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Sometimes medicines should be taken on an empty stomach. One example is the antitubercular drug, isoniazid.

Some medicines are so strong they should be taken only on a full stomach or with a snack to minimize stomach irritation. One such example is the anticonvulsant, phenytoin. Each drug has its own requirements for optimum effectiveness.

Generally, but not always, it is a good idea to take a capsule-type drug along with food. The reason for this is that the capsule must dissolve before the drug can be released and absorbed. Food tends to slow down the movement of the capsule through the digestive tract and allows more time for the capsule coating to dissolve and the drug to be absorbed.

Beverages and medications

What is the best beverage to use with medications? The best all-around choice is water.

The exception to this general rule occurs with iron supplements. The best beverage for washing down an iron tablet is orange juice. Other high vitamin C foods such as fruit juice, half a grapefruit, or a tomato are good alternatives.

The reason for this exception is that most people find it hard to get enough iron because iron is usually very poorly absorbed. Researchers have found that a small amount of vitamin C can increase the body's ability to use iron. If vitamin C and iron are in the intestine at the same time, then the body will absorb more of the iron.

Carbonated beverages are rarely a good choice to accompany medications because the carbonation increases stomach acidity. Many drugs are destroyed by too much stomach acid.

Alcohol and drugs

Alcohol is never a good choice for washing down medications. Alcohol is a drug itself and can interact with other medications and make them too potent.

As a drug, alcohol causes the body to lose zinc and magnesium. It reduces the body's ability to use vitamin B-6 and iron. It also decreases the absorption capability of the intestines.

As a food, alcohol changes the way the liver metabolizes enzymes. Alcohol may activate enzymes so that medicines are used up too quickly or are converted to forms that are too potent. These are long-term effects of alcohol and may occur even if no alcohol has been consumed recently.

Alcohol also can dissolve the coatings of time-release tablets and capsules allowing a burst of drug to be released sooner than it should be.

When taken together, alcohol and tranquilizers can combine to cause a sharp fall in blood pressure, as well as breathing failure. This interaction can be fatal.

Nutritional supplements and drugs

Just as foods can interact with medicines, so can vitamin and mineral pills and other nutritional supplements. When taken in large doses certain vitamins can make a drug too powerful and dangerous to the body. Other nutritional supplements can interfere with the intended action of a medication.

Anyone who takes nutritional supplements, especially large doses or highpotency formulations, should remember that nutritional supplements are a type of drug themselves. To protect yourself, avoid self-medication with large doses of vitamins, minerals, or other nutritional supplements.

Special problems for the elderly

Some researchers have found low blood concentrations of several vitamins, including vitamin B-6, vitamin B-12, niacin, thiamin, folate, and ascorbic acid in the elderly.

The individuals who were studied ate fairly good diets and took vitamin supplements. The researchers concluded that the low blood concentrations of vitamins could be explained by the use of medication. The average American 65 or over spends $100 on medication and has over 13 prescriptions refilled each year. Thus, older adults especially need to be aware of possible food and drug interactions.