Pills to pop before breakfast

Proton pump inhibitors, which suppress acid production in the stomach, are widely prescribed for heartburn. The usual advice is to take them 30 minutes before breakfast, because eating causes acid to be to produced. However, recent studies suggest that these drugs may be more effective when taken before supper at night. A 2003 U.S. study by researchers at the University of Kansas School of Medicine found that heartburn sufferers who took a common PPI before their evening meal were far more likely to report relief in symptoms than those who took the drug in the morning. The theory is that taking them at night ensures that levels of stomach acid are low when the patient goes to bed –  lying prone can make heartburn worse because acid can ‘splash back’ into the oesophagus.

The theory is that taking them at night ensures that levels of stomach acid are low when the patient goes to bed – lying prone can make heartburn worse because acid can ‘splash back’ into the oesophagus.

Another pre-breakfast drug is alendronate, for the bone-thinning condition osteoporosis. ‘Sticking to this time ensures that there is no food in the stomach which can bind to the medication and prevent it working properly,’ says Sid Dajani, a community pharmacist and spokesman for the Royal Pharmaceutical Society.

Cancer drugs that get to work when you’re asleep

Cancer doctors are starting to look at how they can use the body clock to make chemotherapy more effective. One drug known as 5-fluorouracil, used to treat colorectal cancer, is now often given at night shortly before bedtime because this is when healthy cells seem to be at rest. One theory is that they are less likely to interact with the drug at night, leaving the abnormal, and more active, cancer cells to take the full onslaught. However more research is needed to establish cause and effect, says pharmacist Professor Franklin, who adds that exact treatment and timings should be based on a patient’s individual response and side-effects.

During sleep, the function of the digestion system is also markedly reduced. For this reason, it is best to take medications for chronic constipation, such as Lactulose and Fybogel, last thing at night, explains Sid Dajani.

‘The drugs work by irritating the bowel slightly and are slow acting. It helps that bowel movements have slowed right down at night so the drug can get to work. Eight hours later, the patient wakes and typically passes a bowel movement.’

Many people take multiple combinations of drugs, which can make complex timetables hard to follow.

Many people take multiple combinations of drugs, which can make complex timetables hard to follow.

‘Ideally, people should be able to take their medication all at the same time each day, like after brushing their teeth,’ explains pharmacist Sid Dajani. ‘Of course, this isn’t possible at the moment because of restrictions such as eating before or after meals, on waking or last thing at night.’ Controlled release drugs could be the answer. These are medications that are formulated to release their dose at different times of day — they have special coatings which break down at set times, allowing gradual release of active ingredients. Certain tablets already work in a similar way, such as propranolol for high blood pressure.

How can shift workers get their timings right?

Around 3.5 million people work shifts, which can throw their body clocks out of kilter and make hard to judge the best time to take prescribed drugs.

‘Certain drugs like lose-dose daily aspirin, which can be taken to reduce blood pressure, should ideally be taken when you wake because blood pressure rises when you wake up, whether that is 7am or 1pm,’ says Sid Dajani. However, it is better to take it regularly at the same time of day to ensure you don’t forget to take it.

Short acting statins should still be taken at night, whether that is the beginning or end of someone’s working day. And diuretics, which cause frequent trips to the loo, should be taken before a period of activity and wakefulness, whenever that falls in a 24 hour period. Shift workers should discuss their medications with their doctor ‘and perhaps arrange a drugs review with their pharmacist too’, adds Sid Dajani.

 

Thea Jourdan

Thea Jourdan is the founder and editorial director of Hippocratic Post as well as being Editor of Apothecary, the journal of the Worshipful Society of the Apothecaries of London, and a contributor to the Good Health section of the Daily Mail. She sits on the executive committee of the Medical Journalists’ Association.
Thea Jourdan

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