Which medications should be taken with food?

Medications That Should Be Taken With Food

Several medications should be taken with food to minimize gastrointestinal side effects, enhance absorption, or reduce the risk of hypoglycemia, including metformin, α-glucosidase inhibitors, insulin secretagogues, and certain antituberculosis drugs. 1

Diabetes Medications

Medications That Should Be Taken With Food:

• Metformin (Biguanide)

  • Take with food or 15 minutes after a meal to minimize gastrointestinal side effects 1
  • Gradually titrate dose to minimize GI side effects when starting treatment
  • If side effects persist beyond a few weeks, follow up with healthcare provider

• α-Glucosidase Inhibitors

  • Take at the start of meals for maximal effect 1
  • Gradually titrate to minimize gastrointestinal side effects
  • If hypoglycemia occurs, use glucose tablets (monosaccharides) rather than complex carbohydrates, as these drugs prevent digestion of polysaccharides

• Insulin Secretagogues (Sulfonylureas)

  • Take with meals containing carbohydrates to reduce hypoglycemia risk 1
  • Maintain moderate amounts of carbohydrates at each meal and snack
  • Do not skip meals when taking these medications

Medications That Can Be Taken Without Food:

• GLP-1 Receptor Agonists
  • Daily or twice-daily GLP-1s should be given premeal 1
  • Once-weekly GLP-1s can be taken at any time regardless of meals

Antimalarial Medications

• Artemether/Lumefantrine

  • Must be taken with a fatty meal or drink for proper absorption 1
  • Has rapid onset of action but complex dosing regimen

• Atovaquone-Proguanil

  • Must be taken with a fatty meal or drink for optimal absorption 1
  • Relatively slow-acting regimen

• Dihydroartemisinin-Piperaquine

  • Must be taken in fasting condition (opposite of the above) 1
  • Has rapid onset of action

Antituberculosis Medications

• First-line antituberculosis drugs can be taken with food if gastrointestinal upset occurs
  • Although food delays or moderately decreases absorption, the clinical significance is minimal 1
  • If patients experience epigastric distress or nausea, dosing with meals is recommended
  • Taking medications with food is preferable to splitting doses or changing to second-line drugs

Other Medications

• Fluconazole (Azole antifungal)

  • Can be taken with or without food 1

• Ketoconazole (Azole antifungal)

  • Should be taken with food to minimize GI symptoms 1
  • Requires gastric acidity for proper absorption

• Gabapentin

  • Can be taken with or without food 2
  • If taking an antacid containing aluminum and magnesium, wait at least 2 hours before taking gabapentin

• Meloxicam (NSAID)

  • Should be taken in a single oral dose, can be taken with or without food 3
  • Taking with food may help reduce GI side effects, though not specifically required in prescribing information

Special Considerations

Alcohol Consumption

• For individuals using insulin or insulin secretagogues, alcohol should be consumed with food to reduce the risk of hypoglycemia 1

Common Pitfalls to Avoid

1. Not adjusting timing with antacids: Some medications (like gabapentin) require spacing from antacids
2. Ignoring food requirements for antimalarials: Effectiveness of artemether/lumefantrine and atovaquone-proguanil depends on taking with fatty meals
3. Taking dihydroartemisinin-piperaquine with food: Unlike other antimalarials, this must be taken while fasting
4. Skipping meals when on insulin secretagogues: Can lead to dangerous hypoglycemia
5. Discontinuing first-line TB drugs due to minor side effects: Taking with food is preferable to changing medications

Practical Recommendations

• For medications requiring food, a substantial meal is generally better than a light snack
• For medications causing GI upset, taking with food is often helpful even when not specifically required
• When multiple medications have different food requirements, work with a healthcare provider to develop an optimal schedule
• For diabetes medications, coordinate food intake with medication timing to prevent hypoglycemia

Remember that these recommendations are general guidelines, and specific patient factors may necessitate adjustments to optimize treatment outcomes and minimize adverse effects.