Why the timing for taking your medicine matters

How the planned use of time in medicine and synchronised dosages help tackle illness effectively

Girl taking medicineDo you know that asthma strikes mainly at night, and heart attacks are most likely in the morning? And, that breast cancer surgery may be 30 per cent more effective when performed mid-way through the menstrual cycle; or, our cholesterol levels rise during winter, and so do the incidences of heart attacks?

Our bodies are marvellously skilled in maintaining balance. When our body’s temperature escalates, for instance, we sweat to cool down; or, when our blood pressure levels fall, our hearts pound to compensate.

Medical researchers are finding that almost everything from blood pressure to brain function varies rhythmically with the cycles of the sun, moon, and the seasons. What’s more, their insights are yielding new and better strategies: the planned use of time in medicine. This is called chronotherapy, or chronomedicine – zeroing-in on time as a strategy for medicinal treatment.

The inner clock

Chronotherapy is distinctly related to studying and interpreting our inner “timepiece:” the bio-clock, whose functioning is evident through the sleep-wake cycle. It is also closely associated with other mechanisms such as regulation of body temperature, tolerance to pain, sensitivity to drugs, hormonal levels, a variety of emotional deviations, at the time of new and full moon nights, and so on. Complex? Not at all, if only we examine the exact chemistry – whatever is known by way of history, theory, and scientific evidence – of the inner clock that runs us all.

What drives the bio-clock has fascinated mankind from the days of Aristotle. What we really know today is that every function of the bio-clock rises and falls with a kind of expected regularity, tuned as bio-rhythms are to a finer, as yet undiscovered, balance. So delicate is this balance that if a bio-clock goes wrong, it can lead to symptoms of depression, among other illnesses.

The existence of the bio-clock was first demonstrated by Erwin Bunning, in 1939. His research, confirmed by other investigators later, demonstrated that there existed a solitary, master circadian [circa = about; diem = day] clock in all animals, including man, coupled to a series of “subordinate oscillators.”

Research has shown that the pineal gland and its hormone, melatonin, are both needed for maintaining the normal phase and amplitude of different body rhythms and their synchronisation with one another. For example, the level of melatonin in depressed patients has revealed not only decreased values, but also a marked variation in body rhythms.

Melatonin is a chemical messenger. It functions as a chrono-biotic substance: one which has the capacity to reset desynchronised bodily rhythms back to normal by penetrating though all cells and tissues. One outstanding example of the mechanism is “jet-lag,” which, in real terms, is the inability of the air traveller to resynchronise his/her body rhythms with the time of his/her destination, immediately. This is precisely the reason why melatonin has become a sort of a craze, as a low-dose supplement, for reducing “jet-lag” without the hazards, or side-effects, of prescription sleeping pills.

Cyclical tempo

It’s all about cyclical tempo, or regularity, that makes us tick as a species, including the ability to correct bio-clocks that have gone wrong for whatever reason. It’s also not without reason that Frank Brown, after a lifetime of research in the field, was led to the conclusion that many different, subtle geophysical factors, including cyclical changes of the geomagnetic field, could be used by a variety of animals, including man, to reset their internal bio-clocks. In other words, this could relate to the time of the tides, or the day, the phases of the moon, the time of the year etc.

Heed to Your Rhythm

Chronotherapy is rapidly expanding. Its premise: by heeding to the body’s rhythms, you can make medical treatment less toxic – and, more effective. Take for instance, asthma, which has a preference to taking its victim for a bumpy ride, during the night, when mucous production increases, airways narrow, and inflammatory cells work overtime.

Why does this happen? Most patients strive to keep a constant level of medicine in their blood: day and night, with small doses. Studies have shown that a large medicinal dose of any asthmatic medication can be as safe as multiple small doses, and even better for warding off night-time attacks. An identical practice holds good for high blood pressure, which has an inclination to making its presence felt at dawn.

Heart attacks are twice as common at 9 am as at 11 pm. Reason: our blood pressure falls at night, and then peaks as we gear ourselves for the day. Let’s say your blood pressure drugs provide 20-22 hours of relief, which most do, if you had taken them in the morning then they are least effective towards the night.

It’s, therefore, much better, even mandatory, as experts suggest, sticking to a specific time for taking your tablet. Suppose, you take your pill at 8 am, it is working till 10 am; but, by that time you’ve gone through a bad four hours of the day without any protection whatsoever. Bed-time dosage is, therefore, suggested to prevent such a snag.

So, what’s the best option? An anti-hypertensive drug, for instance, or a long-acting tablet, which releases no medication until four hours after it is ingested.

By taking the medication at bed-time, you get peak protection during dawn while averting the usual weaknesses of night-time dosing.

Rajgopal Nidamboor
Dr Rajgopal Nidamboor, a trained physician, is a writer, commentator, and author. In a career spanning 25 years, Nidamboor has published over 2,000 articles, on a variety of subjects, two coffee table books, an E-book, and a primer on therapeutics, aside from an encyclopaedic treatise on Indian philosophy.


Please enter your comment!
Please enter your name here