A whopping three-quarters of Americans admit to not always taking their prescription medicines as directed, according to a report by the National Council on Patient Information and Education. “If you don’t take medicines as your doctor intended, you may not get better, and you may even get worse,” says Ilisa Bernstein, director of pharmacy affairs at the FDA. Here’s how to make sure your medicine goes down the right way:
Be honest with your doctor. Discuss any allergies or problems you’ve had with a medication before. Also, give a rundown of all the medicines you’re taking—prescription or over-the-counter. Mention supplements too: Herbs are natural, but they may lead to drug interactions. Ginkgo biloba can increase the risk of bleeding if taken with aspirin or medications that have anticoagulant properties. Antidepressants shouldn’t be combined with St. John’s wort. Even vitamins and minerals may not mix well with certain meds: Thyroid medicine binds to iron and won’t be absorbed if taken with an iron supplement. Something as simple as an antacid may block other drugs from being properly absorbed.
Come clean about your health habits as well. Smoking cigarettes can change the way your medicines work and can exacerbate any side effects. Mixing alcohol with particular meds can have serious consequences: Three or more drinks a day can lead to liver damage when paired with acetaminophen and can lead to stomach bleeding when paired with ibuprofen.
Don’t be embarrassed to ask for clarification. People confuse medications in countless ways, says Lisa Chavis, author of Ask Your Pharmacist. “One mother tried to refill a 10-day supply of her toddler’s liquid antibiotic after only two days. She told the pharmacist that every time she poured a teaspoonful into the baby’s ears, it came right back out.” That’s because the medication was supposed to be taken by mouth!
Research shows that patients forget more than half of the information they’re told right after they hear it, so bring a pen and paper into the doctor’s office. Discuss with your doctor exactly how you should take your medicine, what time of day you have to take it and for how long. Ask what you should do if you forget a dose: Skip it? Double up the next time? Always finish all of the medicine you are prescribed.
Finally, use only the dosing device that comes with liquid medicine. “Studies have found that household teaspoons range anywhere from 3 milliliters to 7.5 milliliters in size,” says Jan Engle, a pharmacy professor at the University of Illinois College of Pharmacy.
Double-check the label. A doctor’s sloppy handwriting can lead to mistakes, says a report from the Institute of Medicine (IOM). Before leaving the doc’s office, jot down the name of the medicine prescribed and why your doctor prescribed it. It’s also a good idea for the doctor to confirm this on the prescription pad (for example: “Pepcid, for acid reflux”), says Chavis. Look at the label after it’s filled and speak to the pharmacist if the names of the drugs don’t match. He may have substituted a generic for the brand-name drug.
Ask your doctor about electronic prescribing too. This enables a physician to send a prescription to your drugstore via computer. The IOM hopes that all doctors and pharmacies will be utilizing electronic prescriptions by the year 2010. Also, use the same pharmacy to buy all of your medicines so your pharmacist can keep tabs on you.
Understand the side effects. Yes, you really are supposed to read and keep the inserts that come with your drugs, says Ilisa Bernstein. “These inserts tell you what the drug is meant for, the side effects to expect and any potential interactions.” If you can’t bear to wade through the small print, ask your physician or pharmacist detailed questions. Have him highlight the most common side effects, when to call if you experience any of them, how soon you should start to feel better and what to do if you don’t notice any change. Also, find out if you should avoid certain foods and/or beverages. Grapefruit juice, for instance, can increase the strength of certain blood-pressure drugs and heighten the side effects of a fewcholesterol-lowering med
Don’t assume that more is better. If two tablets haven’t helped your hammering headache, another two won’t do any better. Most drugs have what’s called a “ceiling effect,” in which the body’s drug receptors reach their limit. “Exceeding the maximum dose only causes the drug to affect receptors elsewhere in your body, leading to unwanted side effects,” says Patrick J. McDonnell, associate professor of clinical pharmacy at Temple University School of Pharmacy in Philadelphia.
Don’t go above the maximum daily dose of any medication—and be careful of hidden ingredients. Acetaminophen, for example, is found in many prescription painkillers and in a number of multi-symptom cough and cold medicines. “When these drugs are taken together, patients may unknowingly overdose,” says McDonnell.
Never take another person’s prescription. Just because your throat is achy and you’re having trouble swallowing doesn’t mean you have the same strep throat as your husband. Even if you do, doctors take into account your age, weight, existing medical conditions and other drugs you’re on before writing a script. You may be allergic to that drug, or you may be taking a dose that’s suitable for him but not for you. And don’t beg your doctor for an antibiotic! Not only will it not clear up a cold, but the next time you actually need an antibiotic, it might not be effective.
Be diligent about organization. Take doses at the same time every day so it becomes a habit. Set the alarm on your watch, cell phone or BlackBerry to help you remember. You also can keep pill bottles near an object you use daily —like a coffeemaker or an alarm clock. If you feel yourself getting confused about what to take and when, speak to the pharmacist. She may suggest a pill sorter with compartments for different days or even different times of day. Your pharmacist also can color code the bottles or put symbols on them—a sun for a pill you take in the morning and a moon for bedtime pills.
Give Your Meds A Checkup
Store your medicines in a cool, dark and dry place—a bedside table or a shelf in a closet—and examine them at least once a year.
- Look at expiration dates and toss any medicines past their prime.
- Throw out medications that have changed color, formed a residue or developed a peculiar odor.
- Pitch any pills that seem crumbly or capsules that have opened.
- Discard any drugs with a missing or unreadable label on the bottle
When is the right time to take your pills?
While millions take medication every day, few of us pay much attention to the time of day we pop our pills.
Yet new research shows that timing is key to how well certain drugs work, including some used to treat osteoarthritis, cancer and asthma.
More than 60 drugs were found to be more effective at certain times of the day.
For instance, when used to treat symptoms of osteoarthritis, ibuprofen is most effective when taken between noon and 3pm; but if you have rheumatoid arthritis it's probably better to take it after an evening meal.
Some cancer therapies are up to four times more effective when given in the morning compared to the evening, while some cholesterol-lowering statins are best taken at night. .
best taken at night. The researchers ? from New York University ? says this is all down to our circadian clock. This is the 24-hour internal body clock ? driven by the hypothalamus gland in the brain ? which determines when we feel tired.
It also controls more than a hundred other functions, including body temperature, hormone production, blood pressure, bowel movements, alertness and the immune system. The peak time for each varies over the 24-hours.
So what is the best time for taking pills for your condition? Here, we reveal what researchers have found. (Always make sure that you consult your doctor before making any changes to the way you take prescribed medication.)
7am: High blood pressure BECAUSE blood pressure peaks in the morning, patients may benefit from early morning therapy.
A Chinese study found that taking a calcium channel-blocker drug, amlodipine, had a better effect when given at 7am than at 7pm.
Noon: Osteoarthritis PATIENTS with osteoarthritis may experience more pain at night and less during the day.
According to a Texas Tech University report, therapy with ibuprofen and similar drugs should be timed to ensure the highest blood levels of the drug coincide with peak pain.
For osteoarthritis sufferers, the optimal time for a non-steroidal anti-inflammatory drug such as ibuprofen would be around noon or mid-afternoon. That would make it active as symptoms begin to build-up.
3-4pm: Asthma
Night-time worsening of asthma is common, and the drop in lung functioning can be as much as 50 per cent.
This is because the circadian rhythm causes natural hormones to be at lower levels at night, which results in a reduction in the width of the airways.
'A single dose of inhaled steroid in the afternoon has a protective effect against asthma worsening that same night,' say researchers at the University of Sao Paulo.
Other research shows that a 3pm dose of prednisone, an asthma drug, was superior to the same drug given at 8am for improving overnight lung functioning and reducing airway inflammation.
4pm: Colds and flu
Fever and other symptoms of the common cold peak around this time, according to a study at Quebec University, so it is best to take any medication now or just before.
6-7pm: Heartburn
Researchers at Kansas University compared morning and evening use of rabeprazole, a proton pump inhibitor for gastrooesophageal reflux (GORD).
Symptoms were eased in 71 per cent of patients who had it in the afternoon and evening compared to 42 per cent of those who were given it in the morning.
8pm: Rheumatoid arthritis
Research has shown that rheumatoid arthritis patients experience the greatest pain in the mornings.
Taking ibuprofen just after the evening meal may be the most effective way to prevent pain developing overnight, say University of Texas-Tech researchers.
7-9pm: High cholesterol
Studies at the University of Sunderland and other centres show that evenings may be the best time to take simvastatin, one of the most widely used statins for lowering cholesterol.
When patients switched taking the drug from evening to morning, there was a significant increase in 'bad' LDL cholesterol.
7-9pm: Hay fever
According to a University of Colorado report, hay fever symptoms, including sneezing and nasal congestion, peak in the early morning.
This means evening therapy may be best, so that symptoms are treated overnight before they build-up.
10pm: Ulcers
Anti-ulcer drugs may be more effective at this time. Stomach acid levels vary during the day, and ulcer symptoms can peak in the evening and early morning.
Drugs called H2-receptor antagonists have been used as a treatment, and research by pharmacists at the University of Texas suggests bedtime dosing may be most effective.
http://www.dailymail.co.uk/health/article-566081/When-right-time-pills.html
The Best of Times, the Worst of Times
When during the day should you take your medication? Good question.
It takes more than $800 million and 10 years to develop a new drug. Researchers perform study after study, testing a potential new medicine in cell cultures, animals, and humans. They determine whether it treats the right problem safely; should be taken orally, nasally, intravenously, or intramuscularly; and set minimum and maximum doses. But most drug trials ignore a question that increasingly seems crucial: When is the best time of day to take a given medication?
Modern drug development generally assumes that the body maintains a stable internal state. To that end, many prescription drugs are designed to be taken in equal amounts at regular intervals to keep a patient's drug levels steady. The problem is that a growing body of research suggests that our bodies are not constant. Instead, nearly every physiological process oscillates with our internal circadian rhythms. The body's temperature, immune function, and hormone levels all partly depend on whether it's night or day, or sometime in between. Meanwhile, many diseases also have daily rhythms, with symptoms more severe at certain times.
The body's sensitivity to time of day means that a drug proven safe to take in the morning may not be safe at night, or that a dose that works at 8 p.m. may be too small at 8 a.m. Some of the first—and still most compelling—evidence for these time-related differences came from Franz Halberg, widely considered to be the father of chronobiology. In a 1959 experiment that became a classic in the field,Halberg showed that it was easier for mice to survive a toxic dose of ethanol at one time of day than at another. Since then, time of day has proven to be an important factor in the safety and effectiveness of drugs for asthma, high blood pressure, and other conditions.These principles even apply to run-of-the-mill pills like aspirin, which does less damage to the stomach lining when taken in the evening than in the morning. (Conveniently, aspirin is also better at reducing blood pressure when taken before bed.)
Despite this evidence of variation, drug research is almost always done during daylight hours, when the humans leading the studies are awake and alert. And in the animal testing stage, it's almost always done with mice and rats, which are nocturnal—the middle of ourdayis the middle of their night. This can lead to gross misestimations of the effectiveness and toxicity of a drug intended for humans. "How much time, effort and money have been wasted in this way we shall probably never know," chronobiologistJosephine Arendt wrote in her 1998 overview of biological rhythms and medicine.
Chronobiologists have tried—and failed—to change all of this. Several decades ago,Halberg led a delegation of scientists who met with FDA officials. "We recommended to the FDA commissioner that timing as well as dosing be considered in the administration of medications by a requirement in the package insert," Halberg wrote in a 2003 recounting of this effort. "The commissioner explicitly assured the delegation he would do something about it." But according to an assistant FDA commissioner who was a chronobiologist, Halberg says, after the delegation left, "the commissioner told the staff no more than to proceed with 'business as usual.' "
It doesn't help the chronobiologists' cause that they represent a small research niche in a mammoth industry.Unless drug companies think there's serious money at stake, they're unlikely to poke around in the lab just to see whether a new medication has time-related effects. Drug trials that consider chronobiology would be more complex and require more patients than the status quo. What's more, most medical professionals simply aren't aware of the extent to which the body's rhythms influence its response to medicine, Smolensky says. "There is no active conspiracy against chronomedicine," he writes in his book The Body Clock Guide to Better Health. "The biggest barrier is simply inertia."
Yet there are relatively easy ways to address the issue.Research has shown that nocturnal animals can reverse their usual biological rhythms if the rooms in which they are housed are kept relatively dark during the day and lighter at night. Drug studies should, at the very least, use animals on this adjusted schedule. Better yet, they could use two groups of rodents, a standard nocturnal set and another one on a reverse schedule. That way, scientists would be able to notice early on whether time affects how a drug works.
When it comes to human testing, the FDA could mandate small, early stage clinical trials with different groups of patients taking a drug at least three different times of day. If a certain drug turns out to have no time-related differences, we'll be reassured that it's safe to take anytime. Nobody knows precisely how many drugs exhibit time-related effects, but the number isn't tiny. Many different kinds of medications behave this way, and how important the variations are depends on factors like the seriousness of the illness being treated and the side effects of the medication.
Yes, these changes will require drug trials that are larger and more costly. But the return on investment could be huge in some areas. For instance, doctors have already successfully begun integrating circadian rhythms into cancer treatment. Chemotherapy causes its famously debilitating side effects because the drugs used are highly toxic to healthy as well as cancerous cells. It turns out, however, that based on the circadian rhythm, doctors can administer chemo at a time when malignant cells are more susceptible to the drugs than normal ones are. Such carefully timed treatment has been shown to help patients tolerate higher doses of chemo and survive longer. Cancer has become one of chronomedicine's biggest success stories. When will we hear about the next one? The clock is ticking.
http://www.slate.com/articles/health_and_science/medical_examiner/2007/11/the_best_of_times_the_worst_of_times.html
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