When taking oral medication, the liquid used to take it with often doesn’t get a second thought, since it’s typically a small amount simply used to lubricate pills and capsules as they’re swallowed. But new research suggests it matters more than people may realize. A study conducted by researchers at Semmelweis University in Hungary found that certain types of liquids may weaken the outer coating of medications even during short periods of contact, which could release the active ingredient in the medication too early, potentially altering its effectiveness. Most doctors recommend patients take their medications with water, and that advice is usually followed, however certain alkaline mineral and medicinal waters are prime examples of liquids that can alter the effectiveness of some types of oral medications, according to the study. Researchers say that many oral medications, including anti-reflux, gastroprotective and anti-inflammatory pain-relief pills, are designed to retain their active ingredient in the stomach, and release it later in the intestines. Those medications are also typically designed to be taken with tap water, the researchers noted, rather than things like alkaline bottled water with higher mineral contents, which can break down the protective coating of pills. “Maintaining the integrity of the enteric coating is critical, particularly for acid-labile drugs whose therapeutic efficacy depends entirely on protection from gastric degradation,” the researchers wrote in the study, published earlier this year in the journal Pharmaceutics. “Premature coating failure may result in drug degradation in the stomach, subtherapeutic plasma concentrations, treatment failure, or, in some cases, increased gastric side effects, with potentially serious consequences for patient safety and treatment outcomes.” Meanwhile, other liquids like apple juice that were more acidic were found to be less damaging to protective coatings, the researchers said, as many medications are made to withstand the highly acidic environment of the stomach. The researchers said that patients are often not given guidance when it comes to what specific type of water or liquid works best with their prescribed medications. “Collectively, these findings underscore the need for more precise and explicit guidance... regarding suitable liquids for the administration of manipulated gastro-resistant products,” they said. “Recommending slightly acidic or pH-neutral liquids and discouraging the use of alkalizing mineral waters may significantly reduce the risk of unintended premature drug release and improve patient safety, particularly in elderly and dysphagic populations.”
