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I've found caffeine, and especially whatever they put in energy drinks, only interacts with my body in a helpful way when I'm not dehydrated. A Monster on a sweaty day does not get my ditches dug unless I'm chugging water too. Sorry I have no insight why, but maybe your med is a little like that.
Or perhaps it will cause the buildup of something toxic in your system if you aren't drinking enough water to flush it or its metabolic byproducts out.
Doctor here. What medication is it? Why did they prescribe it? Do you have kidney problems?
Sounds like a great question for your doctor.
Could be that that medicine is (like coffee) a diuretic. They make you pee more so you have to drink more water to stay hydrated.
As others have said, ask your doctor.
But to add another potential reason, some medications have dehydration as a side effect (maybe it messes with thirst cues, increases urination frequency, increases sweating, etc).
Not a doctor, but I can think of two possibilities:
Some vitamins and medications are water soluble, so taking them with water helps make sure it all gets into your system instead of being excreted.
2L isn't very much for a full day. People are different, but even 2.5L/day is a little low for many healthy adults. This may be their way of getting you to make sure you're staying hydrated but framing it as a health necessity rather than just a recommendation. Even without the medication, 2L is probably a bare minimum for most people.
This might piss off some of the hydro-homies out there but when talking about water in this context it's also important to remember that food often contains more hydration than most people give it credit for. Even "dry" foods can end up being like 50% water by weight, and something like soup is obviously very close to 100% water, so people who overcompensate by trying to drink like 8L of straight water a day can easily get themselves into serious trouble, and water poisoning is actually a real thing that can happen. I think the least controversial take is that for most people, drinking when you're thirsty is totally sufficient to maintain adequate hydration unless you're in an extreme situation or you have a personal predisposition towards chronic dehydration. I'm not a big fan of the overgeneralized advice that everyone needs to constantly drink "X" much every day.
I can drink 5L on hot days without any increase in peeing. On a cold day I only drink 2.
Have you discovered how sweating works?
Im not a doctor. Adequate hydration (probably) increases flow, or your doctor thinks youre dehydrated, or the medication causes dehydration.
Without knowing which medication, there can only be speculation as to why it requires a specific quantity of water. And even then, the best source of authority would be to ask the doctor for the reason.
Placebos? Docs trying to get you hydrated?
It might need to be fully dissolved in water to enter the bloodstream, otherwise it stays in the digestive track heading into the intestine and gets pooped out. But we're only able to guess if we don't know the medication.