Dr. Oz’s pronouncements that I usually pay attention to for amusement has an article in this month’s Parade Magazine that is right on. The following is what I think about timing meds.
“Unfortunately, there’s a disconnect between what’s taught to doctors and what we know from chronotherapy research [when to take meds],” says circadian biologist Georgios Paschos of the University of Pennsylvania School of Medicine.1 “Except for a few conditions, clinical medicine hasn’t yet caught up with our findings.” Nevertheless, he predicts, this will change in the next decade or two. I propose to catch you up right now concerning the best way to organize your medical treatments.
What Dr. Paschos laments is that research investigating how to provide better medical results by timing medications is known but has not found its way into clinical medical practice. Delayed clinical application is not a new drawback; medicine broadly divides into two camps: physicians (MDs) who concentrate on providing and researching patient care and “basic scientists” (mainly PhDs) who concentrate on researching how our bodies work, how disease disrupts the workings, and how medicine works to correct disease. Having both degrees (MD, Ph.D.) and experience in both disciplines, I appreciate how both work and that their professional communications are primarily group-based. A while back, an attempt to bridge the information gap foraged for a season; it promoted basic science more rapidly being put into practice and was termed translational medicine. Nevertheless, we see medical communication still has gaps.
As mentioned earlier, when to take meds is rarely included with prescriptions. The drug labels tell you how many times a day to swallow them and occasionally advise you to take some with meals. However, our bodies have clocks that synchronize with sleep/wakefulness cycles. For instance, statins that lowers our cholesterol work by inhibiting the liver from making it. Our livers make the most cholesterol as we sleep; therefore statins are most effective when taken after the evening meal until bedtime. Cholesterol is necessary but not in excess; it is the foundational molecule to make a number of hormones, especially adrenal steroids and sex hormones. However, it is almost impossible, even with the most powerful statins, to lower cholesterol to a level that interferes with hormone production.
Next, especially with once a day meds, there is a drug concept that is important—drug absorption curve. Low dose aspirin is glazed with a retardant to keep it from dissolving in the stomach and causing erosions, which can bleed. Such are labeled enteric-coated or safety-coated. Enteric-coated, low-dose tablets are the recommended aspirins to take for wellbeing. Their major function is to prevent heart attacks, among other benefits, by partly disrupting the clotting mechanism. The optimal time to achieve the highest level of aspirin in the morning is to take aspirin at night.2 Taking coated aspirin at night makes sense because the greatest numbers of heart attacks and the most serious ones occur in the morning hours.3
People having arthritis pain should note when they have the worst episodes and time their NSAIDS pain meds four to six hours before. Usually, this means the arthritis meds should be taken in the mornings.
As mentioned, medicines that are taken once a day are termed extended-release (ER). Many meds are available in ER form. Usually, that is the more desirable form because their absorption and reduction are slower that meds that must be taken more often. Taken less often, they should be taken more regularly. I asked my doctor to arrange my meds so that I take them all once a day. ER meds concentration is lowest just after being taken. As a group, they should be taken at night because metabolism and a lot of risks decrease as we sleep.
Non-compliance is common in the elderly. One can forget to take meds or forget they have taken meds. A Pill Organizer will help prevent this. Develop a routine to ensure compliance. Just before going to turning off the lights and going to bed, I need to do three things: set up coffee, get nightly water poured, and take meds. I leave the meds on the counter when taken to assure me the next morning that they were taken. Establish a routine to take meds and stick to it. Pair it with other repetitive tasks so each reinforces the other. Also, your “smartphone” can be helpful in reminding as a backup when to take meds.
There are meds that should be taken with meals and others that should be taken on an empty stomach. It does not always hold true but a rule often applies that if the medication should be taken with meals, the pharmacist will place a label advising so on the prescription. If no label is present, take the medicine on an empty stomach; unless it upsets your stomach. Pain meds are rarely labeled because they usually are taken as needed, but some, especially narcotics, should be taken with food to avoid an upset stomach.
There are some foods that should be avoided when taking certain medicines. When taking blood thinners, one should memorize that considerable list of potentially harmful foods and supplements.
Grapefruit interacts with a number of meds.4 Particularly, grapefruit affects the absorption of cholesterol-lowering meds and some heart meds and may raise their levels in the blood dangerously high. If you are taking those meds, it would be wise to substitute other citrus and avoid grapefruit altogether.
The liver and kidneys eliminate medications; medications don’t just disappear. People with diseases of these organs likely will need to have doses reduced. When getting new prescriptions, patients with decreased function of these organs should remind the prescriber by saying, “Does this dosage take my kidney or liver problems into account?
1. Simon M. Timing When to Take Your Daily Medications. In: AARP Bulletin http://www.aarp.org/health/drugs-supplements/info-12-2013/timing-of-daily-medications-key.html; 2013.
2. Bonten TN, Saris A, van Oostrom MJ, et al. Effect of aspirin intake at bedtime versus on awakening on circadian rhythm of platelet reactivity. A randomised cross-over trial. Thrombosis and haemostasis 2014;112.
3. Suarez-Barrientos A, Lopez-Romero P, Vivas D, et al. Circadian variations of infarct size in acute myocardial infarction. Heart 2011;97:970-6.
4. Bailey DG. Grapefruit-medication interactions. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne 2013;185:507-8.
