Why can some pills be taken on an empty stomach and work while others are advised to be taken with a meal, or they may make you sick or the expected affect may come on stronger?
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Some drugs (like analgesics) increase the acid secretion in the stomach so you have to take it with food for the acid to digest the food. Otherwise, this increased amount of acid can cause stomach ulcers (stomach digesting itself).
Other drugs (like anti edematous) are actually isomers of digestive enzymes (like alpha chemotrypsin) so if you took it with food, it will work on food and be wasted rather than absorbed into bloodstream.
Those were the most common mechanisms. But there are many others such as:
Some drugs are irritants so you should take them with food to “dilute” them until they are broken down and absorbed.
Some drugs require some intrinsic factors to be absorbed and eating will stimulate the digestive tract to secrete good amounts of those factors.
Think about diabetic patients, they have to eat after taking hypoglycemic drugs to avoid hypoglycemia.
Other drugs are targeting the intestines so they are “enteric-coated” to protect them from stomach acid. Eating will stimulate large amount of acid secretion and may damage the coat sooner before reaching the intestine.
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