By Rosanna Sutherby, PharmD
Many people have questions and concerns about their medications. Part of my work as a pharmacist involves helping patients navigate the complexities of their medication regimens. The following are the five questions that I hear most commonly at the pharmacy.
Many medications interact with alcohol. Alcohol is a central nervous system (CNS) depressant and can increase the drowsiness effect of some medicines. It can also cause nausea and vomiting with some medications, and increase the risk of bleeding with others. Because it is metabolized by your liver, alcohol can interact with other medicines that are also processed through the liver. Mixing alcohol with these medicines can decrease their effectiveness as well, or even make them toxic.
You should avoid drinking alcohol if you are taking any the following medications:
- sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), and temazepam (Restoril)
- anxiety medication, such as alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium)
- antidepressants, such as fluoxetine (Prozac), citalopram (Celexa), and venlafaxine (Effexor)
- attention deficit-hyperactivity disorder (ADHD) medications, such as methylphenidate (Concerta, Ritalin) and amphetamine/dextroamphetamine (Adderall)
- warfarin (Coumadin)
Related: Losing the War on Warfarin
- muscle relaxants, such as cyclobenzaprine (Flexeril) and Carisoprodol (Soma)
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- seizure medicine, such as gabapentin (Neurontin), topiramate (Topamax), and lamotrigine (Lamictal)
- antihistamines, such as diphenhydramine (Benadryl), loratadine (Claritin), and cetirizine (Zyrtec)
- nausea medicine, such as meclizine (Antivert) and promethazine (Phenergan)
- opioid pain medication, such as hydrocodone and oxycodone
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), meloxicam (Mobic), and celecoxib (Celebrex)
- acetaminophen (Tylenol)
- diabetes medication, such as glyburide, metformin, and glipizide (Glucotrol)
- metronidazole (Flagyl)
This list does not include all medicines that may interact with alcohol. Talk with your pharmacist or healthcare provider about the effect of alcohol on your medication.
It is wise to take some medications with a meal to prevent upset stomach; however, not all drugs should be taken with food. Some medicines work better when taken with a meal, while others require an empty stomach to obtain the best effect.
- Antibiotics: Take antibiotics with food to minimize diarrhea and upset stomach. Do not take fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin, gemifloxacin, and ofloxacin) with milk or other products that contain cations (e.g., calcium, magnesium, and aluminum).
- Acetaminophen (Tylenol): You can take acetaminophen with or without food; however, the medication is absorbed faster when taken on an empty stomach.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Always take NSAIDs with food to decrease the risk of stomach bleeding.
- Antihistamines: Antihistamines, such as fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec) work better if you take them on an empty stomach.
- Antidiabetic medications: To prevent episodes of low blood sugar, you should take medication to treat diabetes with your first meal of the day or 30 minutes before meals.
- Thyroid medicine: Thyroid medication, such as levothyroxine (Synthroid, Levoxyl, Unithroid) should be taken first thing in the morning on an empty stomach.
- Medication for osteoporosis (porous, brittle bones): Bisphosphonates (drugs that slow down bone loss), such as alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva) must be taken on an empty stomach with a full glass of water 30 to 60 minutes before eating or taking any other medication.
- Iron supplements: Iron is absorbed better in an acidic environment; therefore, take it on an empty stomach for maximum absorption. However, if you cannot tolerate iron on an empty stomach, you can take it with food.
Generally, you can take ibuprofen or acetaminophen to reduce fever or pain while taking most antibiotics. However, you should avoid ibuprofen and other NSAIDs if you are taking a fluoroquinolone antibiotic, such as the following:
- ciprofloxacin (Cipro)
- levofloxacin (Levaquin)
- moxifloxacin (Avelox)
- gemifloxacin (Factive)
- ofloxacin (Floxin)
Generally, if you forget to take your medicine, you can take your medication as soon as you remember if it is not close to the time for your next dose. Do not double your dose, except in the case of oral contraceptives. You can take two birth control pills if you miss one dose. If you miss more than one dose, follow the instructions provided by the manufacturer.
Talk to your pharmacist for more specific instructions on what to do if you forget to take your medicine.
Insurance plans have formularies that help determine what medications will be covered. Often, these formularies are further divided into tiers that represent different out-of-pocket pricing for the medicines. The cost of your medication may depend on your coverage and the tier in which it falls.
If your insurance does not cover your medication or if your medicine falls into a high tier, prescription discount cards can offer prescription savings.
Prescription discount cards, or prescription savings cards, help you obtain the lowest prescription price for your medication. If your insurance does not cover your medication or the cost is too high on insurance, a free Rx savings card may save you up to 80% or more off the retail price. You can use the ScriptSave WellRx discount card for the best prescription savings at a pharmacy near you.
Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.