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Q: Is there a special order in which medication should be taken when more than one is directed to be taken with meals? How do enteric-coated pills work and how long does it take them to be effective? Why are you directed to take medication at different times during the day?

-- B.K., Orlando, Fla.

A: Good questions, all.

Drug treatment requires getting a drug into the body (administration) so it can get into the bloodstream (absorption) and travel to where it's needed (distribution).

There are many routes of administration for drugs: inhalation, intravenous injection, intramuscular injection, topical application, suppository, etc. But by far the most common method of administration is oral -- taking tablets, capsules and liquids by mouth.

Not only must the health-care professional decide which drug to recommend and how much over what period of time, but also by which route of administration. Each route has its own purposes, advantages and disadvantages.

The appropriate route of administration is chosen by taking into account a number of factors, primarily effectiveness and safety, criticality of time, and convenience to the user.

Injections (especially intravenous) and inhalation get a medication into the bloodstream the quickest. But for the most part, injections are reserved for time-critical or emergency situations in a health-care setting; intramuscular injection of insulin is one exception.

For most medicines, the oral route is adequate in terms of time and, obviously, more convenient. It is usually the safest and least expensive, too.

The formulation of the oral drug is also important. Liquids are absorbed more quickly and they are more convenient for infants than pills. Enteric coatings and time-released capsules are designed to release active ingredients over time to allow absorption gradually, for a sustained effect.

Another factor of oral drug administration is in the hands of the patient -- when to take the medicine. The instructions that come with the prescription or on over-the-counter packaging are important, but often incomplete. For example, they generally don't tell you why you should take a pill with meals or at bedtime.

The directions serve two purposes: to provide optimum therapeutic effectiveness with minimum side effects. You may be asked to take a pill on an empty stomach to maximize the speed at which the dose reaches the bloodstream, or to take the pill with food to avoid irritation of the stomach walls.

Some directions are obvious (or should be). Sedatives should be taken before bedtime, not upon awakening.

Of course, problems of drug interaction (the effect of one drug on another drug and their combined effect on the patient) is another subject for discussion.

Remember, you can always find out more information on the drug, dose, route of administration, possible side effects, etc. by asking your doctor or pharmacist. A number of books are also available that provide this information, including the Physicians' Desk Reference.

One final thought on safety of drugs -- follow directions on amount. I learned this early in my cooking efforts. Believe me, twice the recommended amount of salt doesn't make something taste twice as good.

Update on exercise: Recent medical research shows that, when it comes to exercise and health, a person can't rest on his or her laurels.

In a recent study published in the American Heart Journal, both men and women were shown to have a lower risk of premature death the more they exercised as they got older.

It was also shown that having exercised years in the past but not in the pretransmitted did not improve longevity.

So not matter how old you are, beginning to exercise now will increase your length of life and the quality as well. But if you are out of shape or have medical problems, it's wise to check with a doctor before starting a rigorous exercise routine.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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