As nurses, at some point you may have provided discharge instructions or outpatient instructions to a patient that “this medication must be taken with food.” However, does the instruction just stop there? What else is instructed to patients when a medication must be taken with food? Take with a snack or take after dinner? What does this look like for your patient?
Some patients may not have the means to meet this requirement or even the appetite. Are examples provided? Some nurses may not be aware that for some medications the exact caloric requirement may make a difference in whether or not the medication works.
In my clinical practice of psychiatric nursing, there are two antipsychotic medications in particular that require a certain amount of calories in order to be effective. Lurasidone requires 350 calories. Another is Ziprasidone, which for any calories less than 500 results in variable symptoms. In other words, at 500 calories, absorption is increased up to two-fold in the presence of food, which results in less variable responses in patient symptoms. Standard guidelines when prescribing medications to patients can include increasing the dose if the desired effect is not achieved. However, with medications such as Lurasidone or Ziprasidone, the calories necessary are irrespective of fat content and studies have shown that increasing the dose of these medications in the absence of food does not work; in fact, higher doses increase the likelihood of extrapyramidal symptoms. For other medications, food can affect the bioavailability of a medication, therefore increasing or even decreasing drug absorption.
Understandably, interprofessional collaboration with a dietician or nutritionist as well as considerations for the setting (such as treatment in outpatient, inpatient, or residential) are necessary, and immediate access to such resources may vary. Yet, as one of our roles in nursing practice can involve providing education to our patients, it’s important that we remember additional factors that can affect treatment outcomes. Taking medications with food may not always be to simply decrease GI side effects. Dinner for one patient may not mean the same quantity or quality in another. Thus, it is vital to inquire and be knowledgeable about foods that have a certain amount of calories or at least be able to instruct patients to areas for further resources. USDA food composition databases can be used as a start.
Marie Smith-East is a family psychiatric mental health nurse practitioner, SAMHSA MFP ANA Doctoral Fellow, and a PhD student at the University of Central Florida in Orlando, Florida.
Bushra R, Aslam N, Khan AY. Food-drug interactions. Oman Med J. 2011;26(2):77-83.
Gandelman K, Alderman J.A, Glue P, et al. The impact of calories and fat content of meals on oral ziprasidone absorption: A randomized, open-label, crossover trial. J Clin Psychiatry. 2009;70(1):58-62.
Preskorn S, Ereshefsky L, Chiu YY, Poola N, Loebel A. Effect of food on the pharmacokinetics of lurasidone: Results of two randomized, open‐label, crossover studies. Hum Psychopharmacol. 2013;28(5):495-505.
If I have a cup of tea first thing in the morning, does that constitute food to be taken with medicines that require food?
Great article! I knew about calories needed with Latuda but did not know about Geodon. I also loved this article because even as a patient, I’ve never really clarified with my provider what do they mean with food. Very useful. Thank you!