December 15, 2020
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Timing may improve potency and help you cope with side effects.
We all want our medicines to be as effective as possible, and that requires effort on our part. It may be necessary to avoid taking pills with certain foods or drinks, and to check that medications won’t interfere with each other.
And in some cases, it may be important to take a drug at a particular time of day. This approach, known as chronotherapy, is gaining attention as research suggests a relationship between when we take medications and how well they work.
Best at bedtime
Some drugs appear to work best if you take them at bedtime. That’s the case with certain statins, which inhibit the body’s production of cholesterol. “Some statins, such as fluvastatin [Lescol], lovastatin [Mevacor], and simvastatin [Zocor], don’t last long in the body. Take these at night, when the liver produces the most cholesterol. Other statins last longer in the body, even if taken early in the day, so the timing of those drugs is less important,” says Joshua Gagne, a pharmacist and epidemiologist with Harvard-affiliated Brigham and Women’s Hospital.
Blood pressure medicine may be another example. One reason: “Taking blood pressure medications at night may lead to peak drug levels the next morning, when heart attack risk is usually higher,” says Dr. Deepak Bhatt, a cardiologist and editor in chief of the Harvard Heart Letter.
If you take diuretics to treat high blood pressure, however, you may want to rethink taking a nighttime dose. Diuretics increase the need to urinate, which may interrupt sleep. See if taking a thiazide diuretic at bedtime interrupts your sleep. If not, it’s fine to take it at night, and that may help lower your blood pressure.
Another reason to take a medication at night is if it makes you sleepy, like the antidepressant trazodone (Desyrel). “Some antidepressants are sedating, which is helpful for people who have trouble getting to sleep. In fact, trazodone is more often used as a sleep medication than as an antidepressant these days,” says Dr. Michael Craig Miller, assistant professor of psychiatry at Harvard Medical School.
Better in the morning
Sometimes it’s better to take certain medicines in the morning. One reason is to help with absorption of a drug; it’s best if you take it before breakfast. “Food, beverages, and other medications can interfere with the body’s absorption of certain drugs, which reduce their effectiveness,” Gagne notes. An example is the class of drugs called bisphosphonates — such as alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel) — which are used to help prevent bone fractures in people with osteoporosis. “Take them first thing in the morning with a large glass of plain water, at least 30 minutes before eating or drinking anything or before taking any other medications,” Gagne advises.
Another reason to consider a morning dose is to avoid sleep difficulties at night. “The antidepressants called selective serotonin reuptake inhibitors, or SSRIs, are taken in the morning, because they can interfere with sleep, especially as you begin taking them,” Miller says.
What you should do
When your doctor prescribes a new medication, ask about the best time of day to take it for maximum effect. The proper timing for taking a pill can depend on many factors. An example: proton-pump inhibitors (PPIs) such as omeprazole (Prilosec, Zegerid), which block the production of stomach acid to reduce heartburn.
“PPIs really need to be taken on an empty stomach, 20 to 30 minutes before a meal, usually in the morning. But if you have mostly evening or nighttime symptoms, ask your doctor about taking omeprazole 20 to 30 minutes before dinner on an empty stomach, since none of the PPIs truly lasts 24 hours,” says Dr. Kyle Staller, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital.
If the timing of one medication doesn’t work for you, there’s probably another you can take at a different time of day. Consider migraine prevention drugs: “Tricyclics such as amitriptyline [Elavil] are generally recommended at bedtime because they tend to increase the amount of deep sleep. Topiramate [Topamax] can be taken in morning and evening hours,” says Dr. Sait Ashina, a neurologist who specializes in headache treatment at Harvard-affiliated Beth Israel Deaconess Medical Center.
Feeling overwhelmed? Get your doctor’s or pharmacist’s advice, and use a pillbox to stay organized. “Hopefully we can time it so the drug will be most effective,” Gagne says. “Ultimately, what’s most important is finding a time that ensures you’ll take your medications every day.”
Source: HARVARD MEDICAL SCHOOL
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