The type of drink you take your pills with may impact how well your medication works, study finds
Taking your medications with certain drinks may make them less effective and lead to undesirable side effects, a study suggests.
Researchers in Hungary sought to understand how different types of liquids could affect enteric-coated medications, which are tablets or caplets covered in a protective polymer.
This keeps the medication from disintegrating when it reaches harsh stomach acids and releasing its ingredients too early before they can treat the necessary areas.
The team looked at 22 common drinks taken with medications, including tap water, apple juice, diet soda, tea and alcohol.
They also analyzed alkaline water, which has a higher pH than regular tap water. pH measures how acidic a substance is, with lower numbers indicating higher acidity and higher numbers showing lower acidity.
After exposing the drugs to conditions mimicking stomach acid, the team found alkaline water caused the greatest damage to the pills’ protective lining, with the coating dissolving in as little as five minutes.
And after about 30 minutes, 90 percent of the pills’ active ingredients had been released too early, minimizing effectiveness.
More acidic liquids like diet soda and juice caused less damage and apple juice showed almost no premature active ingredient release, indicating that the protective coating had stayed far more stable than with alkaline water.
A new study has found taking pills with certain liquids may make them less effective
The researchers, from Semmelweis University in Hungary, warned that the findings show adults taking medications with liquid need more education on which beverages to choose.
‘In the pharmacy, we regularly see that many patients are unaware of how much it matters what they take their medication with,’ Adrienn Demeter, first study author and PhD student at the Faculty of Pharmaceutical Sciences of Semmelweis University, said.
‘This can also affect whether the treatment works as intended.’
The study, published in the journal Pharmaceutics, analyzed 22 different beverages: Coca-Cola Zero, fruit tea, apple juice, dry white wine, lemon iced tea, Rajec water (spring water), coffee, sparkling water, lactose-free milk, regular milk, filtered water, green and black tea, tap water, almond milk, alkalizing tea and several Hungarian brands of mineral water.
The researchers measured the pH of each drink, as well as the conductivity, which is the drink’s ability to carry an electrical current. Conductivity depends on the substance’s concentration of dissolved ions like salts, minerals, acids and electrolytes.
Standard drinking water usually has a conductivity range between 50 and 1,500 μS/cm (microsiemens per centimeter), while drinks with added potassium or sodium, such as sports drinks, usually have higher levels.
It’s unclear which specific drugs were tested, but the researchers said common enteric-coated medications include proton pump inhibitors (PPIs) – which reduce stomach acid production – and nonsteroidal anti-inflammatory drugs (NSAIDs) – drugs meant to reduce pain and inflammation.
The above chart shows the pH (acidity) of each drink in the bars and conductivity (a solution’s ability to carry an electric current, which shows how concentrated it is) in the dots. Coca-Cola Zero had the lowest pH while Salvus water (an alkaline water sourced from Hungary) had the highest
The tablets were left in the liquids for five-, 15- and 30-minute intervals. After soaking, the pills were transferred to a solution mimicking stomach acid.
The researchers found alkaline waters caused significantly greater damage to the enteric coating than other drinks, leading to the drugs’ ingredients being released prematurely.
The premature release in alkaline water began after five minutes, and after 15-30, up to 90 percent of the ingredients had been released early.
However, tap water and more acidic drinks like diet soda and juice caused minimal effect.
‘The small drug particle does not know whether it is already in the intestine or still sitting in a glass. If the pH of the surrounding environment is similar, the coating may begin to dissolve in the same way,’ Dr Nikolett Kállai-Szabó, senior study author and associate professor at the Faculty of Pharmaceutical Sciences of Semmelweis University, said.
‘Healthcare professionals generally assume that medications are swallowed with plain tap water, but that is not always obvious to patients today, given the wide variety of mineral and medicinal waters available on the market.’
The researchers cautioned that the study was done in lab models and not in humans, so the exact effect in humans is still unclear. However, they encouraged taking enteric-coated medications with tap water rather than alkaline water.
