18 November, 2023

Time Your Medicines Right

Introduction:
I am reasonably certain that most of you have, at least once, wondered when is the right time to take your medicines. It happens to be the most common question asked of doctors. While the answer is not quite straightforward, there are certain thumb rules one can apply that work in most situations. This article addresses a few of those basic rules. The write-up is intended to provide you with basic insight and by no means replaces instructions written on medication strips/boxes or advice from a medical practitioner. It is always good to discuss with your doctor the type of medicines prescribed to you, their role, and the best way/time to consume them.

Morning vs Evening:
For many medicines, it doesn’t matter. Examples are once-daily antibiotics, vitamin tablets, and certain heart medications like aspirin and clopidogrel. For others, it depends on what is being treated.

Here is a list of certain medications and ideal times:
Levothyroxine: This should be taken on an empty stomach, with no food or drink for the next 1 hour.

Acid-reducing drugs (antacids): They come by various names: omeprazole, pantoprazole, rabeprazole, ranitidine etc. These medicines should be taken at least 30 minutes before meals. People whose acidity symptoms are mostly at night should take this 30 minutes before dinner.

Hypertension medications: Since our blood pressure is typically a few points higher during the daytime, medications taken in the morning will help control daytime blood pressure. If you are taking multiple medicines for hypertension, it is a good idea to take at least one of those at night-time. A few medications like Prazosin (also used for prostate problems) can cause dizziness upon standing and should be taken when the risk of dizziness/fall is the lowest.

Asthma/allergy medications taken in the morning may better control daytime symptoms. If the majority of the symptoms occur at night, then adjustments need to be made accordingly.

Diuretics (water pills): These medications remove excess water from the body by increasing urination frequency. Taken in the morning, they are better tolerated (as compared to the evening dose, which will interrupt sleep by requiring frequent bathroom trips).

Sedatives: Sleeping aids should obviously be taken before bedtime.

Laxatives: Medications for constipation typically take 4-6 hours to show their effect, so they should be timed accordingly.

Cholesterol medications: Studies suggest these medications might work better and be better tolerated at night.

*The above list is not exhaustive, but to give you an idea on how to time your medicine

Before vs After Food:
Food typically interferes with drug absorption, making them less efficacious. So, in theory, most medications should be taken before food (or on an empty stomach), with no food consumed at least 1 hour after that. Practically, medications are better tolerated with less nausea or stomach upset if taken after food. Also, except for a few, the effect of food on drug absorption is not very significant.

Medications recommended to be taken on an empty stomach include:
– Levothyroxine (as mentioned above)
– Acid-reducing medications
– Certain antibiotics: like Amoxicillin, Ampicillin
– Short-acting insulin (pre-meal insulin): this should be taken once the food is already served and good to go
– Oral diabetes medications should be taken with food (can be taken JUST before or after food)
– Drugs used for bone health called bisphosphonates (Alendronate for example)
– Weight loss drug Rybelsus (Semaglutide)

Medications recommended to be taken after food:
– Pain medications (analgesics)
– Aspirin
– Iron supplement tablets/syrup
– Potassium supplements
– Newer blood thinners like Dabigatran, Rivaroxaban
– Steroids like prednisone, dexamethasone etc.
– Oral therapies like mouthwash or oral antibiotic paint. If applied before food, these drugs will be swallowed prematurely.

Please note that while the above write-up can be a general guide, every drug therapy is tailored for a particular individual and should be used as per professional guidance. This article aims to give you an overview of how medications interact with time and food. Also, the information provided here is mostly for common medications. Specific treatment modalities require more comprehensive assessment and should be discussed with the treating provider.

Here are certain myths that should be addressed as well:
– Consuming medicines with warm or cold water doesn’t make any difference.
– There is no compelling reason to take any medicine with milk or any other liquid other than water.
Lying on the bed immediately after taking medicine may hurt your food pipe (oesophagus). To minimize the risk, it’s recommended to stay upright for some time, ideally for an hour at least. This is particularly true for bisphosphonates like Alendronate.
Asthma inhalers, blood pressure medications, diabetes medicines, including insulin, etc., do not make your body addicted to them. If you are prescribed these medications, that’s because your body needs them, and you are not able to get rid of them because the disease for which these medicines were prescribed in the first place is still present.

I am sure I didn’t answer all your questions on this topic. Feel free to message me with your queries; I will happily answer them.

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