As Jenny stepped on the bathroom scale she held her breath. If the glowing red numbers at her feet weren’t lying, she’d gained another pound!
Ten months ago the cramps and diarrhea of her Crohn’s disease were out of control so her rheumatologist at the Virginia Mason clinic in Seattle started her on a new medicine called prednisone. Taking it every day had solved her intestinal problems, but at a price: a raging appetite along with ballooning hips, puffy cheeks and sinking self-confidence.
They’d tried to cut her prednisone dose back several times but each time the cramps and bloody diarrhea came roaring back. Finally she’d had enough and went back to Virginia Mason to insist they take her off the prednisone no matter what before she turned into the Incredible Hulk.
Her doctor agreed. “But this time, before we try to taper it let’s move half of your prednisone dose to the evening first.”
“But I’m already taking the prednisone in the evening.”
“What? When did you start taking it in the evening?”
“I started taking it in the morning but it really upset my stomach so I ended up switching it to dinnertime instead.”
“No wonder we couldn’t get your prednisone dose down!”
Who knew taking a medicine at a certain time could be so important?
How about you? Are you taking your medicine at the “right” time? With some medicines it can make a big difference in how effective the medicine is or how much you are bothered with side effects. Some medicines should be taken on an empty stomach to help you absorb each dose, while others are best taken with food to avoid stomach upset. And a few medicines are more potent if taken at a particular time of day.
When instructed to take a medicine on an empty stomach you should take it at least 30 minutes before eating or 2-3 hours afterward. The thyroid replacement medicine levothyroxine and the stomach acid blocking medicine omeprazole work best if you take them first thing in the morning, about 30 minutes before breakfast. With the bone building medicines alendronate (Fosamax®) or risendronate (Actonel®) even plain coffee can interfere with getting it into your body.
Most medicines should be taken with food. Stomach upset is the most common side effect reported by people taking medicine in clinical trials, where they keep track of every possible side effect. Unless told otherwise, it’s much easier on your stomach to take medicines with food, especially antibiotics, vitamins and minerals. Many antibiotics can cause nausea, cramps and vomiting if they’re all alone in your stomach. A common diabetes drug called metformin (Glucophage®) is notorious for causing nausea and diarrhea. The popular pain medicines naproxen (Aleve®) and ibuprofen (Motrin®) are very irritating to the stomach, causing cause stomach pain and even bleeding if taken without food or a full glass of water to dilute their irritating effect.
Some cholesterol medicines are more potent if you take them late in the day. Medicines like atorvastatin (Lipitor®) or simvastatin (Zocor®) called “statins” are examples of this. Statin medicines work by blocking the last step needed to make cholesterol, and because your body makes cholesterol at night, statin medicines drop your cholesterol better if you take them in the evening or at bedtime.
Why did Jenny have trouble tapering her prednisone when she took it in the evening? Your body makes an important hormone called cortisol. Cortisol helps you respond to stress, and you make more of it or less of it depending on how much is needed and how much is already in your body. If you take prednisone your body “sees” it as having extra cortisol around so it decreases the amount it makes the next day. As you continue on prednisone over time your body makes less and less cortisol, which can leave you vulnerable when you need large amounts of cortisol quickly to response to stress like a serious infection. When stopping prednisone it can take weeks to months for your body to recover from its lowered cortisol production.
Taking prednisone in the morning minimizes the impact it has on your own cortisol production, making it easier to taper the dose. After moving her prednisone dose from dinnertime to breakfast Jenny was finally able to get off it completely. And now she smiles when she sees the red glowing numbers on her scale each week.
What time is the best time for you to take your medicine?
