- Researchers found that alkaline beverages like mineral water can affect how some pills release medication into the body.
- Most labels lacked guidance on how different drinks can interact with medications.
- Experts recommended taking all medications with plain tap or bottled water.
When you take a pill, it’s easy to flush it down with whatever’s around—but as it turns out, not all beverages are created equal.
In a new study, researchers set out to learn how different beverages interact with pills, and particularly how they interact with pills’ gastro-resistant or enteric coatings—coatings designed to control the speed at which medication is released, or to prevent pills from dissolving in the stomach. These coatings are commonly used, including in popular medications such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and proton pump inhibitors like Prilosec.
Interestingly, the researchers identified a couple of popular beverages that meaningfully affect these coatings. Below, a pharmacist and gastroenterologist weigh in on the findings.
Meet the Experts: Christine D. Sommer, Pharm.D., clinical informatics pharmacist with First Databank, Inc.; and Edmundo Rodriguez-Frias, M.D., double-board-certified gastroenterologist with Full of Life, a recovery center in Marlton, New Jersey.
How was the study conducted, and what did it find?
For the study, published in Pharmaceutics, scientists reviewed 103 gastro-resistant or enteric-coated medications. In a lab experiment, researchers examined how quickly these medications released their active ingredients when mixed with beverages of different acidities, ranging from Coke Zero (pH 2.82) to mineral water (pH 8.57). Other beverages tested included apple juice (pH 3.26), milk (pH 6.74), black tea (pH 7.19), and tap water (pH 7.62). The data showed that alkaline (high pH) beverages like mineral water affected the pills’ coatings.
The researchers also reviewed the medications’ labeling to see if guidance was offered on how best to administer the pills. They found detailed instructions on this subject were uncommon.
“The study showed that some beverages, such as mineral water, which tends to be more alkaline than tap or plain bottled water, can affect how quickly gastro-resistant dosage forms release medication,” explains Christine D. Sommer, Pharm.D., a clinical informatics pharmacist with First Databank, Inc. “Unfortunately, most medications that are affected do not address this issue in their drug labeling.”
Why pH may affect medication absorption
“Some medications are broken down by acid in the stomach. These medications are formulated into gastro-resistant forms that have a coating that dissolves more slowly in acidic environments (such as the stomach) and more quickly in alkaline environments (such as the small intestine),” Sommer says. “Taking them with an alkaline beverage, such as mineral water, can cause the gastro-resistant coating to dissolve too soon, releasing the medicine too early in the digestive tract. This results in the medicine breaking down before it can be absorbed by the body.”
This study was conducted in a lab, and as such, can’t fully capture how these medications and beverages interact in the body; more human trials are needed to fully understand this phenomenon. But to avoid any potential negative interaction or interference, Sommer says it’s always a good idea to take medication with tap water or still bottled water.
Plain water also “provides minimal risk of interfering with either dissolution or absorption,” adds Edmundo Rodriguez-Frias, M.D., a double-board-certified gastroenterologist with Full of Life, a recovery center in Marlton, New Jersey. “It’s generally the safest and most predictable option, unless the medication labeling recommends something else. Always follow the instructions listed on your medication label for the best results.”
The bottom line
Unless instructed otherwise, it’s always best to take any medication (especially delayed-release medication) with plain water, Sommer says.
If you’re unsure if these findings apply to your prescriptions or over-the-counter drugs, don’t hesitate to ask your pharmacist or your doctor about how best to administer your medication—or to answer other questions you might have about drug safety.
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