Decoding Drug Labels

Mary Poppins wasn’t perfect. A spoonful of sugar may not make the medicine go down.

By Judy Colbert

Your prescription is filled; you’ve talked with your doctor and the pharmacist. It’s only after you get home that you find several warning labels on the prescription bottle: “Take with plenty of water.” “Take in the morning on an empty stomach.” “Do not store in the bathroom.”

How dire are the warnings? What happens if you don’t take it with 8 ounces of water or if you take it with coffee or soda or juice? Why do you need to take the medicine in the morning? Why shouldn’t you store the medicine in the bathroom? What would happen if you took the medicine with food instead of on an empty stomach? Rest assured that the warnings are there for a reason. Take note of these helpful tips to ensure that you’re not taking an unknown risk along with your next handful of pills.

A glassful of water helps the medicine go down.

Ann Smith, PharmD, and national practice leader of MedCo Women’s Therapeutic Resource Center, says you need to take medicine with a glass of water to make sure it’s diluted sufficiently enough to be an accurate dose as it goes through your bloodstream. “It’s important that the drug make it to your stomach,” says Dr. Smith, “and doesn’t stick to your esophageal wall.” This is especially important as it relates to osteoporosis medications, which are often accompanied by instructions directing you to stand or sit for 30 to 60 minutes after taking the medicine.

But beware: don’t wash down your pills with whatever’s handy—there can be interactions with various beverages. Certain prescriptions, tetracycline for example, should not be taken with milk, which can bind to the medication. Grapefruit juice can affect how your body breaks down cholesterol-lowering drugs. And alcohol can cause a fatal reaction with some prescriptions.

Food makes a difference.

If you take a pill with food that’s supposed to be taken on an empty stomach, says Rosalie Baez, PharmD, pharmacy services director for Family Physicians Group, the “absorption of medication may be zero to 50 or 60 percent less than when taken on an empty stomach. Generally, this means two hours after eating or an hour before. If you wake up in the middle of the night to go to the bathroom, says Baez, “3 or 4 a.m. is a perfect time” to take a pill so long as it is around the same time each day.

Find your prescriptions a safe home.

Dr. Smith says that the storage requirements attached to many drugs are developed during drug trials. Some drugs might spoil and become useless—or even harmful—if they aren’t refrigerated or kept cool. Storing medication in the bathroom seems logical, but the heat and the humidity may cause the drugs to break down. “Furthermore,” says Dr. Smith, “teens head straight to the bathroom to find drugs to use in experiments or ‘pharm parties,’ where teens take medications indiscriminately” or swap one type of pill for another. Young children also have easy access to drugs stored on the counter. Germs misting from a flushing toilet can reach 6 feet and into medications if the bottles aren’t closed.

Don’t mix and match.

Brian Booth, PhD, deputy director of the Division of Clinical Pharmacology within the Center for Drug Evaluation and Research of the U.S. Food and Drug Administration, says, “Simultaneous use of several drugs or dietary supplements (herbal remedies, vitamins, and traditional therapies) may impact a patient’s treatment for cancer and other diseases.”

Have questions? Go to the source.

“All pharmacists in the United States are required by law to give patient counseling and to review each prescription before it is dispensed,” says Ernest Gates Jr., president of Gates Healthcare Associates. There is no substitute for a face-to-face conversation with a pharmacist, something that doesn’t happen when prescriptions are delivered through the mail.”

W. Steven Pray, PhD, DPh, Bernhardt professor of nonprescription products and devices at the College of Pharmacy at Southwestern Oklahoma State University, stresses the importance of using the same pharmacy for all of your prescriptions. Pray strongly recommends “finding a pharmacist you’re comfortable talking to and discussing your situation, particularly if you have medications prescribed by different doctors that should not be used together.” Otherwise, he says, “You’re just being treated like a number. When you find a pharmacist who offers some personal service and care, stick with that pharmacy.”

Start, and don’t stop.

Not taking medications as prescribed, says Gates, is bad, but not taking them at all is worse. Gates says an estimated 20 percent of all prescriptions are never picked up or used.

And once you start taking prescription medications, says Pray, take the medicine until it is finished. If you’re taking an antibiotic or antibacterial prescription and stop halfway through the course of the medicine because you feel better, “your infection is not going to be dealt with and it could come back stronger and resistant to medicine.”