Written by Kristianne Hannemann, PharmD | Reviewed by Austin Ulrich, PharmD, BCACP
Key takeaways:
Some medications work better when taken on an empty stomach. Common examples include thyroid medications, bisphosphonates, and sucralfate (Carafate).
The general rule of thumb is to take your medication either 1 hour before or 2 hours after a meal. But how long you should wait before eating or drinking can differ depending on the medication.
Check with your pharmacist or prescriber if you should take any of your medications on an empty stomach. Make sure you understand what to separate from your medications, and for how long.
Access savings to related medicatios.
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If you’ve ever been told to take medication on an empty stomach, you might still have a few questions about how to do so. For instance, can you still enjoy your morning cup of coffee after taking your pill? And how long do you need to wait after you’ve taken your medication before eating?
Well, a lot of research has gone into finding out how foods and drinks affect medications. And, depending on the medication, the answers to your questions might vary.
Why should certain medications be taken on an empty stomach?
Generally, there are a few reasons why some medications need to be taken on an empty stomach. These include:
Slowed absorption: Food can delay the time it takes for certain medications to be absorbed by your body. This can cause the medication to take longer to work.
Lower absorption: Some foods, drinks, and supplements can lower the amount of medication that gets into your body. This usually happens when these foods or drinks attach to the medication in your stomach.
Faster or slower breakdown: Some juices, like grapefruit juice, can cause certain medications to get broken down faster in your body. If this happens, your medication might not work as well. Juices can also sometimes cause medications to get broken down more slowly. This can lead to a buildup in your body and cause more side effects.
What does it mean to take a medication on an empty stomach?
Taking medicine on an empty stomach typically means you do so either 1 hour before or 2 hours after meals. Although this is a good general rule to follow, some medications have more specific instructions. So, it’s important to understand what this means for your medication. And keep in mind that some medications should be taken with food, so it’s helpful to know the difference.
You might be wondering, how long does it take for your stomach to empty? After a meal, it normally takes around 1 hour and 30 minutes to 2 hours for your stomach to empty. But, the type of meal you eat plays a role in how fast it moves through your stomach. For example, a high-fat meal can slow down the time it takes for your stomach to empty. Certain health conditions and medications can also slow down stomach emptying. And other medications can speed it up.
What about coffee, juice, or other products? The answer will differ depending on the product. But try not to mix any foods, drinks, or other medications without speaking with a healthcare professional first. This is because even your morning coffee could affect the way some medications get absorbed into your body.
Next, we’ll discuss a few common examples.
Do not crush. If you have difficulty swallowing pills, you may be tempted to crush, split, or chew the tablet to make it easier to take. Here’s a list of medications that should always be swallowed whole.
Always take with food. While you should take some medications on an empty stomach, others should always be taken with food. Learn more about medications you should take with a meal or snack and why.
Avoid dairy with these medications. Dairy products can interfere with how your body absorbs certain medications. Pharmacists cover which medications can interact with dairy products, and how you can avoid potential issues.
Thyroid medications
If you have hypothyroidism, you may be taking a thyroid medication like levothyroxine (Synthroid, Levoxyl, Tirosint). If so, you’ve probably been instructed to take it first thing in the morning on an empty stomach. That’s because certain foods and drinks can change the way it works in your body.
For example, walnuts, high-fiber foods, and soybean flour may affect levothyroxine absorption. And common breakfast drinks, like grapefruit juice, coffee, and milk, have been shown to do the same.
Levothyroxine should be taken 30 to 60 minutes before breakfast. This includes your morning coffee. Take it at least 4 hours before or after other medications, unless you’ve checked with your prescriber first.
Interactions with other thyroid medications, like Armour Thyroid and NP Thyroid, haven’t been researched. That’s because these medications were grandfathered instead of going through the FDA approval process. They contain similar ingredients to levothyroxine, so it’s still typically recommended to take them on an empty stomach.
Bisphosphonates
Alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel) are a few examples of bisphosphonates. They’re a group of medications that help prevent bone breakdown and are used to treat osteoporosis.
Some foods, antacids, and supplements can attach to bisphosphonates in your stomach. This interferes with absorption, which is why an empty stomach is best when taking them. You may need to avoid taking these medications with juice, too. One study showed orange juice lowered alendronate absorption by about 60% compared to water.
For alendronate and risedronate, it’s recommended to take your dose at least 30 minutes before your first food, drink, or medication of the day. It’s recommended to wait at least an hour with ibandronate.
Drink a full glass (6 oz to 8 oz) of plain water with your pill. This helps the tablet move down to your stomach faster. By doing so, you can prevent damage to your esophagus (the tube that moves food from your mouth and into your stomach).
Sucralfate
Sucralfate (Carafate) is an oral medication that’s used to treat intestinal ulcers. It works by forming a protective coating over the ulcer.
Sucralfate must be taken on an empty stomach. This means at least 1 hour before or 2 hours after a meal. There aren’t specific foods to avoid while taking sucralfate, just that you should avoid food in general during this window. But when you do eat, it may help to minimize spicy and high-fat foods that may irritate ulcers.
What if you take sucralfate with food? If it’s taken with food, the medication may not coat the ulcer properly. This means your ulcer could take longer to heal.
If you’re also taking an antacid, don’t take it within 30 minutes before or after taking sucralfate. Otherwise, it could lower the ability of sucralfate to attach to your ulcer.
Sildenafil (Viagra)
Sildenafil (Viagra) is a medication commonly used to treat erectile dysfunction (ED). And while it can be taken with or without food, taking it after a high-fat meal (think cheeseburger and fries) can make it take longer to work.
Your best bet for sildenafil to work as fast as possible is to take it on an empty stomach. But, if you need to take it with food, make sure to choose low-fat options.
Rybelsus
Rybelsus (semaglutide) is an oral medication for treating Type 2 diabetes. This medication is best taken first thing in the morning on an empty stomach.
Food can significantly lower Rybelsus absorption. This is also the case if you drink too much water with it. That’s why it’s recommended to wait at least 30 minutes before eating or drinking after taking Rybelsus. And while you can take your dose with water, limit the amount to 4 oz (120 mL) or less.
Rybelsus can also interact with other oral medications. So it’s recommended to take them at least 30 minutes after your Rybelsus dose. But these instructions may differ depending on which medications you take.
Captopril
Captopril is a medication used to treat high blood pressure and heart failure. It’s also used to treat kidney problems in people with Type 1 diabetes.
Taking captopril with food can lower its absorption and cause it to be less effective than taking it on an empty stomach. Ideally, you should take captopril 2 hours after meals to make sure you’re getting the most from your medication. You can also take it 1 hour before meals.
Bethanechol
Bethanechol is a medication used to treat urinary retention. It should be taken on an empty stomach to avoid nausea and vomiting. Specifically, you should take it 1 hour before or 2 hours after meals.
You might find this hard to do since bethanechol is typically taken 3 or 4 times a day. It might be helpful to set an alarm and plan to take it around your meal schedule.
Ampicillin
Some antibiotics can be taken with or without food. But ampicillin is one that must be taken on an empty stomach.
Research shows that when it’s taken with food, the absorption of ampicillin is delayed and less of it gets into your body. This can make it less effective at treating your infection. It’s recommended to take ampicillin 30 minutes before or 2 hours after meals.
Zafirlukast
Another medication that can be affected by food in your stomach is zafirlukast (Accolate). Zafirlukast is taken by mouth twice daily to prevent and treat asthma symptoms in adults and children ages 5 and older.
During clinical studies, researchers found that food lowered the amount of zafirlukast absorbed into the body by 40%. Take this medication on an empty stomach, at least 1 hour before or 2 hours after meals.
Proton pump inhibitors
Proton pump inhibitors (PPIs) are medications commonly used to treat gastroesophageal reflux disease (GERD). They work by blocking the final step of acid secretion in your stomach.
Food triggers your stomach to produce acid. So, you’ll want your PPI to block acid secretion before acid gets triggered. That’s why it’s typically recommended to take PPIs before meals. The one exception is pantoprazole (Protonix) tablets, which work just as well whether you take the medication with food or on an empty stomach.
Some PPIs don’t have specific recommendations for timing. But the general rule of thumb is 30 to 60 minutes before a meal. However, esomeprazole (Nexium) should be taken at least 1 hour before meals.
Isoniazid
Isoniazid is an antibiotic that’s used for preventing and treating tuberculosis (TB). It should be taken on an empty stomach because studies have shown it’s not absorbed as well when it’s taken with food.
Many times, isoniazid is taken along with other antibiotics. If it’s easier for you, you can take isoniazid at the same time as your other medications. But it’s best to check with a healthcare professional about possible interactions with your specific medications.
The bottom line
Many foods and drinks can cause certain medications to be less effective. In this case, you may need to take them on an empty stomach. What this means can depend on your particular medication.
It’s important to know if any of your medications should be taken on an empty stomach. If you aren’t sure about timing or specific interactions, ask a healthcare professional to give you more details.
References
Accord Healthcare Inc. (2022). Levothyroxine sodium tablet [package insert].
Amneal Pharmaceuticals. (2023). Bethanechol [package insert].
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