Do you know what’s the best time to take your pills?

I alike many other millions of us take medicine on a daily basis – no choice you see. However, do you or just how much attention do you pay to the time of day that you take your medication. Yet as always I read that an increasing number of experts say that it is far more important than we think — especially when it comes to arthritis and osteoporosis, as the time you take your medication can have a significant impact on the effectiveness of the medication and how well it then protects you. An increasing number of our medical and health experts are saying that the time you take your medication can have a significant impact. This understanding relates and means to patients who are on anticoagulants to prevent heart attacks and strokes could maximise the effect by taking the pills when they wake up. As it is thought that the key is the circadian rhythm, our very own 24-hour internal body clock driven by the brain’s hypothalamus gland. This controls not only our immune system but also our blood pressure, our body temperature, our hormone production, our bowel movements and even our tiredness. So given all this, what is the best time to take our medication? OSTEOPOROSIS The most commonly prescribed drugs for osteoporosis are bisphosphonates, which prevent the loss of bone mass. For more information on this, please click on: ‘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. HIGH BLOOD PRESSURE The article I read also said that possibly taking your blood-pressure tablets at night may in fact be better to control hypertension and reduce the risk of heart attack and stroke. The results of a 5year Spanish study highlighted the importance of reducing blood pressure at night. In healthy people blood pressure dips at night between 10-20% — 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% 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. For more information on this, please click here: ARTHRITIS Osteoarthritis patients are likely to find their joint pain the worst in the afternoon, according to a recent Texas Tech University study. The researchers concluded that the best time to take a non-steroidal anti-inflammatory drug such as ibuprofen would be around 12pm 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. For more information on this, please click here: 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 3 million people in Britain may suffer from an underactive thyroid — the majority of them are 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 apparently takes some time to occur within the body. Many doctors suggest that taking thyroid medication first thing in the morning is best. But 2 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. For more information, please click on the following link: HEART MEDICATION For some time it’s been known that heart attacks and strokes are 3 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.’ For more information, please click on the following link:

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