The right choice for your patient
Most medicines can be given with a spoonful of soft food the patient can swallow safely. Giving medicines with food is helpful for:
- patients with swallowing difficulties
- covert oral administration of medicines
This page lists sources of information and advises how to use them alongside pharmaceutical and clinical considerations.
Medicines need to be in an appropriate form to be given with food. See Checking if tablets can be crushed or capsules opened.
Why and how medicines are given with soft food or thickened fluid provides practical advice, including the choice of food.
If you need further support, the SPS Medicines Advice service (for NHS primary care health professionals in England) or local medicines management teams may help.
Sources of information
The following resources provide advice on administering medicines and information on drug-food interactions.
SPS resources
Medicines suitable for adults with swallowing difficulties provides lists of medicines suitable for patients with swallowing difficulties, in some therapeutic classes. They note if medicines can be given with soft food.
Each list includes multiple medicines within the therapeutic group and can be used to consider suitable alternatives.
Using solid oral dosage form antibiotics in children provides information on giving common antibiotics with soft food.
Summaries of Product Characteristics
Summaries of Product Characteristics (SmPCs) include information on administration and may advise if a medicine should or should not be given with food (see section 4.2).
Additional information may be provided in the interactions (4.5) and pharmacokinetics (5.2) sections.
British National Formulary
Drug monographs state (in the medicinal forms section) if dispensing labels are needed. The following labels refer to food and drink:
- take with food (label 21)
- take before food or on an empty stomach (labels 22 and 23)
- avoid milk (label 7)
Medicines for Children
Medicines leaflets advise on giving medicines to children. Some include information on giving medicines with food.
Stockley’s Drug Interactions resources
Stockley’s Drug Interactions and Stockley’s Interactions Checker (subscription to Medicines Complete required for both) provide information on the clinical relevance of drug-food interactions. When using the checker, enter drug name and click on ‘Food, drink and smoking interactions’.
Pharmaceutical and clinical considerations
Some medicines need particular consideration.
In most cases, the benefit to the patient of mixing with a small amount of food immediately before administration will outweigh any risks. A notable exception is bisphosphonates.
Bisphosphonates
Oral bisphosphonates are not suitable for people with swallowing difficulties or for covert administration.
The bioavailability of bisphosphonates taken with food is negligible. They must be taken on an empty stomach and food avoided for 30 minutes afterwards in order to be effective.
Review if bisphosphonate therapy must be continued. If so, suggest the patient is switched to zoledronic acid injection or denosumab injection, depending on the indication for use.
Medicines ‘on an empty stomach’
Bioavailability of some medicines can be reduced by food (they may require dispensing label 22 or 23), but in most cases the interaction can be managed pragmatically.
Consider to what extent bioavailability is affected by food and whether the medicine has a narrow or wide therapeutic index.
High-risk medicines
For medicines with a narrow therapeutic index, a small reduction in bioavailability may lead to reduced clinical effect.
Advise the patient to take the medicine consistently with regards to food and mealtimes. Ideally give at the same time each day, with similar food. This way, blood levels will be stable, and the dose can be adjusted if necessary.
When switching from taking a medicine on an empty stomach to with food, the effect may be similar to a dose change. Monitor for therapeutic or adverse effects. See the Medicines Monitoring tool for advice.
For example, levothyroxine bioavailability might be reduced by food and some SmPCs say it should be given 30 minutes before breakfast. For people needing to take it with food:
- levothyroxine tablets can be crushed and mixed with soft food (off-label)
- advise the patient to take the medicine with similar food each time
- check blood levels before (if possible) and after the switch, and adjust the dose if necessary
Medicines taken with just a spoonful of food are less likely to be affected than those taken at meal times. If appropriate, consider scheduling medicines administration away from meal times. The key is to take medicines consistently; the administration schedule must be convenient for the patient (and carer).
Low-risk medicines
For medicines with a wide therapeutic index (typically those where the recommended dose is the same for all adults), the effect of food may not be clinically relevant.
For example: perindopril bioavailability is not expected to be reduced by food to a clinically relevant extent.
Medicines not to be given with milk
Medicines that should not be given with milk must not be given with dairy products such as yoghurt or custard. Also avoid calcium-fortified non-dairy products such as some ‘plant milks’. Apple puree is a suitable alternative if safe for the patient to swallow.
Giving medicines with thickened fluids
Consider thickened fluids in the same way as soft food. Medicines that can be given with a spoonful of soft food, can be given with a spoonful of thickened fluid if appropriate for the patient.
Crushed tablets or capsule contents should only be mixed with thickened fluid immediately before administration. Studies have shown reduced dissolution of medicines mixed with thickened fluid and left overnight.
Attempting to thicken liquid medicines is not recommended, as achieving the right consistency reliably is difficult.
Macrogol (polyethylene glycol (PEG)) laxatives must not be mixed with starch-based thickeners. The resulting mixture is thin and watery and will not thicken. If you must thicken a macrogol laxative, use a gum-based thickener.
Thickeners and thickened fluids has more information.