My two-cents Rx
BENJ S. BANGAHAN, M.D., FPCP, FPCCP
The laymen sufferers of symptoms, who have found comfort, convenience and ease in the google service provided in the internet in as far as self-treating their complaints, as touched in last week’s topic, have now a common issue that has kept most of them wondering as to when is the best time to take oral medications —
before, or after, meals? As can be expected, like any other day-to-day confusion, it is solved by the supposed to be easiest and the most readily available talent, the common sense, because of which, in the area of clinical problems, so many missed hits would result.
Anything done or propounded in medicine, may it be a simple move that apparently looks trivial, or a complicated one that sounds or appears befuddling, has a clinical reason relevant to the patient. These are usually carried out by the attending doctors when they find them applicable to their patients. Talking about them here we have to stay fundamental in order for us to get across easily. The basic criteria that necessitate some rules of thumb are, absorption of the drug in the stomach, the physical effects of the food particles upon the drugs taken and the metabolic and chemical interactions of the drug with food particles.
Good absorption of drugs are often correlated with empty stomach, though not always, and empty stomach refers to those periods about one or so hours before eating and two hours post food intake. Good absorption of course guarantees that the drugs administered are absorbed almost totally and subsequently metabolized, for the simple reason that there is nothing to stand on the way to serve as physical barriers for the newly swallowed medicines. Most of the drugs that are classifiable in this group are the gentle ones – that is, stomach-friendly, since they do not have the potentials for damaging the stomach — and even include almost all the antibiotics.
On the other hand, newly taken in food particles still have their physical property to serve as hindrance to the rapid absorption of a newly taken medication, thereby serving as a barrier to the contact of the drug with the stomach per se , offsetting side effects. When such drug happens to be one that is potentially stomach damaging, such hindrance rendered by the food particles obviate the possible
secondary problems that can possibly be created, like gastritis, gastric ulceration or subsequent stomach bleeding, conditions that can bother the patient with pain, anxiety, and of course monetary expenses. While the rate of the absorption is staggered, the absorption still goes on and gets completed, but of course longer, hence no problem of the effect not being rendered. Most of the drugs that belong in this group are the pain relievers, non-steroidal anti-inflammatory drugs and the steroids.
There are other peculiar metabolic changes that occur with the presence of food in the stomach, which are all part of the physiologic changes naturally designed. Blood flow to the gastrointestinal areas is increased together with the release of bile, while acidity of the stomach is increased (pH becomes lower) and the movement of the gastrointestinal area is also enhanced. All together these are meant to render physiological care upon the food items that have been brought to the stomach.These changes are for the purpose of enhancing the absorption of the food taken, the ultimate purpose of which being to supply the needs of the organs. At such time, the absorption of drugs given timely with the physiologic phases is also enhanced.