EDP column by Professor Ketan Dhatariya

“My GP has told me to take my pills just before I go to bed, but I keep forgetting. Is it really that important to keep to a certain time?”

This is a very common problem. Taking tablets at a certain time of day can be irritating and difficult. Sometimes it is easy to get into a routine – like taking tablets with your meals – but if you have to take tablets only occasionally – like antibiotics, then they can be easily forgotten. Lots of studies have shown that the more frequently a tablet has to be taken, the more chances there are of forgetting to take a dose. This is why doctors try and minimise the number of tablets they prescribe and try and give formulations of tablets that require as tablets to be taken as infrequently as possible

What determines how often a drug has to be taken? Essentially this comes down to the questions ‘how long does the drug remain in the system” or “how long does the effect last”? For some drugs, they hang around for ages – the technical term is that they have a ‘long half life’ and can be taken once a day or sometimes even once a week. Drugs that have a short ‘half life’ need to be taken more frequently maybe four or five times a day.

Lots of things can determine how fast a drug works, like taking it with or after food can delay the absorption of the drug as it will sit in the stomach for longer – although sometimes this is a good thing e.g. aspirin. Other time it is important to take tablets on an empty stomach, as food can interfere with the absorption of the drug e.g. some kinds of antibiotic. Timing of drugs is important. One important class of medication that is said to be better taken at night are the cholesterol lowering drugs called ‘statins’. These work by preventing the formation of cholesterol in the liver. Early studies with older drugs in this class suggested that there was a greater cholesterol lowering effect when the drugs were taken last thing at night, but repeating those studies with some of the newer drugs in the same class showed that this was no longer the case, but the practice has persisted and most doctors will encourage people to take them at night.

With other tablets, like the oral contraceptive pill, it is important to take it at the same time every day, as any delay can lead to a reduction in it’s effect.

However, my suggestion to you is that if you forget to take them at night, take them at a time you will remember to take them – something is better than nothing.