Whether to take this medicine before or after meals” is a question often asked by patients, but the scientific use of drugs requires more than just the time. Choose the right time to take a certain drug, sometimes not only to improve the efficacy, but also to reduce the side effects of drugs.
1, antibiotics
It is advisable to take them before meals, so that the drug is not mixed and diluted by the food in the stomach more, and can play a better efficacy.
In addition to amoxicillin, sparfloxacin is almost unaffected by food, the absorption of other drugs are affected by food, the bioavailability of high before meals, but most of these drugs have certain side effects on the gastrointestinal tract, so you can choose to take half an hour before or after meals according to the situation; some drugs such as furantoin, metronidazole, erythromycin, ethambutol, rifampin, etc., because of the gastrointestinal side effects, the patient Some drugs such as furantoin, metronidazole, erythromycin, ethambutol, rifampicin, etc., can be taken immediately after meals because of large gastrointestinal side effects and patients cannot tolerate.
2.Antipyretic and analgesic drugs
Usually taken at noon, because 11-12 a.m. is the time when the body is most sensitive to pain. Morphine and dulcolax have the best analgesic effect when used at 9:00 pm. Aspirin, on the other hand, can be effective and long-lasting when taken around 7 a.m. (after a meal), and less effective if taken at 6 p.m. and 10 p.m. As for anti-arthritis drugs, extended-release drugs that relieve pain and inflammation once a day for patients with rheumatoid arthritis should be taken in the evening as appropriate. And osteoarthritis patients should take the drug in the morning or noon.
3, cardiac glycosides drugs
Patients with heart failure have the highest sensitivity to cardiac glycosides such as digitalis, digoxin, and trichothecene C at around 4:00 am. The effect of the drug at this time is 40 times more effective than other times. If the conventional dose is used, it is very easy to be poisoned, so this time to give cardiac glycosides must consider the dose of drugs and toxic side effects.
Digoxin is taken at 8:00-10:00, the peak blood concentration is slightly lower, but the bioavailability and effect is the largest; 14:00-16:00, the peak blood concentration is high and the bioavailability is low, so digoxin taken in the morning can not only increase the efficacy, but also reduce its toxic effects.
4.Statin drugs
These drugs inhibit the synthesis of cholesterol in the liver by inhibiting hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase, and also enhance the expression of low-density lipoprotein receptors in hepatocyte membranes, so that the concentration of serum cholesterol and low-density lipoprotein cholesterol can be reduced.
Since cholesterol is mainly synthesized at night, nighttime administration is more effective than daytime administration. For example, simvastatin, fluvastatin, lovastatin, atorvastatin calcium, etc., are more effective when given at night than three times a day.
5.Anti-hypertensive drugs
In a 24-hour day, blood pressure is highest at 9:00-11:00 and 16:00-18:00, and starts to fall slowly from 18:00 to the lowest at 2:00-3:00 the next morning. Therefore, hemorrhagic strokes tend to occur during the day, while ischemic strokes tend to occur at night.
Patients with mild hypertension should not take medication at night before going to sleep, and patients with moderate to severe hypertension should only take one-third of the daytime amount, because taking medication at night for physiological hypotension lowers blood pressure, which leads to insufficient blood supply to the cerebral arteries and the formation of cerebral thrombosis on the basis of cerebral atherosclerosis.
Antihypertensive drugs taken once a day (including controlled-release preparations) are mostly administered at 7:00 pm.
For antihypertensive drugs taken twice a day, two doses at 7:00 a.m. and 14:00 p.m. are appropriate, so that the peak time of drug action coincides with the two peak periods of natural fluctuations in blood pressure.
Alpha-blockers (such as terazosin and doxazosin) are often administered at bedtime because they cause postural hypotension. Blood pressure medication lowers blood pressure, which leads to insufficient blood supply to the cerebral arteries and the formation of cerebral thrombosis on the basis of cerebral atherosclerosis.
6, hypoglycemic drugs
Diabetic patients are most sensitive to insulin in the early morning, when the amount of insulin injection is small and effective. Methylglyoxaline (D860) is taken orally at 8:00 a.m., the effect is strong and long-lasting, and it takes a large dose in the afternoon to get the same effect.
7.Cholesterol-lowering drugs
Since the production of cholesterol and other blood lipids in the body increases in the evening, it is advisable for patients to take cholesterol-lowering drugs at dinner time.
8.Anti-asthma drugs
The ventilation function of asthma patients has obvious circadian rhythm, the airway resistance is the smallest during the day and the largest at 0:00 to 2:00 a.m. Therefore, asthma patients often develop or deteriorate at night or in the early morning. And early morning asthma patients are most sensitive to acetylcholine and histamine.
Anti-asthmatic aminophylline extended-release tablets, long-acting β2 agonists (bambuterol, procaterol), and leukotriene receptor antagonists (montelukast sodium) are significantly more effective in calming asthma when taken once a night at 0.5 hours before bedtime than when given twice a day.
9. Anti-allergic drugs
If Cycloheximide is taken at around 7:00 a.m., it can maintain its effect for 15-17 hours, while if it is taken at 7:00 p.m., it can only last for 6-8 hours. Paracetamol and Benadryl should be taken half an hour before bedtime to reduce the impact of side effects such as drowsiness on life.
The treatment of skin allergy drugs, such as Xyosmin, Tefenadin, paracetamol, etc., can be taken half an hour before bedtime, as it has a partly hypnotic effect.
10, anti-angina drugs
The peak circadian rhythm of angina attack is from 6:00 a.m. to 12:00 p.m., and there is also a circadian rhythm in the efficacy of drugs for angina.
Calcium antagonists, nitrates and beta-blockers used in the morning can significantly dilate coronary arteries and improve myocardial ischemia, while the intensity of the effect of taking them in the afternoon is not as strong as the former. Therefore, it is best for angina patients to take anti-anginal drugs immediately upon waking up in the morning. As amlodipine and lenopril have a slow onset of action, their peak blood time takes 6-12h and 7h respectively, if given before bedtime, the peak blood time can appear in the early morning.
11.Anti-tumor drugs
Tumor cells and normal cells have different biological clocks. Tumor cells grow most vigorously at 10:00am, and the second growth peak is at 22:00-23:00am, while normal cells grow fastest at 16:00am. Therefore, chemotherapy at 10:00am/midnight 22:00-23:00am has the highest killing power to tumor cells and the lowest damage rate to normal cells. Therefore, some people proposed the “zero point chemotherapy” drug delivery scheme, that is, to give chemotherapy drugs at midnight.
12.Glucocorticoid drugs
The peak secretion of human hormone is between 7:00 and 8:00 in the morning, and then drops rapidly by about 1/2 after 2-3 hours, and then gradually decreases until the least amount is secreted at midnight.
The dose for one day is given at 7:00-8:00 a.m. or once every other morning at 7:00-8:00 a.m., which can reduce the feedback inhibition of hypothalamic-pituitary-adrenocortical system and reduce the serious consequences of declining adrenocortical function and even cortical atrophy, and the incidence of peptic ulcer bleeding is reduced, and the chance of concurrent infection is also reduced.
13, digestive system drugs
Antacids: such as magnesium aluminum carbonate (Daxi), sodium bicarbonate tablets, rhubarb soda tablets, etc. Taken one hour after meals, can effectively neutralize the gastric acid secreted after meals.
H2 receptor blockers: such as Tegretol, ranitidine, famotidine, etc. They can be taken half an hour after breakfast and at bedtime if taken twice a day, or at bedtime if taken once a day. This can effectively inhibit the secretion of gastric acid at night and after meals.
Proton pump inhibitors: such as omeprazole. It is advisable to take 15-30 minutes before breakfast because the concentration of gastric acid is high at that time, and omeprazole is an inactive precursor which can be converted into active form only in acidic environment. The maximum inhibitory effect on gastric acid secretion can be achieved by taking it before breakfast. If taken twice a day, it is added before bedtime.
Gastric mucosa protective drugs: such as aluminum thioglycollate, bismuth potassium citrate, etc. It should be taken half an hour to one hour before meals or before bedtime, which is good for protecting the gastric mucosa. If taken with antacids before bedtime, they should be separated by at least half an hour and taken after antacids.
Gastrointestinal propellants: such as cisapride, domperidone, etc. should be taken half an hour before meals.
Digestive aids: such as multi-enzyme tablets, Combi body, etc. Should be taken at mealtime, because pancreatic enzymes are easily destroyed by stomach acid.
14.Antispasmodic drugs
Such as atropine, belladonna, pivetonium bromide, etc. Should be taken before or during meals.
15.Laxative drugs
Salt laxatives (such as magnesium sulfate, castor oil, etc.), should be taken in the morning on an empty stomach. Because of salt laxatives through the local action to cause intestinal peristalsis to enhance and accelerate defecation, and the effect occurs quickly.
Plant laxatives (such as rhubarb, senna, etc.) and fruit guide tablets, etc., often taken before bedtime, about 8-12 hours to play a role, just in the next day defecation.
16.Biliary drugs
Should be taken before meals, the need to play a local therapeutic role in the gastrointestinal tract drugs
17.Calcium medication
Human blood calcium levels are lowest between midnight and early morning, so calcium supplements taken before bedtime can make calcium fully absorbed.
18.Iron supplements
The absorption rate of iron supplements for anemic patients is 1 times higher at 7:00 p.m. than at 7:00 a.m. Therefore, iron supplements for anemic patients should be taken at around 7:00 p.m.
19.Vitamins
Generally, they should be taken between meals. When vitamin K is used to stop bleeding, it should be taken in time. Antibiotics, because of the fast excretion, in order to maintain a certain concentration in the blood, should be taken every 6 hours.
Vitamins A, D and E should be taken immediately after meals because they are fat-soluble and oil-based foods help absorption.
Vitamin B1 and B2 should be taken during or after meals, although they are water soluble, but because the small intestine has a special absorption function for them, taking them after meals can improve the absorption rate, while vitamin C is also absorbed in the small intestine, but it will destroy the vitamin B12 in food, taking them one hour after meals can effectively avoid them.