When during the day should you take your medication?

Health and medicine explained.
Nov. 1 2007 11:13 AM

The Best of Times, the Worst of Times

When during the day should you take your medication? Good question.

(Continued from Page 1)

Chronobiologists have tried—and failed—to change all of this. Several decades ago,Halberg led a delegation of scientists who met with FDA officials. "We recommended to the FDA commissioner that timing as well as dosing be considered in the administration of medications by a requirement in the package insert," Halberg wrote in a 2003 recounting of this effort. "The commissioner explicitly assured the delegation he would do something about it." But according to an assistant FDA commissioner who was a chronobiologist, Halberg says, after the delegation left, "the commissioner told the staff no more than to proceed with 'business as usual.' "

It doesn't help the chronobiologists' cause that they represent a small research niche in a mammoth industry.Unless drug companies think there's serious money at stake, they're unlikely to poke around in the lab just to see whether a new medication has time-related effects. Drug trials that consider chronobiology would be more complex and require more patients than the status quo. What's more, most medical professionals simply aren't aware of the extent to which the body's rhythms influence its response to medicine, Smolensky says. "There is no active conspiracy against chronomedicine," he writes in his book The Body Clock Guide to Better Health. "The biggest barrier is simply inertia."


Yet there are relatively easy ways to address the issue.Research has shown that nocturnal animals can reverse their usual biological rhythms if the rooms in which they are housed are kept relatively dark during the day and lighter at night. Drug studies should, at the very least, use animals on this adjusted schedule. Better yet, they could use two groups of rodents, a standard nocturnal set and another one on a reverse schedule. That way, scientists would be able to notice early on whether time affects how a drug works.

When it comes to human testing, the FDA could mandate small, early stage clinical trials with different groups of patients taking a drug at least three different times of day. If a certain drug turns out to have no time-related differences, we'll be reassured that it's safe to take anytime. Nobody knows precisely how many drugs exhibit time-related effects, but the number isn't tiny. Many different kinds of medications behave this way, and how important the variations are depends on factors like the seriousness of the illness being treated and the side effects of the medication.

Yes, these changes will require drug trials that are larger and more costly. But the return on investment could be huge in some areas. For instance, doctors have already successfully begun integrating circadian rhythms into cancer treatment. Chemotherapy causes its famously debilitating side effects because the drugs used are highly toxic to healthy as well as cancerous cells. It turns out, however, that based on the circadian rhythm, doctors can administer chemo at a time when malignant cells are more susceptible to the drugs than normal ones are. Such carefully timed treatment has been shown to help patients tolerate higher doses of chemo and survive longer. Cancer has become one of chronomedicine's biggest success stories. When will we hear about the next one? The clock is ticking.


Frame Game

Hard Knocks

I was hit by a teacher in an East Texas public school. It taught me nothing.

Chief Justice John Roberts Says $1,000 Can’t Buy Influence in Congress. Looks Like He’s Wrong.

After This Merger, One Company Could Control One-Third of the Planet's Beer Sales

Hidden Messages in Corporate Logos

If You’re Outraged by the NFL, Follow This Satirical Blowhard on Twitter

Sports Nut

Giving Up on Goodell

How the NFL lost the trust of its most loyal reporters.

How Can We Investigate Potential Dangers of Fracking Without Being Alarmist?

My Year as an Abortion Doula       

  News & Politics
Sept. 15 2014 8:56 PM The Benghazi Whistleblower Who Might Have Revealed a Massive Scandal on his Poetry Blog
Sept. 15 2014 7:27 PM Could IUDs Be the Next Great Weapon in the Battle Against Poverty?
Atlas Obscura
Sept. 16 2014 8:00 AM The Wall Street Bombing: Low-Tech Terrorism in Prohibition-era New York
  Double X
The XX Factor
Sept. 15 2014 3:31 PM My Year As an Abortion Doula
  Slate Plus
Tv Club
Sept. 15 2014 11:38 AM The Slate Doctor Who Podcast: Episode 4  A spoiler-filled discussion of "Listen."
Brow Beat
Sept. 15 2014 8:58 PM Lorde Does an Excellent Cover of Kanye West’s “Flashing Lights”
Future Tense
Sept. 16 2014 7:36 AM The Inspiration Drought Why our science fiction needs new dreams.
  Health & Science
Bad Astronomy
Sept. 16 2014 7:30 AM A Galaxy of Tatooines
Sports Nut
Sept. 15 2014 9:05 PM Giving Up on Goodell How the NFL lost the trust of its most loyal reporters.