Do Hot Or Cold Drinks Affect Amoxicillin Absorption?

In our latest question and answer, our pharmacist discusses whether or not the temperature of a beverage affects the absorption of amoxicillin.

Question

I had to take amoxicillin capsules before dental treatment. I swallowed them with tap water 1 hour before treatment, and nearly 2 hours after eating 2 slices of toast. The water was very cold. I have since learned that cold water slows the emptying of the stomach and affects absorption. Would ingesting cold water seriously delay the absorption of the antibiotics? Do the capsules dissolve easily in the stomach? What happens if they sit in the stomach for too long due to cold water delaying stomach emptying? Would they be affected by stomach acid?

Asked by Avers On Feb 07, 2023

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Feb 07, 2023
Last updated Apr 12, 2024

Key points

  • Studies indicate beverage temperature can slightly affect how quickly the contents of the stomach move to the gastrointestinal tract, but it generally is not clinically significant.
  • There is no evidence to suggest that beverage temperature affects amoxicillin absorption. It can be taken with hot or cold beverages.

Answer

Thanks for reaching out and great question!

Although studies have found that the temperature of a beverage can slightly affect gastric emptying (i.e., how quickly food or other substances move from the stomach to the gastrointestinal tract), it generally isn't clinically significant.

Additionally, when it comes to medication, there is little evidence to suggest that the temperature of the beverage used to swallow it will significantly affect its overall absorption.  Some studies have found that taking medication with a hot beverage may slightly increase how quickly it is absorbed, but the extent of absorption (i.e., how much of a drug is absorbed overall) is generally unaffected.

There are plenty of other factors that have a much more significant role in drug absorption, such as stomach acidity, whether or not a drug is in solution, and whether or not there is food present in the stomach.

What Do The Studies Say?

A good place to start when researching how the temperature of a beverage could affect drug absorption is to look for studies that have evaluated how temperature can affect gastric emptying, which again, is how quickly the contents of the stomach move to the intestines.

In general, the vast majority of studies find that cold beverages do delay gastric emptying, but only to a very minor degree. One such study, published in Nutrition Reviews, stated the following:

Several studies have shown that beverage temperature can slightly affect the gastric emptying rate, but only for about 10 min post-ingestion. The intragastric temperature appears to rapidly return to normal core levels and the beverage temperature has little effect on overall rates of gastric emptying.

Nutrition Reviews, Volume 73, Issue suppl_2, 1 September 2015, Pages 57–72

There have not been many studies that have specifically evaluated the role the temperature of a beverage used to swallow a medication plays in the absorption of that medication.

The ones that have been published show very little overall differences in drug absorption.

One study evaluated the rate and extent of absorption of caffeine, by measuring plasma levels of the drug in those who consumed it via a hot beverage (coffee) or a cold beverage (chilled energy drink). The study found small, but no clinically significant differences in absorption:

The results of this study are consistent with previous caffeine pharmacokinetic studies and suggest that while rate of consumption, temperature of beverage and vehicle (coffee versus energy drink) may be associated with slightly different pharmacokinetic parameters, the overall impact of these variables is small.
Clin Toxicol (Phila) . 2016;54(4):308-12.

Now, we don't have any specific studies evaluating the effects of different temperature beverages with a drug like amoxicillin. Nevertheless, based on all available evidence, while how quickly the drug is absorbed may be very slightly delayed by taking it with a cold beverage, there is no data to suggest that the overall extent of absorption of medication is affected.

It is important to note that while beverage temperature doesn't appear to significantly affect the overall absorption of most (if not all) medications, whether a not a drug is already in solution absolutely does affect absorption, which is why liquid medications tend to work faster than medication in a solid dosage form (e.g., tablets or capsules).

I have seen articles online citing a study that showed acetaminophen (the pain reliever in Tylenol) being more quickly absorbed in a hot beverage versus in a tablet form as evidence that hot beverages improve drug absorption. However, this study evaluated a drug already in solution, versus a drug in a tablet dosage form. A drug in solution absorbing more quickly than a solid dosage form, like a tablet, would be expected.

Final Words

Having taken your amoxicillin with a cold beverage will not have a significant influence on its absorption, so you don't have to worry about it in that regard.

You also asked if amoxicillin is affected by stomach acid (presumable by being exposed too long due to taking it with a cold beverage). Amoxicillin is stable in gastric acid and theoretically having the drug exposed slightly longer by taking it with a cold beverage will not negatively affect it.

Thanks again for reaching out and please do so again anytime! 

References

  • Pharmacokinetic analysis and comparison of caffeine administered rapidly or slowly in coffee chilled or hot versus chilled energy drink in healthy young adults, PubMed
  • Does a Hot Drink Provide Faster Absorption of Paracetamol Than a Tablet? A Pharmacoscintigraphic Study in Healthy Male Volunteers, PubMed
  • Fate of ingested fluids: factors affecting gastric emptying and intestinal absorption of beverages in humans, Oxford Academic

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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