The People's Perspective on Medicine

Should You Take Your Pills at Breakfast or Bedtime?

How do you take your pills? Are you a morning person or a nighttime person? What beverage do you swallow them with? You'll be surprised to learn it matters.
Medication during breakfast, injector of insulin together with a bottle of pills, conceptual image, composition horizontal

How do you take your pills? If you are like most people you barely give it a moment’s thought. After all, the instructions on your medication bottle may be vague: “Take 1 (one) tablet by mouth every day.” Does it matter whether you swallow your tablets and capsules with juice in the morning during breakfast? Should those pills be taken on an empty stomach or with food? Do they work better if you take them at bedtime? Such information is often lacking.

Check Your Pill Bottles!

Do you take any medications? What about vitamins, minerals, herbs or other dietary supplements? Chances are good that precise instructions are lacking.

Don’t believe us? Take a moment to retrieve some of your bottles. We’ll wait. What do you see? Typical labels often say unhelpful things like:

“Take 1 capsule daily”

or

“Take one pill daily with food or as directed by a healthcare practitioner”

or

“Take 1 capsule three times a day between meals”

or

“Take before meals”

Why Are Such Instructions Worthless?

Does “before meals” mean 5 minutes, 30 minutes or an hour before eating? It could make a difference for some medications.

Does “with food” mean in the middle of a meal, after a meal or with a snack? How much food you eat and the kind of food you consume can impact drug absorption. A breakfast of eggs, sausage and toast with butter is quite different from a breakfast of bran buds, skim milk and blueberries. The amount of fat in the meal can impact how fast the drug gets into your bloodstream. 

Liquids Matter!

Some people swallow all their pills with a big glass of water. Others pop them down with a sip of coffee or tea. We have watched a tennis partner swallow “vitamin I” (ibuprofen) on the court without even a swallow of water.

How you take your pills can have a profound impact on how well they work or whether they will cause side effects. NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen or naproxen should never be swallowed without a big glass of water!

Info on How to Take Your Pills May be Lacking:

We hate blaming the victim. It seems like adding injury to insult. It’s not surprising that most patients are uncertain about the best way to take their medicine. Often, the only instruction they get is to take it once a day. Pharmacists and doctors rarely offer detailed guidance.

We should not blame health professionals either. There is often limited research on how you should take your pills when it comes to time of day, food or beverage. Even when there are data, they may not be widely communicated.

Should You Take Your Blood Pressure Pills at Night?

A recent study from Spain, for example, revealed the surprising information that drugs for blood pressure control work better if they are taken at bedtime rather than in the morning (European Heart Journal, Oct. 22, 2019). There were more than 19,000 people with hypertension in this randomized controlled trial.

Those taking their pills in the evening had better blood pressure control overnight without losing daytime effectiveness. In addition, during more than six years of follow-up, they were less likely to experience heart attacks, heart failure, strokes or other cardiovascular complications.

You can read more details about this research at this link:

When Should You Take Your BP Pills? Morning or Bedtime?

Some people should not take their blood pressure pills at night:

Philip wrote that his ACE inhibitor ramipril made his cough worse at night:

“After taking my blood pressure medicine at bedtime, I found the coughing to be much worse during the night. It was so bad that I lost most of my sleep.”

We encouraged Philip to let his doctor know that coughs triggered by drugs like lisinopril or ramipril are a problem. There may be another BP medicine that is less likely to cause a cough. We are also concerned about ACE inhibitors and lung cancer, especially if people put up with a cough for years. There’s information at this link

People should never change their medication regimen without checking first with the prescriber. Some BP meds contain diuretics. Taking them in the evening may lead to more trips to the bathroom during the night. That could be a problem for older people.

That is what JMR complained about:

“I would not want to take one of two BP meds at night primarily because it does have a diuretic compound. I have found that if I fail to take it in morning and take it towards evening, I have interrupted sleep. That’s because I need to go to the bathroom several times at night. It tires me out.”

George was pleased with the switch:

“I changed my time from morning to evening and noticed in a few days that the slight swelling in my lower legs is totally gone. I will continue at evenings and monitor that change. It might be that dosing in evenings and then lying flat that the body does not have as hard a time fighting gravity to return blood flow back to upper body. Taking BP pills in mornings may lead to fluid buildup during day. In my case the swelling was apparent by evening. This is just my personal observation.”

Statins: Should You Take Your Pills at Night?

Blood pressure pills are not the only medicines that might be better taken at the end of the day. For years, many doctors have recommended that their patients taking the cholesterol-lowering drugs lovastatin (Mevacor) or simvastatin (Zocor) take them in the evening, when they are most effective.

This recommendation doesn’t hold for all statins, though. Time of day doesn’t seem to make any difference for atorvastatin (Lipitor) or rosuvastatin (Crestor).

Thyroid: Take Your Pills at Bedtime?

People taking levothyroxine (Levoxyl, Synthroid) to treat hypothyroidism have long been admonished to take their pill immediately upon rising and hold off on coffee or breakfast for at least half an hour or preferably an hour. Some people find this impractical on a busy morning.

More recent research shows, however, that people who take levothyroxine at night get better results (Archives of Internal Medicine, Dec. 13, 2010). Ideally, this should be at least two or three hours after the last meal of the day, since food can interfere with the effectiveness of the hormone (Journal of Clinical Endocrinology and Metabolism, Oct. 2009). 

Take Your Pills with Water or Juice?

What liquid do you use to swallow your pills? You may not think it matters, but you have doubtless heard or read that grapefruit juice can interact with certain medications. It can boost blood levels of medicines like felodipine (Plendil), nifedipine (Procardia), atorvastatin (Lipitor), simvastatin (Zocor), buspirone (BuSpar) or zaleplon (Sonata). Amiodarone is strongly affected by grapefruit juice, which could increase the risk of side effects.

You can learn more about grapefruit and drug interactions at this free link

Acid Beverages Could Spell Other Trouble:

Fruit and vegetable juice, soda and wine are all acid drinks. So is coffee. They may all reduce the effectiveness of antibiotics like ampicillin, penicillin or erythromycin (American Journal of Nursing, March, 1975). 

Should You Take Your Pills with Milk?

Milk and dairy products in general are a bad idea with tetracycline-type antibiotics. The calcium can diminish absorption of the antibiotics into the blood stream and reduce effectiveness.

Milk is also a bad choice if you use bisacodyl laxatives (Bisacodyl, Dulcolax, Fleet Bisacodyl, etc). That’s because such drugs may not dissolve correctly if you create an alkaline environment in your stomach. The presence of the laxative in the stomach without the protective enteric coating may cause gastritis.

What About Water?

It is hard to go wrong with water. Just make sure that you drink enough while you are taking your pills. Too little liquid means that you may miss out on as much as half of the dose of an antibiotic like erythromycin (Postgraduate Medicine, July 1977).  Trying to take your pills dry or with minimal water also means you run the risk of getting it stuck in your throat, where it could cause irritation.

Taking an NSAID like ibuprofen or naproxen without liquid could lead to digestive tract upset or even an ulcer. My tennis partner has been warned that swallowing his “vitamin I” without liquid is not a good idea.

The next time you get a prescription, be sure to ask the doctor and the pharmacist for specific instructions about the best way to take the pill. You can learn more about interactions with food from our free Guide to Drug and Food Interactions. You’ll find it in the Health Health Guides section:

You can also access our free Drug and Alcohol Interactions in our Health Guides Section.

How do you take your pills? Share your experience in the comment section below.

Rate this article
star-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-empty
4.4- 255 ratings

Today's Newsletter Reading List

    About the Author
    Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
    Blood Pressure Treatment
    $4.99

    Learn about pros and cons of the various medicines used to lower blood pressure, as well as multiple non-drug approaches to blood pressure control such as diet, supplements and special foods.

    Blood Pressure Treatment
    Citations
    • Hermida RC et al, "Bedtime hypertension treatment improves cardiovascular risk reduction: The Hygia Chronotherapy Trial." European Heart Journal, Oct. 22, 2019. https://doi.org/10.1093/eurheartj/ehz754
    • Bolk N et al, "Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial." Archives of Internal Medicine, Dec. 13, 2010. DOI: 10.1001/archinternmed.2010.436
    • Bach-Huynh TG et al, "Timing of levothyroxine administration affects serum thyrotropin concentration." Journal of Clinical Endocrinology and Metabolism, Oct. 2009. DOI: 10.1210/jc.2009-0860
    • Welling PG, "How food and fluid affect drug absorption: Results of initial studies." Postgraduate Medicine, July 1977. DOI: 10.1080/00325481.1977.11712246
    Join over 150,000 Subscribers at The People's Pharmacy

    We're empowering you to make wise decisions about your own health, by providing you with essential health information about both medical and alternative treatment options.

    Showing 21 comments
    Comments
    Add your comment

    For years, I’ve taken carvedilol, 12.5 mg, each morning and each bedtime for blood pressure control. Then, a year ago, I began having midnight waking, hot flashes, sweats, greatly elevated BP, and elevated catecholamines (shown in 24 hour urine collection), and anxiety/panic every night, causing severe loss of sleep. My new PC suggested I take 1 mg of Prazosin (mini-press), an alpha blocker, at night to offset the beta blocker, and a miracle occurred.

    From the first nighttime dose I slept through the night, and my morning BP was only mildly elevated 140/81). I took the a.m. beta blocker, and it dropped to l30/74). I had concerns though, because Prozosin is on the Beers list of meds that are not safe for older patients and can create much dizziness. On my next visit to my cardiologist, I told him about the change and wanted him to be ok with it, which he was. The blood pressure continued to be managed despite daytime dizziness, and my sleep was restored for about 3 months. Then all my former symptoms returned again.

    I’m now being screened for a possible adrenal lesion/adenoma/tumor called a pheochromocytoma,not such a rare occurrence as once was thought. If my tests are positive, and I have surgery, its removal, 9 out of l0 times, will cure all the symptoms. I will be tested for a genetic factor also. Keep fingers crossed. Nighttimes have been a nightmare. Prior to this bad year, I have been healthy and happy!

    I take Synthroid, and set my alarm for 3:30 am. That way, I am not interfering with it’s effects with my night-time dose of iron, and my impossible to give up dose of coffee at 5:30 am. It is annoying, and taking it at 3:30 often wakes me up, so I don’t sleep for awhile after, but as my dog often gets up at the same time for a walk, it isn’t a total problem.

    What about vitamins? I take them just before meals with as little water as possible.

    What about someone who has many different health problems and has to take multiple pills throughout the day?

    I am on a dozen prescriptions from different specialists for separate health problems. Each doctor of mine knows all of the prescriptions and vitamins and supplements I take.

    However, my insurance requires mail order for some medications, but not for all, and controlled substances cannot be mailed in my state so I must have them filled at a local pharmacy. Therefore, it is impossible to have only one pharmacist who has the entire picture.

    When I take my Levothyroxine when I first wake up and keep my stomach empty for the hour as prescribed, can I take my other morning medications during that hour or do they constitute a lack of the required empty stomach?

    If I am on four medications that must be taken with food and two that do not say that, can I take all of them with food? Who do I ask, each of my doctors AND each of my pharmacists?

    So there are many complexities that arise when multiple prescriptions must be taken when I wake and when I go to bed, but also periodically throughout the day.

    I often wish I could hire a private pharmacist to handle this for me and not rely on each specialist to know about the medications prescribed by every other specialist. Maybe that day will come and insurance will cover it!

    Can we drink too much water with our medication? I was very thirsty this morning when I woke up. With my Armour Thyroid and Cytomel I drank 6 oz. of water and then 4 oz. more. I wondered if doing this interfered with the absorption of these drugs? Does it vary from drug to drug?

    It shouldn’t interfere with absorption.

    Interestingly, taking meds/supplements doesn’t mention swallowing them with food. I learned this method, which I find so, so much easier, while working at a hospital. You chew up your food until you have a strong urge to swallow, pop the capsules or pills in your mouth, and down they go with great ease. Some of the patients even had contests about how many they could swallow at once… that’s how easy it is. Try it… starting with just one… and you’ll see what I mean.

    I tried to take my Levothyroxine at night – it gave me heartburn! Now what?

    When the pharmacy affixed label says “take with food” how much food? Does 8 oz of juice count? How about 2 oz of milk? When you are directed to take 2 doses 12 hours apart it’s hard to get them both “with a meal.”

    Great questions and good point. The amount of food needed may vary, both by drug and by patient.

    I set my alarm for 6 every morning. When it goes off, I take my thyroid medicine with a couple sips of herbal tea, then fall back asleep for another hour and a half. That way my morning coffee won’t interfere.

    You seem to be suggesting that blood pressure, thyroid, and statin drugs all be taken at night. This could be a problem if they can’t all be taken at once.

    Can they?

    Jerry

    You are correct. Thyroid hormone should not be taken with the others. So people on all of those might need to take their levothyroxine in the morning.

    I take my BP med like Coreg and Clonidine 3 times a day, as I have HTN for 45 years and it fluctuates during the day.
    Once a day can not work for me as the hypotensive effect of the pills do not last 24 hours.
    It may be a good idea to take at night if you are younger and take only 1 pill a day , at the beginning of your HTN therapy

    Excellent article ! Really wish doctors/ pharmacist would discuss such specifics when issuing a prescription.

    This is a very helpful article. Thank you. But now, I have a question. As I have aged, I have increasing difficulty swallowing pills. I have switched to chewables whenever I can, such as chewable ibuprofen, aspirin, Tylenol. If I have to take a pill, such as an antibiotic, I crush it and mix it with yogurt or applesauce. So, does your advice on drinking lots of water apply also to chewables and crushed pills?

    Each pill requires specific instructions. Some can be crushed. Others can not be crushed. Some are compatible with applesauce but not yogurt. Be sure to check with your pharmacist. That is why they are trained so intensely!

    Adequate water is ALWAYS a good idea, especially with drugs that can be irritating to the GI tract, like aspirin or NSAIDs.

    Since it is suggested that some pills are better taken in the evening, that would mean most of mine. My question is; can most pills be taken together all at once?

    Thank you.

    NJ

    Many pills can be taken at the same time, but you should check with your pharmacist about your specific medications.

    Good information! Thank you so very much.

    I started taking my Levothyroxine at night, but when I had an appointment with the specialist she told me to take it in the morning. I was also taking a vine leaf supplement as I’d read that it helped. She told me to stop taking that too.

    * Be nice, and don't over share. View comment policy^