While millions of us
take medicine daily, few pay much attention to the time of day we take it.
Yet a growing number of
health experts say this is much more important than patients think — indeed
when it comes to conditions such as arthritis, osteoporosis and heartburn, the
time you have your medication can have a significant impact on its
effectiveness and how well it protects you.
New U.S. research,
published last week, seems to support this. A study of mice, published in the
journal Nature, identified why heart rhythm problems are more common in the
morning.
Experts
believe this understanding means patients who are on anticoagulants to prevent
heart attacks and strokes could maximise the effect by taking the pills when
they wake up.
It’s thought the key is
the circadian rhythm, our 24-hour internal body clock driven by the brain’s
hypothalamus gland. This controls not only the immune system but also blood
pressure, body temperature, hormone production, bowel movements and
tiredness.
So what’s the best time
to take your medication? We asked the experts...
OSTEOPOROSIS
The most commonly
prescribed drugs for osteoporosis are bisphosphonates, which prevent the loss
of bone mass.
‘The key thing with bisphosphonates is that they are poorly absorbed,’ says Sarah Leyland, senior nurse at the National Osteoporosis Society. This is because they do not dissolve well, especially in oils and fats. ‘So you need to take your pill first thing in the morning with water on an empty stomach after a night of not eating. Then patients must wait up to hour to eat or drink.’
Many osteoporosis
patients have to take calcium and vitamin D but these too can disrupt
absorption, so patients should also wait at least an hour after taking their
bisphosphonates, she adds.
‘If you eat or drink
something other than water, or take another medication, it could mean you won’t
get any benefit from it, so it could be a total waste of time taking it.’
HIGH BLOOD PRESSURE
Taking blood-pressure tablets at night may better control hypertension and greatly reduce the risk of heart attack and stroke, research published last year suggests.
While millions of us
take medicine daily, few pay much attention to the time of day we take it
The results of the
five-year Spanish study highlighted the importance of reducing blood pressure
at night. In healthy people blood pressure dips at night between 10 to 20 per
cent — those whose blood pressure doesn’t fall as it should are more likely to
suffer from heart attack and stroke, the researchers said.
In the study of 2,156
men and women with high blood pressure, those who routinely took at least one
of their blood-pressure medicines at night had a 33 per cent lower risk of
angina, stroke and heart attack than those who took all their blood-pressure
pills in the morning.
‘This study confirms
sleep-time blood pressure as the most relevant predictor of cardiovascular
risk,’ says lead researcher Ramon Hermida of the University of Vigo.
‘Sleep-time blood pressure is best reduced when medication is taken at
bedtime.’
However, those who now
take their pills in the morning should not begin taking them at night without
speaking with their doctor, says Hermida. ‘There’s a risk for nocturnal
hypotension (abnormally low blood pressure) which could increase the risk of
stroke,’ he adds.
ARTHRITIS
Osteoarthritis patients
are likely to find their joint pain is worst in the afternoon, according to a
recent Texas Tech University study. The researchers concluded that the optimal
time for taking a non-steroidal anti-inflammatory drug such as ibuprofen would
be around noon to mid-afternoon, so that it takes effect as symptoms begin to
build up.
They also found that
rheumatoid arthritis patients generally experience the greatest pain in the
mornings, so taking painkillers just after their evening meal may be the most
effective way to prevent pain developing overnight.
HIGH CHOLESTEROL
It is now recommended
that cholesterol medicines be taken at bedtime instead of first thing in the
morning. Studies at the University of Sunderland found that when patients
taking simvastatin, one of the most commonly prescribed statins, switched from
evening to morning, there was a significant increase in ‘bad’ LDL cholesterol.
Another study published
in the International Journal of Clinical Practice in 2008 revealed that taking
another commonly prescribed statin, atorvastatin (brand name Lipitor), in the
evening was better than taking it in the morning — it was associated with fewer
heart attacks, blockage of the arteries as well as greater improvements in total
‘good’ cholesterol and better blood vessel function. Experts think this
may be because most cholesterol is produced at night, while we are not eating.
UNDERACTIVE THYROID
As many as three million
people in Britain are said to suffer from an underactive thyroid — the majority
of them women. Most thyroid medicines contain levothyroxine, a synthetic
version of the thyroid hormone T4.
The T4 hormone needs to be first converted to the active form of thyroid hormone T3 for it to be effective. This takes a long time to occur inside the body.
The T4 hormone needs to be first converted to the active form of thyroid hormone T3 for it to be effective. This takes a long time to occur inside the body.
Traditionally, many
doctors suggest that taking thyroid medication first thing in the morning is
best. But two recent Dutch studies have found that taking medication at
bedtime rather than the morning results in ‘higher thyroid hormone
concentrations’. The researchers suggested that as the bowel is slower at
night, it takes longer for the levothyroxine tablet to move through the
intestinal system.
This results in longer
exposure to the intestinal wall, and so better absorption of the
medication. Other studies have shown that the key is taking thyroid
medication consistently at the same time each day. To ensure quick absorption,
doctors also advise avoiding calcium and iron supplements, high fibre foods,
antacids and antidepressants for at least two hours after taking a thyroid
pill.
HEART MEDICATION
For some time it’s been
known that heart attacks and strokes are three times more likely to happen in
the morning than any other time, but until now it’s not been clear
why. But research published last week by Case Western Reserve University
School of Medicine in Ohio has identified a protein called KLF15 that is
crucial in regulating the heart’s rhythm.
The researchers found
levels of the protein rise and fall in a 24-hour cycle. The heart’s electrical
impulses are slowest from 6am to noon. ‘As the duration between impulses slow
down, this makes the heart more likely to go out of rhythm, to short circuit or
for electrical storms to occur,’ says Professor Mukesh Jain, who led the
research.
This increases the risk
of a heart attack — which means that the best time to take heart medication is
first thing in the morning.
‘This realisation will
be one of the most important innovations in medicine in the next 20 years,’
says Professor Russell Foster, a circadian rhythms specialist at the University
of Oxford. ‘Certainly, if I was taking anti-stroke medication I know at
what time of the day I’d take it. It should be delivered before you properly
wake up. You should lie there calmly and take it, then get up.’
HEARTBURN
The general advice is to
take proton-pump inhibitors (PPIs, drugs which suppress acid production) 30
minutes before the first meal of the day.
However, a recent study by the University of Kansas found the drugs were more effective against acid reflux when taken in the evening. More than 70 per cent of patients with gastro-oesophageal reflux disease who took a commonly prescribed PPI, rabeprazole, in the afternoon or evening found their symptoms were eased, compared with 42 per cent who took it in the morning.
However, a recent study by the University of Kansas found the drugs were more effective against acid reflux when taken in the evening. More than 70 per cent of patients with gastro-oesophageal reflux disease who took a commonly prescribed PPI, rabeprazole, in the afternoon or evening found their symptoms were eased, compared with 42 per cent who took it in the morning.
They suggested this
could be because the drug will act throughout the night, when heartburn can be
exacerbated by lying down. They concluded that before the evening meal would be
the preferred time for patients to take their medication, particularly those
who suffer at night. However, Marcus Harbord, gastroenterologist at the
Chelsea and Westminster Hospital, suggests splitting the daily dose, providing
half in the morning then half in the evening, to keep symptoms at bay at all
times.
Source: Daily mail U.K