Practice · Interactions

[2026 update] Antibiotics and a course of something with delayed emptying

Practice › Interactions metformin needs a source delayed gastric emptying insulin hypoglycaemia

n.szaboTL229 Jun 2026#1

On the subject in the title: Antibiotics and a course of something with delayed emptying Working notes rather than a conclusion.

Something changed and I would like to know whether it should have.

Same compound, same supplier, same technique, 8 weeks apart, and the experience is not the same. I have ruled out the obvious differences and I am left with the ones I cannot rule out from here.

Before anyone suggests it: yes, I have the dates written down, and yes, I checked them rather than remembering them.

24 likes 29d

e.vargaTL230 Jun 2026 · edited#2

The opening post put the caveat in the right place and I want to underline it.

I have no financial interest in anything named in this thread and I want to say so before I comment on Antibiotics, because it is the sort of subject where it matters.

26 likes 28d

a.batistaTL21 Jul 2026#3

Food interactions: most interactions are absorption interactions. Some medications absorb better with food, others better on an empty stomach. With an incretin agonist that already slows gastric emptying, food effects interact with the drug effect as well.

0 likes 27d

k.perrinTL21 Jul 2026#4

Good question, well framed, and I would like to see it answered properly.

2 likes 27d

d.tammTL22 Jul 2026#5

k.perrin, post #4: Good question, well framed, and I would like to see it answered properly. Go to post

Post #2 is the version of this I will quote in future. One addition.

Adding a reference point for Antibiotics. Mine is a single case, collected without controls, and I am posting the method alongside it so it can be discounted appropriately.

8 likes in reply to #4 26d

a.nwosuTL22 Jul 2026#6

Where I part company with post #5, and it is a narrow parting.

The failure mode on Antibiotics is boring rather than dramatic. It is almost always the step everyone assumes was done correctly because it is too simple to get wrong.

19 likes 26d

o.vogelTL23 Jul 2026#7

A supplement is a drug for interaction purposes, and the fact that it is sold without a prescription tells you nothing about whether it interacts. The paperwork is usually worse rather than better.

The honest answer is that it depends, and here is what it depends on.

0 likes 25d

a.zamoraTL23 Jul 2026#8

I would call the community position on Antibiotics likely rather than established, and I would be comfortable defending that hedge.

0 likes 25d

e.ferreiraTL3Regular3 Jul 2026 · edited#9

Oral medications versus time: if you take an oral medication 30 minutes before semaglutide (which slows gastric emptying), the delayed stomach emptying affects when and where the oral medication is absorbed. Separating by a larger interval (1 to 2 hours) usually resolves this.

4 likes 25d

h.falkTL24 Jul 2026#10

Anticoagulant questions come up regularly and are the clearest case for professional advice rather than discussion, because the consequence of being wrong is not gradual.

13 likes 24d

g.valckenaereTL3Regular4 Jul 2026 · edited#11

e.ferreira, post #9: Oral medications versus time: if you take an oral medication 30 minutes before semaglutide (which slows gastric emptying), the delayed stomach emptying affects when and where the oral medication is absorbed. Separating by a larger interval (1 to 2 hours) usually resolves this. Go to post

On Antibiotics, I would rather understate and be corrected upward than overstate and be quoted. That is a house style here and it is a good one.

9 likes in reply to #9 24d

s.roosTL24 Jul 2026#12

a.zamora, post #8: I would call the community position on Antibiotics likely rather than established, and I would be comfortable defending that hedge. Go to post

Taking post #11 at face value and following it one step further.

Supplements and herbs: many have no established interaction. Some do. If you are taking something unusual, checking a reference (like a pharmacist) is more useful than guessing from forum discussion.

The general answer and the answer for your case may diverge here.

2 likes in reply to #8 23d

j.vandermolenTL3Regular5 Jul 2026#13

I read post #11 twice before replying, because I had assumed the opposite.

The number people quote for Antibiotics is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own.

0 likes 23d

a.lindqvistTL25 Jul 2026#14

Collapsed as off-topic by two members at trust level 3 or above

Antibiotics was covered in the wiki last year and the page has a review date on it, which is a better starting point than my memory of a thread.

careful_beginnerTL1Member6 Jul 2026#15

g.valckenaere, post #11: On Antibiotics, I would rather understate and be corrected upward than overstate and be quoted. That is a house style here and it is a good one. Go to post

Helpful, and short, which on this subject is harder than long.

13 likes in reply to #11 22d

m.ilungaTL26 Jul 2026#16

A pharmacist can answer most questions in this subcategory in a few minutes with access to a proper interaction database, and that access is the thing a forum does not have.

5 likes in reply to #9 22d

desiccant_notesTL2Member6 Jul 2026#17

Everything in post #16 holds. The case it does not cover is the one I have.

The version of Antibiotics that I was taught turned out to be a teaching simplification. Useful, and not true in the way I had assumed it was.

0 likes 22d

m.ramosTL27 Jul 2026#18

Narrowing post #16, because the general version has more than one answer.

Whatever the answer on Antibiotics turns out to be, the method for getting there is the same: state the assumption, do the arithmetic in public, invite the correction.

28 likes 21d

j.habermannTL3Regular7 Jul 2026#19

On post #16 — agreed on the reasoning, with one qualification.

Where a published interaction study exists it usually reports an area-under-curve ratio, and that number is far more informative than a yes-or-no answer.

I am aware this is the third time this month I have made this point.

2 likes 21d

t.tullochTL27 Jul 2026 · edited#20

desiccant_notes, post #17: Everything in post #16 holds. The case it does not cover is the one I have. The version of Antibiotics that I was taught turned out to be a teaching simplification. Useful, and not true in the way I had assumed it was. Go to post

The most defensible general position in this subcategory: identify the plausible mechanism, check whether it has been studied, and where it has not, say that rather than filling the gap.

0 likes in reply to #17 21d

m.perrinTL27 Jul 2026#21

m.ilunga, post #16: A pharmacist can answer most questions in this subcategory in a few minutes with access to a proper interaction database, and that access is the thing a forum does not have. Go to post

On Antibiotics I would separate what is worth knowing from what is worth acting on. The first list is long and the second is short, and conflating them is how threads get heated.

4 likes in reply to #16 20d

s.karlsen_rphTL3Pharmacist8 Jul 2026#22

Reporting rather than recommending, on Antibiotics. What happened is above. Whether it should have is a different question and not one I am qualified to answer.

13 likes 20d

o.vukovicTL28 Jul 2026#23

Building on post #20 rather than restating it.

SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern.

27 likes 20d

orbitrap_olaTL3Mass spectrometrist8 Jul 2026 · edited#24

Post #22 put the caveat in the right place and I want to underline it.

Anticoagulant questions come up regularly and are the clearest case for professional advice rather than discussion, because the consequence of being wrong is not gradual.

0 likes 19d

k.salinasTL29 Jul 2026#25

m.perrin, post #21: On Antibiotics I would separate what is worth knowing from what is worth acting on. The first list is long and the second is short, and conflating them is how threads get heated. Go to post

I will take the caveat as seriously as the claim, which is the point of putting it there.

2 likes in reply to #21 19d

d.fontaineTL29 Jul 2026#26

Alcohol is not contraindicated in the labelling and it does irritate a stomach that is already emptying slowly. There is no published interaction study, and the conservative reading is the obvious one.

Same conclusion as the reply above, reached differently, which is mildly reassuring.

8 likes 19d

f.sjobergTL29 Jul 2026#27

Taking post #24 at face value and following it one step further.

The most defensible general position in this subcategory: identify the plausible mechanism, check whether it has been studied, and where it has not, say that rather than filling the gap.

20 likes 19d

dr_okonkwoTL4 Moderator10 Jul 2026#28

careful_beginner, post #15: Helpful, and short, which on this subject is harder than long. Go to post

Summarising the Antibiotics thread so far, since it is long and the answer is buried: the first reply has the method, the fourth has the correction to it, and the rest is people agreeing at length.

0 likes in reply to #15 18d

m.lindqvistTL210 Jul 2026#29

My position on Antibiotics is current rather than settled. I have revised it once already and I expect to again, so treat it accordingly.

12 likes 18d

r.restrepoTL210 Jul 2026#30

I read post #26 twice before replying, because I had assumed the opposite.

A supplement is a drug for interaction purposes, and the fact that it is sold without a prescription tells you nothing about whether it interacts. The paperwork is usually worse rather than better.

26 likes 18d

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