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Define "empty stomach"


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#1 Fat Guy

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Posted 21 March 2011 - 08:57 PM

I have some medication here and it says not to take it on an empty stomach. What does that mean. I'm pretty sure my stomach hasn't really been empty since 1969. But seriously, let's say I eat a yogurt. For how long after that is my stomach considered not empty?
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#2 Pierogi

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Posted 21 March 2011 - 09:19 PM

LOL, I think I'm in the same boat about the concept of "empty stomach".

That said, I have some meds that I take in the morning with the same warning. Thinking, as you do, that I still have food left in my gut from dinner (which I eat late) and midnight snack, I, for many years, didn't eat anything with/before/or after them.

Then my tummy started to rebel, and I felt generally crappy. I found a little "something" helped immensely, especially if it were something dairy or starchy. For some reason, yogurt doesn't sit well with me in the morning, so I got into the habit of making scones/muffins/biscuits for a morning pill cushion. Now that I'm not working, a couple of spoonfuls of cottage cheese, or hummous, or a bite or two of leftover dinner does the trick.

It doesn't have to be a full-on "trucker's breakfast" of eggs, pancakes, meat, etc. but something in the tummy makes for a happier tummy and a happier day. A serving of yogurt should do it, or one of your smoothies. Or a bagel or such. Something to "coat" the insides (to phrase it as delicately as I can), and cushion the meds, and to absorb the nasties of the meds.
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#3 Honkman

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Posted 22 March 2011 - 01:06 AM

It usually means to take the dose at least one hour before or two to three hours after eating. This will help to have a relative consistent oral exposure of the drug. If you would take your drug with your food most likely the oral exposure of your drug will be lower and therefore the drug much less efficacious

Edited by Honkman, 22 March 2011 - 01:06 AM.


#4 sparrowgrass

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Posted 22 March 2011 - 05:44 AM

My meds say one hour before or 2 hours after eating.
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#5 Darienne

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Posted 22 March 2011 - 03:42 PM

I have similar meds to take at 6 am and boy do I ever not want to eat ANYTHING. A cup of coffee please. But then I now have GERD and can't afford to disregard the warning.

My pharmacist said a minimum of 150 calories should be taken.

So I have tried a variety of this and that and settled on 1/2 Morning Glory Muffin and it seems to be working out. (Using the original recipe even.)
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#6 pastrygirl

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Posted 22 March 2011 - 03:48 PM

My meds say one hour before or 2 hours after eating.


I too take meds with these guidelines for an empty stomach. So if Fat Guy needs to take his NOT on an empty stomach, would that be within 2 hours of a meal? An hour after a smaller snack? Or just take with some sort of food?

#7 weinoo

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Posted 22 March 2011 - 03:51 PM

I would think even Fat Guy would have an empty stomach upon awakening. Or two hours after a meal.
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#8 CDRFloppingham

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Posted 22 March 2011 - 04:17 PM

Interesting responses.

I am probably the most expert in pharmaceuticals (from what I can gather) among the eGullet posters.

I agree that "empty stomach" reasonably means 1 hour prior to eating or 2 hours post prandial.

Honkman is wrong. Food effect can either increase the overall absorption (AUC) or speed of absorption (tmax) or decrease those indices; it depends on the formulation.

Whether this makes an appreciable difference depends on what the drug and indication are.

Edited by CDRFloppingham, 22 March 2011 - 04:18 PM.


#9 janeer

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Posted 22 March 2011 - 05:32 PM

Actually, in this case I think it means with or after food--it's a precaution against nausea/upset stomach from ingesting the pills when the stomach is empty. One hour before, your stomach would be empty.

#10 SaltySnack

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Posted 22 March 2011 - 07:07 PM

I take medicine on an empty stomach every morning. The medicine hits my system in roughly half an hour. I feel a distinct reaction when the medicine kicks in. I can tell whether I've eaten too much the night before when I don't feel the medicine kick in or rather it takes longer for me to feel it. It's definitely very interesting. I typically make sure I feel the medicine kick in and then wait a little bit before eating.

#11 Fat Guy

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Posted 22 March 2011 - 07:21 PM

I'm thinking specifically about ibuprofen. You're not supposed to take it on an empty stomach. So let's say I need to take it at midnight. Do I need to eat something at 11:59pm or am I covered by what I had for dinner a few hours earlier?
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#12 gfweb

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Posted 22 March 2011 - 07:25 PM

Interesting responses.

I am probably the most expert in pharmaceuticals (from what I can gather) among the eGullet posters.

I agree that "empty stomach" reasonably means 1 hour prior to eating or 2 hours post prandial.

Honkman is wrong. Food effect can either increase the overall absorption (AUC) or speed of absorption (tmax) or decrease those indices; it depends on the formulation.

Whether this makes an appreciable difference depends on what the drug and indication are.



Exactly right. There are all sorts of food/drug interactions. Some drugs need fat for absorption (isotretinoin), others need some acid in the stomach (triazoles), others are retarded by ions like Ca, K, Mg, Fe (cipro or tetracycline). Still others need an empty stomach. Some are affected by food that you ate days ago eg Vit K and coumadin, or grapefruit juice and cyclosporine. One rule doesn't fit all drugs. The best rule is to ask your doc.

To make it even more complex pharmacy computers put many warnings on drugs that aren't important. Best to ask the doc when you get t he Rx.

#13 gfweb

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Posted 22 March 2011 - 07:28 PM

I'm thinking specifically about ibuprofen. You're not supposed to take it on an empty stomach. So let's say I need to take it at midnight. Do I need to eat something at 11:59pm or am I covered by what I had for dinner a few hours earlier?


Ibuprofen will irritate the heck out of an empty stomach. Dinner at 7 won't help a pill at midnight.

In any event, I wouldn't take ibuprofen before bed. Its asking for an irritated esophagus. Why not take a longer acting drug earlier instead, like naproxen (alleve)?

#14 Fat Guy

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Posted 22 March 2011 - 07:33 PM

Advil at 6-hour intervals works better for me than Aleve, Voltaren, Mobic or Celebrex. I've experimented extensively. The issue with ibuprofen is that no matter how you schedule it you wind up with one dose falling late at night. I've taken to eating a yogurt just before using the drug, but have wondered if that's really necessary, or if I can eat it an hour before, or two hours, etc.
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#15 gfweb

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Posted 22 March 2011 - 07:38 PM

Its hard to know what necessary is. You might be fine with an empty stomach 9 times out of ten. Many who take these meds long term go on an antacid to prevent irritation, but who wants to take another pill...

I'd be sure not to lie flat for half hour or so after taking the pill and to take it with at least good volume of fluid.

#16 Honkman

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Posted 23 March 2011 - 12:29 AM

Interesting responses.

I am probably the most expert in pharmaceuticals (from what I can gather) among the eGullet posters.

I agree that "empty stomach" reasonably means 1 hour prior to eating or 2 hours post prandial.

Honkman is wrong. Food effect can either increase the overall absorption (AUC) or speed of absorption (tmax) or decrease those indices; it depends on the formulation.

Whether this makes an appreciable difference depends on what the drug and indication are.


Agreed that my response was perhaps too much of an generalization but based on my work experience a large majority of small molecules drugs tend to have lower absorption when taken with "full" stomach. But as you mentioned there are drugs with increased AUC. As I mentioned before one other key reason why you often prefer human taking drugs on empty stomach (and we using fastened animals) is the more consistent behavior of the drug exposure.

#17 Darienne

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Posted 23 March 2011 - 05:15 AM

The best rule is to ask your doc.

To make it even more complex pharmacy computers put many warnings on drugs that aren't important. Best to ask the doc when you get t he Rx.

I would take great exception to what gfweb says here: "ask the doc". Would that it were true. In the best of all possible worlds it might be. Maybe he/she has better doctors than we do here.

Ask your pharmacist would be my advice. My pharmacist has on more than one occasion saved me from the terrible mistakes that my family doctor has prescribed for me, while knowing what else is wrong with me and what meds I am already on. Doctors seem to know very little about the myriads of drugs available now. How on earth could they?

My neurologist even knew nothing...NOTHING...about testing for Tegretol levels once a year. Really inspires confidence, alright.

No, ask your doctor if you like...then ask your pharmacist.
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#18 gfweb

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Posted 23 March 2011 - 05:30 AM

You need competent doctors. Docs should know everything important about a drug they prescribe.

#19 Darienne

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Posted 23 March 2011 - 05:35 AM

You need competent doctors. Docs should know everything important about a drug they prescribe.

Sorry. That would be nice.

I live in Ontario and am thankful that I even have a doctor. We don't get to 'change' doctors here.

Actually, the drug snafus that I have been saved from would curl your hair, and I suspect a lot of Ontarians (I can't speak for the rest of Canada) might well have similar stories. The pharmacist is my best friend here.
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#20 Special K

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Posted 23 March 2011 - 08:07 AM

After taking way too much Ibuprofin for years, and noticing that it's become less and less effective - not to mention bad for my hypertension - I've just switched (with my doctor's blessing) to turmeric, 1,000 mg twice daily. I've only taken two pills so far, so it hasn't had a chance to kick in yet. If it does, I'll let you know.

Fat Guy, I'd keep taking the 12 p.m. Advil with the yogurt (I would think that just a few spoonsful (spoonfuls?) within an hour of taking the pill would be enough - "a light snack" is what I've read), and I'd also elevate the head of the bed. You don't need an ulcer or esophageal problems on top of your other aches and pains!

K

p.s. My prescription Ibuprofin had a cute little picture of a submarine sandwich and a note to "take with food." Woo hoo! A guilt-free sub! :biggrin: