycline preparations, since the calcium contained in milk forms an insoluble compound with the components of the drug. Sometimes in the annotation to the drug you can find a direct mention of the inadmissibility of drinking milk. For example, the manufacturer of Hilak Forte indicates: “take with a small amount liquids (excluding milk).”

Fruit juices, especially sour ones, negate the effect of taking, for example, antacids, reducing the acidity of gastric juice. You should not drink juice or compote with cardiac glycosides (digoxin, etc.) and sulfonamides (streptocide, sulfalene, etc.), which are alkaline in their chemical nature (and juices contain fruit acids). It is known that sour fruit and vegetable juices negatively affect the effectiveness of antibiotics such as erythromycin, sumamed, ampicillin, and, conversely, significantly increase activity (up to toxic effect) aspirin, nitrofurans (furagin, furazolidone), paracetamol, ibuprofen.

Avoid taking the tablets with tea. The tannin contained in it can form insoluble compounds and simply cause some drugs to precipitate (papaverine, codeine, aminophylline, cardiac glycosides, etc.)

Coffee is also not suitable, for example, when taking sedatives. This applies to many other drugs as well.

Sometimes, to reduce the irritating effect of the medicine, it is advisable to drink it with jelly. You just need to remember that the mucous decoction slows down the absorption of the drug.

You cannot drink antibiotics with Cola or Baikal, otherwise insoluble iron-containing complexes may form in the lumen of the gastrointestinal tract, which reduces the effectiveness of antibacterial therapy.

The only one universal remedy for washing down the tablets there was and still is water (but not with ice, but at room temperature). Usually a quarter glass is enough, but special cases(salicylates) larger amounts may be required.

Vodka, herring, tablet

Another, important, particularly for Russia, question arises - what about alcohol? Vodka, cognac, wine, beer - how do they combine with various medicines? The short answer is that alcohol and drugs do not mix. That is, if you are prescribed any treatment and have to take pills, you will have to forget about alcohol for this time.

Some medications, when combined with alcohol, turn into an explosive mixture that can incapacitate or even kill a person for a long time. Remember the domestic film “Criminal Talent”. The heroine of Alexandra Zakharova plied men in a restaurant with alcohol in which clonidine was dissolved, and then cleaned them out. The method was at one time very common among prostitutes who wanted to get money from a client without providing the agreed amount.

Metronidazole in combination with alcohol can also make you sad for a long time, as it causes an effect similar to the effect of anti-alcohol drugs (Teturam, Antabuse, Esperal), up to coma.

Antibiotics, antidepressants and many other drugs are also very unfriendly to alcohol. pharmacological groups. There is only one choice: either drink or get treatment.

Finally, read the instructions

How do you remember what to drink with what? In fact, don’t make huge tables for yourself that can only be mounted on the wall - there are so many various combinations possible even when taking one drug. And if you have to take several medications, then you’re not far from panic.

In fact, everything is much simpler. First of all, pester your doctor with questions about your medication regimen. Secondly, take out the instructions for the purchased medicine from the trash can and study it carefully. Still we're talking about about your health and here no information can be superfluous.

If the instructions do not specifically indicate what exactly should be taken with this or that medication, take it with boiled water at room temperature (about +20 o C). Refrain from drinking alcohol and, just in case, put away grapefruit juice until better times. You never know.

Unfortunately, I am currently undergoing a lot of treatment. A number of medications are prescribed to be taken half an hour before meals, and a number of others - 10 minutes after. Please explain the mechanism of action IN CONNECTION with food intake and how important it is to adhere to the “temporary” instructions? For example, can I sit down at the table not half an hour after taking the medicine, but 10-15 minutes later?

The fact is that some drugs should be taken on an empty stomach, because... their absorption directly depends on this. That is, if you take a drug that is so addictive while eating, its bioavailability (the amount of the drug that enters the bloodstream after absorption from the gastrointestinal tract) will sharply decrease. Therefore, such drugs are prescribed 30-40 minutes before meals.

If it is not possible to take them within such a time interval, then you can take it 1 hour after eating. Thus, the rule: DRUGS THAT ARE PRESCRIBED BEFORE MEALS SHOULD BE TAKEN EITHER 30-40 MINUTES BEFORE OR 1 HOUR AFTER A MEAL. Taking it earlier or during meals is a waste of the drug.

It will not reach the proper therapeutic concentration in the blood. Now there is a group of drugs that can (and some even should) be taken with food. These are either drugs that are aggressive towards the coolant (gastric mucosa) - they have an ulcerogenic (ulcer-forming) effect.

Such drugs include the well-known aspirin. In addition, there are drugs that can be prescribed with a “buffer” - a neutralizer. This is a calcium chloride solution. It is recommended to take this drug with milk - it has irritating effect on coolant. During meals, you can take drugs whose bioavailability does not depend on food intake (it’s just more convenient to take the medicine during meals, without adjusting for “before” and “after”).

Here's an example. There are 2 antihypertensive drugs from the group of ACE inhibitors. One is kaproten, the other is ednit. So, capoten should be taken only on an empty stomach (30-40 minutes before or 1 hour after a meal), and ednit can be taken both during meals and on an empty stomach.