What is the Best Time to Take My Medication?

Submitted by Dr Becky Wise

Chronotropy, or taking medication on a schedule that maximizes the efficacy of the medication, while allowing for a flexible dosing schedule that fits your lifestyle can be challenging. This is especially true when taking several different medications. However, understanding how your medication works and knowing the best time of day to take your medication will allow you to receive the most benefit.

Cholesterol:
“Statin’s” such as simvastatin (Zocor), atorvastatin (Lipitor), and rosuvastatin (Crestor) are considered first-line therapy for treating high cholesterol. This class of medication works by blocking the production of cholesterol by the liver. Since the majority of cholesterol made by the liver occurs at night, statins should typically be taken after your evening meal to decrease the amount of cholesterol produced by the liver. To aid in this process, you should avoid eating high-fat meals for dinner to reduce the building blocks used to produce cholesterol.

What is the Best Time to Take My Medication?
What is the Best Time to Take My Medication?

Thyroid:
Levothyroxine is the drug of choice to treat patients with hypothyroidism. Since levothyroxine is poorly absorbed and interacts with several other foods or medications, levothyroxine should be taken in the morning at least 30-60 minutes before breakfast. This will allow your body to maximize the amount of drug that is absorbed, since food slows this process down. However, there is some evidence that taking levothyroxine every night at bedtime, 4-6 hours after a meal, may be beneficial as well. Since GI motility is slowest at night, this may increase the amount of time the medication is in the GI tract thus increasing absorption. Therefore, if taking levothyroxine in the morning interferes with your schedule, nighttime dosing may be an appropriate option.

As mentioned, there are several drug and food interactions that can affect the absorption of levothyroxine. This includes antacids, vitamins, milk, fortified orange juice, or other supplements that may contain calcium, iron, folate, or vitamins A, D, E, or K. Levothyroxine should not be taken within 4 hours of these products (4 hours before or after). So, if you take a Multivitamin every day take your levothyroxine every morning and your vitamin around lunch time or later.

Absorption is also variable between different manufacturers. So, once your thyroid levels are normalized, it is important to continue taking medication from the same manufacturer. If your pharmacy changes it to a different generic product, be sure to question what effects, if any, you should watch for.

Heartburn (GERD):
Proton-pump inhibitors like omeprazole (Prilosec), esomeprazole (Nexium), or lansoprazole (Prevacid) and H-2 antagonists like ranitidine (Zantac), famotidine (Pepcid), or cimetidine (Tagamet) are commonly used to treat symptoms associated with heartburn. These medications reduce the amount of acid produced by your stomach so the condition becomes manageable and less painful. For patients suffering from nighttime acid reflux while lying down/sleeping, these medications are best taken 30-60 minutes before your evening meal. This will help prevent acid reflux/heartburn both after your meal, and the effects will last to the time in which your stomach increases acid production (10 p.m.-2 a.m.). However, if your heartburn is more prevalent during the daytime, taking your medication 30-60 minutes before breakfast may be a better option.

Hypertension
Typically, blood pressure is higher during the day and lower at night while we are sleeping. However, as we age (>55) this rhythm typically changes so that our blood pressure no longer dips at night while we are sleeping. This change is a risk factor for stroke, heart attack and kidney disease. Thus, ACE inhibitors (such as Lisinopril or Enalapril) and ARB’s (such as Losartan or Irbasartan) are best if taken at bedtime due to the time it takes for these medications to reach effective levels. Taking these medications at night can normalize your blood pressure and potentially decrease risk factors associated with “non-dipping.” However, if taking an ACE inhibitor or ARB in combination with a diuretic such as hydrochlorothiazide (HCTZ) nighttime dosing should be avoided to prevent poor sleep patterns because of multiple trips to the bathroom. These medications are generally dosed in the morning or before lunch.

Arthritis
There are two common types of arthritis, osteoarthritis and rheumatoid arthritis. With osteoarthritis, pain symptoms vary throughout the day as we begin to move around whereas rheumatoid arthritis pain symptoms are worse in the morning upon wakening. NSAIDs such as ibuprofen and naproxen are common treatment options for both types of arthritis. Since the onset of pain symptoms are different, so are the recommended dosing for each. Typically NSAIDs should be taken 4-6 hours before the pain is at its worst. Therefore, dosing for osteoarthritis will vary throughout the day depending on when you experience the most pain. But, for Rheumatoid arthritis, NSAIDs are typically taken before bed to provide symptom relief upon wakening.

Asthma:
Asthma medications reduce inflammation and relax airways to prevent an exacerbation or “attack”. These attacks occur 50-100 times more likely during early morning hours. So, based on the time to effect, oral medications such as Singulair should be taken midafternoon and inhaled steroids such as budesonide and fluticasone should be taken late afternoon. Rescue inhalers have a very rapid action so they should be used immediately upon onset of symptoms.

Timing to avoid side effects:
In addition, the side effects you experience from a medication may be a determining factor for when you take a certain medication. For example, if a medication tends to make you sleepy, you want to wait until bedtime to take that medication. On the other hand, if a medication is stimulating, keeping you awake, you want to take that earlier in the day so that you are able to sleep at night. Also, if a medication make you nauseous, ask a pharmacist if you should take it with food, or right before bed.

Take home message:
Although these may be the “best effectiveness times”, the best time of day for a medication may be the time that fits into your schedule. Compliance to your therapy regimen is important and all of your medications should be taken on a consistent schedule. If you miss the time you normally take your medicine, whether or not you take it is different depending on the drug. How long it is until your next scheduled dose, the time to peak effective concentration in your body, and how much of it “builds up” in your system are all considerations that must be weighed before making the decision to “double up” on the dose or just skip it. It is best to ask your pharmacist about the “rules” for every medication you take – especially if you don’t keep a regular schedule.

Knowing about the “best” time is good information, but if you keep forgetting to take it at that time, you aren’t getting the benefit anyway. So, set up a schedule and take it when you will remember. But, tell your physician and pharmacist WHEN you take it and how often you forget it. This is important to know your medicine is not working for your body, or for your lifestyle.

Written by Jennifer Hammons, PharmD Candidate LECOM School of Pharmacy Class of 2016.

Be Well, Be Wise,
Dr.Becky

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Dr. Rebecca Wise

Wise Words…. is a general medical information column from Dr Rebecca Wise. Dr. Wise has a master’s degree in education as well as her doctorate in pharmacy. She is an assistant professor and ambulatory care specialist at a Medication Therapy Management (MTM) clinic in Erie, PA.

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com
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