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You should/should not take pills with cold water. - (12/18/2018)

By Dr. Ron Gasbarro

The pharmacist was thinking about some of his patients and the ways they take their medications. For instance, Lee says she takes her meds with cold water while she brushes her teeth. Sam takes his pills with his first cup of piping hot coffee. Ted takes his capsules without water but pops them into his mouth as if they were Tic Tacs®. Who is right and who is wrong?

But first, what happens once you put a pill into your mouth? Optimistically, the pill will go down the esophagus, survive the onslaught of digestive juices in the stomach, and enter the small intestine where it passes through the membranes and into the bloodstream. The pharmacist knows that taking water with a medication will allow for easy swallowing without choking. However, does the temperature of the water matter? Ideally, the water should be at room temperature or slightly lukewarm to match one’s body temperature of 98.6°F (37°C). Try an experiment. (Are you listening, Lee?) Put one tablet in a glass of cold water and another in a glass of lukewarm water. Note that the tablet in the lukewarm water will dissolve more quickly than the tablet in cold water. Hence, warm water will make it easier to swallow.

What about taking a medication with hot coffee or tea? Do not take an oral medication with hot water because it can destroy the film coating of the tablet or melt the capsule before these formulations reach the stomach or bowel where most drugs are absorbed into the circulation. (Got that, Sam?) Other pill formulations, when taken with a hot beverage can propel the pill right through the intestines and – plunk! – right into the toilet where it does no one any good. Ancient Egyptians learned this when they first started making pills and coated them with gold or silver. Talk about a high co-pay! Coffee and tea also contain caffeine and other chemicals that may interact with the medication and render it either stronger or weaker than it should be. Not good if you are on certain medications for hypertension, rheumatoid arthritis, or breathing difficulties. Plain water is best. 

Do you even need water to ingest a pill? The pharmacist has seen patients (like our friend Ted) pop a pill into their mouths and gulp it down, without water. Is this bad? Uncoated tablets have a dry chalk-like texture and can stick to the tongue or throat. The taste can be bitter. The pill can lodge halfway down the esophagus and cause choking. This is especially true in the case of gelatin capsules or caplets that can liquefy before they get to the small intestine where they should have been absorbed. Swallowing a pill “dry,” can also irritate the stomach. Drugs used for inflammation or pain, such as the non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen or aspirin, can mix with the normal hydrochloric acid used for digestion. The result is a tummy ache or even a stomach ulcer. 

Got a cough and/or a throat infection? Take the medicine with lukewarm water. The slightly elevated temperature of the water will soothe the throat and allow the medicine to dissolve faster, especially if the formulation contains acetaminophen or ibuprofen. Some of these painkillers are partially absorbed through the stomach lining. Warm water will help them to work faster. Moreover, as most pharmacists will tell you, the correct technique for taking any pill is to sip a mouthful of water before taking the pill so that the throat is not very dry and the tablets can be swallowed easily. 

Bottom line: Avoid water that is too hot or cold. If you are not sure, ask your pharmacist so that you get the most of your medicine. Follow your dose with a full glass of water. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com 

 


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