Few doctors talk to their patients about the best time of day to take medication or 1 undergo surgery, but it can make a big difference. Examples…

If you have high blood pressure, it's usually best to take slow-release medication at bedtime. For osteoarthritis, your pain reliever needs to work hardest in the afternoon. Why does the timing matter?

Virtually every bodily function including blood pressure, heart rate and body temperature-is influenced by our circadian (24-hour) clocks. External factors, such as seasonal rhythms, also play a role in certain medical conditions.

For optimal results when treating...

High Blood Pressure

There are both daily and seasonal fluctuations in blood pressure. It's normal for systolic pressure top number) to drop several points during the warm months, then to rise again in winter. Cold weather is thought to trigger the release of substances known as catecholamines, which may raise blood pressure.

Most people experience a sharp rise about 10 to 25 points, systolic) in blood pressure when they first get up in the morning--this contributes to the morning peak in heart attacks.

Research shows that heart attacks are 40% to 50% more likely to occur during the first six hours after a person awakens than later in the day or during sleep. Blood pressure declines at night and reaches its lowest level during sleep.

With standard treatments for high blood pressure, a patient might experience consistent reductions in pressure, including during times when the reduction isn't needed.

For best results: Ask your doctor about taking a drug that works in sync with the daily rhythms of your blood pressure. For example the calcium channel blocker verapamil (such as Verelan PM) and timed-release diltiazem (Cardizem LA)..as well as the beta-blocker propranolol (InnoPran XL) are all designed to be taken at bedtime.

With each of these slow-release, long-acting drugs, none of the active ingredients is released during the first four hours. Most of the drug effects occur between 6 am and noon, when blood pressure tends to be most elevated.


Caused by inflammation due to wear and tear on the joints, osteoarthritis is almost always more painful late in the day after a full day of activity using damaged joints. A nonsteroidal antiinflammatory drug (NSAID), such as ibuprofen (Advil), is the most commonly recommended pain reliever with significant anti-inflammatory properties.

For best results: Ask your doctor about taking a dose at noon...again in the afternoon.. and at bedtime. This schedule allows drug levels to peak at about the same time that the symptoms are flaring.

Helpful: To help reduce the risk for NSAID side effects, such as gastrointestinal bleeding and ulcer, take each NSAID dose with food. Long-term use of NSAIDs has been linked to increased risk for heart attack, stroke and kidney disease, so if you regularly take an NSAID, discuss these potential risks with your physician. Also ask about taking occasional NSAID "drug holidays" (stopping use of the drug for a day or so each week). Do not discontinue any other drug without asking your doctor.

Rheumatoid Arthritis

NSAIDs also reduce pain caused by rheumatoid arthritis, an autoimmune disease in which the body's immune system "attacks" joints. This type of arthritis tends to hurt more in the morning. After the hormone cortisol, which suppresses the immune system, peaks at about 4 a.m. each day, the immune system reactivates, inflaming joints by 8 a.m. to 10 a.m.

For best results: Take your regular pain reliever dose at bedtime to help reduce morning pain and stiffness associated with rheumatoid arthritis. Taking the medication at night means that the drug reaches effective levels while you sleep, which helps reduce pain when you awaken. Keep another dose on your nightstand to take before getting up in the morning if necessary. Eat a few crackers first to help prevent stomach distress.


Physiological reactions that are more detrimental at night than in the morning are believed to play a role in both type 2 diabetes and metabolic syndrome-a constellation of conditions that includes insulin resistance in which the body's cells don't use insulin properly), abdominal obesity, high blood pressure and elevated LDL "bad" cholesterol.

The body produces and uses insulin most effectively in the daytime hours and its metabolism is most active during the day. The liver, pancreas and muscles are better able to utilize blood sugar (glucose) and burn calories when metabolism is high. Because metabolism slows at night, someone who eats a lot of snack foods, for example, at night will be unable to efficiently remove the resulting glucose and fats from the blood. Over time, this can cause a chronic rise in insulin and cholesterol and may lead to metabolic syndrome.

For best results: People with metabolic syndrome or diabetes (or those who are at increased risk for either condition due to obesity or high blood pressure) should synchronize their meals with their metabolic rhythms. Consume most of your calories early in the day. Eat a relatively light supper-for example, a piece of fish, a green salad and vegetables-preferably at least a few hours before going to bed. Diabetes drugs, such as insulin, should be taken in anticipation of daytime calories and carbohydrates.


Research has identified ways in which the circadian rhythm affects the toxicity and effectiveness of cancer treatments. For example…

  • Chemotherapy. In an important study involving patients with colon cancer, researchers found a measurable response rate of more than 50% in those treated at an optimal time, compared with only 32% in those treated at other times. Patients in both groups were given exactly the same drug and the same dose. The only difference was the timing of treatment.

What accounts for this difference? All cells undergo replication, repair and apoptosis (cell death) at predictable times of day. By pinpointing these times, doctors can deliver chemotherapeutic drugs when cancer cells are most vulnerable-and when healthy cells are more resistant to toxic effects.

For best results: Discuss the optimal timing of your chemotherapy with your oncologist, who will determine this, in part, based on the anticancer drugs used.

  • Cancer surgery. Several different studies have found that the timing of cancer surgery can significantly affect outcomes in women.

For example, research has found that performing breast cancer surgery in women shortly after ovulation can improve the cure frequency between two and two-and-a-half times. The reason may be that elevated progesterone (which coincides with ovulation) may inhibit the production of enzymes that facilitate the metastasis (spread) of cancer.

Conversely, during the first half of the menstrual cycle (the follicular phase), there may be an increase in angiogenesis, the growth of blood vessels that supply tumors. There also may be delays in cancer-cell death or changes in immune activity.

For best results: If you are a woman facing cancer surgery, discuss its timing within your menstrual cycle with your doctor. The optimal timing depends on the type of cancer and the individual patient.

Never Use a Spoon to Measure Meds

Mayo Clinic study participants were asked to pour one teaspoon of cold medicine into ordinary kitchen spoons. They either under- or overpoured mainly because kitchen spoons hold more or less than an official-sized teaspoon.

Best: Use a measuring cap or a dosing spoon when administering medication.

Where to Put Your Patch

For the medication in a transdermal patch I to work effectively, you must periodically alter the site. Where you place it and how often you move it depend on the particular drug being used. Each of the eight or so skin-patch medications on the market has its own specific guidelines, so be sure to read the instructions carefully and discuss correct usage with your doctor or pharmacist. You also must refer to the instructions if your patch becomes loose, falls off or is cut or punctured-otherwise, you may receive too small or too large a dose of medication.

FDA Warns Against Two Zicam Nasal Products

More than 100 people have reported losing their sense of smell after using intranasal zinc products. The FDA advises consumers to stop using and discard Zicam Cold Remedy Swabs (regular and kids size) and Zicam Cold Remedy Nasal Gel. The warning did not involve zinc taken orally.

For refunds: Contact Zicam, 877-942-2626, www.zicam.com/refunds.

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