Drugs in this class include Protonix, Prilosec, Nexium, Aciphex and Prevacid. These medications are usually taken once daily but can be dosed twice daily in more severe cases. These medications work best if they are taken 30 minutes before a meal. The reason for this is because these medications only inhibit the acid pumps in the stomach that are active.
Stomach acid is stimulated when food is ingested to aid in digestion. Taking the medications 30 minutes before food ensures that there will be peak concentrations of the drug in your body when the acid pumps are most active. It's important to note that it can take up to 3 or 4 days of daily dosing before they'll have full benefit. This is because not all proton pumps are inactivated with the first dose.
Our blood pressure does not stay consistent throughout the day. In fact, it follows a fairly predictable 24 hour pattern. The most concerning part of the blood pressure pattern is what happens while we are sleeping. During sleep, our blood pressure dips to it's lowest point of the day. It then later begins to increase around 4 to 6 AM and generally continues to increase throughout the day.
There is a significant population (called "non-dippers") of people whose blood pressure does NOT dip significantly during the evening. It is thought the risk of negative cardiac events is the greatest in the early morning and in those "non-dippers". Most people take their blood pressure medications in later morning and therefore don't have the greatest control of blood pressure when it matters most.
There is good amount of evidence that suggests that taking blood pressure medications at bedtime not only improves blood pressure numbers, it may reduce the risk of heart attack and stroke! Now, only certain medications have good evidence for night time dosing. These drugs include ACE-Inhibitors (drugs that end in "pril"), ARBs (drugs that end in "sartan") & calcium channel blockers. Diuretic medications, also known as water pills, should continue to be taken in the morning as they cause fluid loss and could increase the need to use the restroom at night if they are taken before bed.
Statin Cholesterol Medication
The statin medication class is currently the most effective drug class available to treat high cholesterol. The most significant contributing factor to our blood cholesterol levels is in fact not the cholesterol we take in from our diet, but actually the cholesterol that our own body makes. The statin medications reduce the amount of cholesterol that is created by the liver.
Most statin medications don't last very long in the body, certainly not 24 hours. It is therefore usually recommended to take them in the evening, when our body is most actively making cholesterol for peak effect. Two statin medications that don't follow this recommendation are Lipitor (Atorvastatin) and Crestor (Rosuvastatin) as they last a very long time in the body and the time of dosing therefore does not matter as much.
Levothyroxine For Hypothyroidism
Medications for thyroid replacement come in extremely small dosages. Most medications are measured in milligrams, or 1/1000th of a gram. Levothyroxine is measured in micrograms, or 1/1000 of a milligram! A small change in how the medications is absorbed can cause drastic changes in your thyroid level. For this reason it is extremely important to take levothyroxine consistently. The most common recommendation is to take it first thing in the morning, 30 minutes before food or other medications. Again, the most important thing is to stay consistent in how you take the medication in order to get consistent blood levels!
Biphosphonates For Osteoporosis
Bisphosphonates are a class of medications that are the primary treatment for osteoporosis. They include Fosamax (Alendronate), Boniva (ibandronate), and Actonel (Risedronate). Due to absorption issues, they should be taken first thing in the morning, 30 minutes before other medication or food. The only exception to this is a delayed release form of Actonel known as Atelvia, which should be taken immediately after breakfast.
To Eat Or Not To Eat
Most medications can be taken with or without food with no consequence. Many times it can help reduce nauseousness or diarrhea problems. There are certain situations however, where food can be a critical factor in how your medication is absorbed in your body.
Surprisingly enough, citrus juices can have a major impact on drug absorption in the body. They can significantly INCREASE or DECREASE drug levels, depending on the drug. Grapefruit juice specifically can INCREASE the amount of drug in your body by inhibiting a drug metabolizing enzyme in the liver known as CYP3A4. Drugs that affected by this include:
- Certain "Statin" cholesterol medications,
- Certain antibiotics such as clarithromycin
- Certain blood pressure medications like amlodipine.
Increased concentrations of the above medications in the body can possibly cause unwanted and harmful side effects. On the other hand, citrus juices can also inhibit a drug transporter known as OATP (organic anion transporting polypeptide). This transporter facilitates drug absorption and inhibition leads to less drug being absorbed by the body. Allegra (fexofenadine) is a popular drug that is affected by this interaction. Listen to a commercial for Allegra and you'll notice it says to avoid fruit juices like orange and grapefruit. Other medications affected by this include:
It's very important to not take grapefruit/citrus juices with these medications as the interactions can be significant.
Full Vs. Empty Stomach
As mentioned before, food can have alternating effects on medications. Here is a list of drugs that absolutely SHOULD be taken on a full stomach to enhance absorption of medication:
- Augmentin (Amoxicillin/Clavulanic Acid) Extended Release
Here is a list of medication that should be taken on an empty stomach to enhance absorption:
- Proton Pump Inhibitors (Prilosec, Prevacid etc.)
A common warning sticker you may see on your prescription bottle states that you should not take your medication with calcium or magnesium salts. This warning sticker is on medications that actually bind to what is know as cations, or positively charged ions. Calcium (Ca 2+), Magnesium (Mg 2+), Aluminum (Al 3+) and zinc (Zn 2+) are all positively charged cations which bind to certain medications, drastically reducing their absorption and effectiveness. It is important to avoid cation consumption with medications that interact. Calcium is commonly found in dairy products, antacids (TUMS) and multivitamins. Below is a partial list of medications that interact: