Archive for the ‘Taking medicines: Rules and tips’ Category

Self-Dosing Pain Medications - be careful!

Tuesday, December 16th, 2008

painkillersAllowing patients to control their own pain medication intravenously is four times more likely to cause the patient harm than other medications, a new study says.

The report, published in the December issue of The Joint Commission Journal on Quality and Patient Safety, shows that most mistakes involving intravenous patient-controlled analgesia (PCA) resulted from either human error, equipment issues or communication problems that led to the patient receiving the wrong dosage or drug. PCA errors also tended to be more severe — harming patients and requiring clinical interventions — than other types of medication errors.

“The entire PCA process is highly complex,” lead author Rodney W. Hicks, the UMC Health System Endowed Chair for Patient Safety at Texas Tech University Health Sciences Center in Lubbock, said in a news release issued by the journal’s publisher. “PCA orders must be written, reviewed, and then accurately programmed into sophisticated delivery devices for patients to be pain free. Such complexity makes PCA an error-prone process. Health care organizations should now plan to make the process safer.”

The five-year study uncovered more than 9,500 PCA errors. Patients were harmed in 6.5 percent of these incidents, compared to 1.5 percent for general medication errors.

In PCA, a computerized pump with a syringe of prescribed pain medication is hooked straight into a patient’s intravenous (IV) line. The patient can self-dose by pushing a button.

Hicks and his co-authors make three recommendations to reduce future PCA errors:
Simplify the equipment. Easier step-by-step setup instructions could cut down on programming errors by caregivers setting up the PCA machine’s dosage levels.
Use bar codes and keep an electronic medication administration record. Making a standard practice out of independent double-checks of the PCA orders, the product, and the PCA device could help prevent giving patients’ the wrong medication.
Design and use easy, standardized forms for PCA. Use of universal forms by pharmacists could correct communication issues in the process.

Painkillers Linked to Increase in Overdose Deaths

Deaths from overdoses of prescription drugs, primarily pain relievers, appear to be on the rise throughout the United States, new research suggests.

West Virginia, in particular, has seen a large increase in such unintentional deaths, say government researchers, who have uncovered patterns of “doctor shopping” for drugs and overdosing on medications not used as prescribed.
(more…)

Giving pain medications to children

Friday, February 8th, 2008

PainkillersGiving your child medications, even over-the-counter medicines, should always be carefully monitored by your doctor.

The American Academy of Family Physicians offers these suggestions before you give any pain medication to your child:

  • If a person younger than age 18 has the flu or chickenpox, never give the person aspirin, which could lead to a rare but deadly condition called Reye’s Syndrome.
  • Acetaminophen (the active ingredient in Tylenol) is a generally safe painkiller for young children.
  • Be careful about giving ibuprofen to children who are allergic to aspirin, as they may also be allergic to ibuprofen.
  • Pain relievers may be dangerous for children with asthma, so don’t administer them without a doctor’s consent.
  • Be careful not to give your child too much of the same medication. Sometimes the same active ingredient can be found in more than one medication.

Pain Medication in Young Children: How Are We Doing?

Not very well, especially for children younger than 2 years.

Doctors are known to do a poor job of treating pain. How do we do in treating pain in preverbal and very young children? To answer this question, these authors performed a retrospective chart review of patients 6 months to 10 years old who presented to a pediatric emergency department between 1999 and 2000 with isolated long-bone fractures or second- or third-degree burns.

Patients were excluded if they had closed head injury, chest or abdominal trauma, or a history of developmental delay or other neurologic impairment; 180 children were enrolled. The use of analgesics was assessed in 2 age groups: very young (6 to 24 months) and school-aged (6 to 10 years) children. More very young children than school-aged children did not receive analgesic agents (64.6% vs. 47.6%). When analgesics were used, very young patients were less likely to receive opioids (16.7% vs. 44.0%, respectively) and more likely to receive over-the-counter products (18.8% vs. 8.3%, respectively). Injury patterns differed significantly in the 2 age groups: Second-degree burns were more common in the very young group, and displaced fractures were more common in the school-aged group. Among children with nondisplaced fractures and among those with third-degree burns, there was no difference in analgesic treatment between the very young and school-aged groups.

Pain Medications

Over-the-Counter Pain Relievers

Over-the-counter (OTC) pain relievers include:

  • Acetaminophen (Tylenol, Aspirin Free Excedrin)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs; aspirin, Motrin, Aleve and Orudis KT)
  • Topical Corticosteroids (Cortaid and Cortizone)

Both acetaminophen and NSAIDs reduce fever and relieve pain caused by muscle aches and stiffness, but only NSAIDs can also reduce inflammation (swelling and irritation). Acetaminophen and NSAIDs also work differently. NSAIDs relieve pain by reducing the production of prostaglandins, which are hormone-like substances that cause pain. Acetaminophen works on the parts of the brain that receive the “pain messages.” NSAIDs are also available in a prescription strength that can be prescribed by your physician.

Topical pain relievers are also available without a doctor’s prescription. These products include creams, lotions, or sprays that are applied to the skin in order to relieve pain from sore muscles and arthritis. Some examples of topical pain relievers include Aspercreme, Ben-Gay, Icy Hot and Capzasin-P. Corticosteroid creams are also available.

Prescription Pain Relievers

Prescription pain relievers include:

  • Corticosteroids
  • Opioids
  • Antidepressants
  • Anticonvulsants (antiseizure medications)

What Are Corticosteroids?

Prescription corticosteroids provide relief for inflamed areas of the body by easing swelling, redness, itching and allergic reactions. Corticosteroids can be used to treat allergies, asthma and arthritis. When used to control pain they are generally given in the form of pills or injections. Examples include: Deltasone, Hydeltrasol and Solu-Medrol.

Prescription corticosteroids are strong medicines and may have serious side effects, including:

  • Weight gain
  • Upset stomach
  • Headache
  • Mood changes
  • Trouble sleeping
  • Weakened immune system

To minimize these potential side effects, corticosteroids are prescribed in the lowest dose possible for as short of a length of time as needed to relieve the pain. Efforts are underway to develop safer corticosteroids.

What Are Opioids?

Opioids are narcotic pain medications that contain natural, synthetic or semi-synthetic opiates. Opioids are often used for acute pain, such as short-term pain after surgery. Some examples of opioids include:

  • Morphine
  • Fentanyl
  • Oxycodone
  • Codeine

Opioids are effective for severe pain and do not cause bleeding in the stomach or other parts of the body as can other types of pain relievers. It is rare for people to become addicted to opioids if the drugs are used to treat pain for a short period of time.

Side effects of opioids may include:

  • Drowsiness
  • Nausea
  • Constipation
  • Itching
  • Breathing problems
  • Addiction

What Are Antidepressants?

Antidepressants are drugs that can treat pain and/or emotional conditions by adjusting levels of neurotransmitters (natural chemicals) in the brain. These medications can increase the availability of the body’s signals for well-being and relaxation, enabling pain control for people with chronic pain conditions that do not completely respond to usual treatments.

Chronic pain conditions treated by low-dose antidepressants include some types of headaches (like migraines) and menstrual pain. Some antidepressant medications include:

  • Selective Serotonin Reuptake Inhibitors (SSRIs) such as Celexa, Prozac, Paxil, and Zoloft
  • Tricyclic antidepressants such as Elavil, Norpramin Sinequan, Tofranil, and Pamelor
  • Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs) such as Effexor and Cymbalta

These drugs require a steady dose of the medicine build up in the body over a period of time to work. The doses needed to treat pain are often lower than those needed to treat depression.

In general, antidepressants have fewer long-term side effects than frequent, ongoing use of other pain medicines. Generally, SSRIs and SSNRIs have fewer side effects than tricyclic antidepressants. The most common side effects with antidepressants include:

  • Blurry vision
  • Constipation
  • Difficulty urinating
  • Dry mouth
  • Fatigue
  • Nausea
  • Headache

What Are Anticonvulsants?

Anticonvulsants are drugs typically used to treat seizure disorders. Some of these medications are shown to be effective in treating pain as well. The exact way in which these medicines control pain is unclear but it is thought that they minimize the effects of nerves that cause pain. Some examples include Tegretol, Neurontin and Lyrica.

In general they are well tolerated. The most common side effects include:

  • Drowsiness
  • Dizziness
  • Fatigue
  • Nausea

Other Pain Treatments

Another means of topical pain relief comes in the form of a Lidoderm patch, which is a prescription medication.

If your pain is not relieved by the usual treatments, your doctor may refer you to a pain management specialist. Doctors who specialize in pain management may try other treatments such as certain types of physical therapy or other kinds of medicine. They may also recommend TENS, a procedure that uses patches placed on the skin to send signals that stop pain.

Patient-controlled analgesia (PCA) is a method of pain control that allows the patient to control the amount of pain medication administered. This is often used in the hospital to treat pain. By pushing a button on a computerized pump, the patient receives a pre-measured dose of pain medicine. The pump is connected to a small tube that allows medicine to be injected intravenously (into a vein), subcutaneously (just under the skin), or into the spinal area.

Taking an antidepressant? Do NOT stop suddenly!

Saturday, January 26th, 2008

AntidepressantsIf you want to stop taking an antidepressant, it’s important to speak with your doctor first, the American Academy of Family Physicians says. The doctor may recommend weaning your body off the medication gradually.

People who stop an antidepressant too quickly may trigger a host of symptoms that doctors call antidepressant discontinuation syndrome. Symptoms may include:

  • Anxiety.
  • Feelings of depression or sadness.
  • Moodiness and irritability.
  • Tiredness.
  • Headaches and dizziness.
  • Nausea and vomiting.
  • Diarrhea.

If an antidepressant is causing an unpleasant side effect, your doctor may opt to lower your dose or prescribe a different type of antidepressant altogether.

What are antidepressants?
Antidepressants are medicines used to help people who have depression. Most people with depression get better with treatment that includes these medicines.

How do antidepressants work?
Most antidepressants are believed to work by slowing the removal of certain chemicals from the brain. These chemicals are called neurotransmitters. Neurotransmitters are needed for normal brain function. Antidepressants help people with depression by making these natural chemicals more available to the brain.

How long will I have to take an antidepressant?
Antidepressants are typically taken for at least 4 to 6 months. In some cases, patients and their doctors may decide that antidepressants are needed for a longer time.

What are the different kinds of antidepressants?
Antidepressants are put into groups based on which chemicals in the brain they affect. There are many different kinds of antidepressants, including:

Selective serotonin reuptake inhibitors (SSRIs)

  • citalopram (brand name: Celexa)
  • escitalopram (brand name: Lexapro)
  • fluoxetine (brand name: Prozac)
  • paroxetine (brand names: Paxil, Pexeva)
  • sertraline (brand name: Zoloft)

[ Antidepressants on CanadianMedsWorld ]

These medicines tend to have fewer side effects than other antidepressants. Some of the side effects that can be caused by SSRIs include dry mouth, nausea, nervousness, insomnia, sexual problems and headache.

Tricyclics

  • amitriptyline (brand name: Elavil)
  • desipramine (brand name: Norpramin)
  • imipramine (brand name: Tofranil)
  • nortriptyline (brand name: Aventyl, Pamelor)

Common side effects caused by these medicines include dry mouth, blurred vision, constipation, difficulty urinating, worsening of glaucoma, impaired thinking and tiredness. These antidepressants can also affect a person’s blood pressure and heart rate.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

  • venlafaxine (brand name: Effexor)
  • duloxetine (brand name: Cymbalta)

Some common side effects caused by these medicines include nausea and loss of appetite, anxiety and nervousness, headache, insomnia and tiredness. Dry mouth, constipation, weight loss, sexual problems, increased heart rate and increased cholesterol levels can also occur.

Norepinephrine and dopamine reuptake inhibitors (NDRIs)

  • bupropion (brand name: Wellbutrin)

Some of the common side effects in people taking NDRIs include agitation, nausea, headache, loss of appetite and insomnia. It can also cause increase blood pressure in some people.

Combined reuptake inhibitors and receptor blockers

  • trazodone (brand name: Desyrel)
  • nefazodone (brand name: Serzone)
  • maprotiline
  • mirtazpine (brand name: Remeron)

Common side effects of these medicines are drowsiness, dry mouth, nausea and dizziness. If you have liver problems, you should not take nefazodone. If you have seizures, you should not take maprotiline.

Monamine oxidase inhibitors (MAOIs)

  • isocarboxazid (brand name: Marplan)
  • phenelzine (brand name: Nardil)
  • tranlcypromine (brand name: Parnate)

MAOIs are used less commonly than the other antidepressants. They can have serious side effects, including weakness, dizziness, headaches and trembling. Taking an MAOI antidepressant while you’re taking another antidepressant or certain over-the-counter medicines for colds and flu can cause a dangerous reaction. Your doctor will also tell you what foods and alcoholic beverages you should avoid while you are taking an MAOI. You should not take an MAOI unless you clearly understand what medications and foods to avoid. If you are taking an MAOI and your doctor wants you to start taking one of the other antidepressants, he or she will have you stop taking the MAOI for a while before you start the new medicine. This gives the MAOI time to clear out of your body.

Will antidepressants affect my other medicines?
Antidepressants can have an effect on many other medicines. If you’re going to take an antidepressant, tell your doctor about all the other medicines you take, including over-the-counter medicines and herbal health products (such as St. John’s wort). Ask your doctor and pharmacist if any of your regular medicines can cause problems when combined with an antidepressant.

Daily Cialis doses: How to take these sex pills

Wednesday, January 9th, 2008

Cialis pills onlineEli Lilly and Co on Tuesday said U.S. regulators approved once-daily use of two low-dose forms of its Cialis anti-impotence drug, offering greater convenience for men expecting frequent sexual activity.

The Indianapolis drugmaker said the once-daily formulations, in dosages of 2.5 milligrams and 5 milligrams, will allow men to attempt sexual activity any time between doses.

“In clinical trials, when taken without restrictions on the timing of sexual activity, Cialis for once daily use improved erectile function over the course of therapy,” Lilly said in a release.

The low-dose daily formulations, already approved in parts of Europe, “may be most appropriate for men with erectile dysfunction who anticipate more frequent sexual activity (e.g. twice weekly),” Lilly said.

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The company said the low-dose formulations provide “a new option for men who may be looking for a dosing option that can be taken without regard to timing of sexual activity.”

The treatment, which has global annual sales of $1.2 billion, has been available in the United States since 2003 in dosages of 5 milligrams, 10 milligrams and 20 milligrams, and taken as needed. Those dosages provide effectiveness for up to 36 hours.

Company spokeswoman Keri McGrath said no dosage forms of the medicine, including the newly approved lower ones, are appropriate for heart patients who take nitrates, including nitroglycerin.

Members of the class of drugs to which Cialis belongs — including Pfizer Inc’s rival Viagra and GlaxoSmithKline Plc’s Levitra — can dangerously lower blood pressure when used alongside nitrates.

The drugs, used by millions of men worldwide, also carry new warnings about potential risk of sudden hearing loss.

Shares of Lilly were up $1.05, or 1.9 percent, to $55.60 in morning trading on the New York Stock Exchange, in line with a 2 percent advance for the drug sector.

Cialis Information

Generic Name: tadalafil

Brand Names: Cialis

What is tadalafil?

Tadalafil relaxes muscles and increases blood flow to particular areas of the body.

Tadalafil is used to treat erectile dysfunction (impotence).

Tadalafil may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about tadalafil?
Do not take tadalafil if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitro-Bid, and others), isosorbide dinitrate (Dilatrate-SR, Isordil, Sorbitrate), and isosorbide mononitrate (Imdur, ISMO, Monoket). Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite (”poppers”). Taking tadalafil with a nitrate medicine can cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack. During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect of tadalafil Do not take tadalafil more than once a day. Allow 24 hours to pass between doses. Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis.

Tadalafil can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking tadalafil, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. It is not clear whether tadalafil is the actual cause of vision loss.
Stop using tadalafil and get emergency medical help if you have sudden vision loss.

How should I take tadalafil?

Take tadalafil exactly as it was prescribed for you. Do not take it in larger doses or for longer than recommended by your doctor. Follow the directions on your prescription label.
Take this medication with a full glass of water.

Tadalafil can be taken with or without food.

Tadalafil is usually taken only when needed, just before sexual activity. The medication can help achieve an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctor’s instructions.
Do not take tadalafil more than once a day. Allow 24 hours to pass between doses. Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection (priapism) can damage the penis. Store this medication at room temperature away from moisture and heat.

Putting in Eye Drops - Tips

Friday, December 28th, 2007

Eye drops tips

Remember . . .

  • When putting drops into your eyes, follow doctor’s orders.
  • Be sure your doctor knows about any other drugs you may be taking (including over-the-counter items like vitamins and aspirin) and about any allergies you may have.
  • Wash your hands before putting eye drops into your eyes.
  • Be careful NOT to touch the tip of the dropper to any part of your eye.
  • Make sure the dropper stays clean.
  • If you are putting in more than one drop or more than one type of eye drop, wait five minutes before putting the next drop in. This will keep the first drop from being washed out by the second before it has had time to work.
  • Store the eye drops and all medicines out of reach of children.

Steps for Putting in Eye Drops

  1. Start by tilting your head backward while sitting, standing, or lying down. With your index finger placed on the soft spot just below the lower lid, gently pull down to form a pocket.
  2. Let a drop fall into the pocket
  3. Slowly let go of the lower lid. Blinking a few times is all right, but try not to shut your eyes tight or squint. This may push the drops out of your eye.
  4. Gently press on the inside corner of your closed eyes with your index finger and thumb for two to three minutes. This will help keep any drops from getting into your system and keep them in your eye, where they are needed.
  5. Blot around your eyes to remove any excess.

If you are still having trouble putting eye drops in, here are some additional tips that may help.

If your hands are shaking:

  • Try approaching your eye from the side so you can rest your hand on your face to help steady your hand.
  • If shaky hands are still a problem, you might try using a 1- or 2-pound wrist weight (you can get these at any sporting goods store). The extra weight around the wrist of the hand you are using can decrease mild shaking.

If you are having trouble getting the drop into your eye:

  • It may be easier to tell if the drop has gone into your eye if you keep your drops in the refrigerator. Your eye will feel the liquid when it is cold better than if it is at room temperature.
  • If you are still not sure the drop actually got in your eye, put in another drop. The eyelids can hold only about one drop, so any excess will just run out of the eye. It is better to have excess run out than to not have enough medication in your eye.
  • If pulling the lower lid out to create a pocket is not working, try this. With your head turned to the side or lying on your side, close your eyes. Place a drop in the inner corner of your eyelid (the side closest to the bridge of your nose). By opening your eyes slowly, the drop should fall right into your eye.

(more…)

How and when to take pills? Tips.

Wednesday, December 26th, 2007

Taking pills tips

Many medications, both prescription and over-the-counter, can negatively interact with foods, supplements or other drugs.

 

 

 

Here are guidelines to help prevent food-drug interactions, courtesy of the American Academy of Family Physicians:

  • Check prescription and over-the-counter drug labels to see if they contain any warnings.
  • Follow directions on all medications carefully.
  • Unless you get your doctor’s OK, never break up pills and mix them with food, and never empty capsules into food.
  • Take medications with a whole glass of water, unless your doctor has given you other instructions. Never take medications with alcohol.
  • Don’t take your medications at the same time as you take vitamins or dietary supplements.
  • Don’t mix medications in a hot drink, as the heat may affect the medication.

Taking drugs with food may take a bite out of costs

Taking an expensive breast cancer drug on a full stomach – as opposed to an empty one as prescribed – could save a patient or their health authority $1700 (?835) a month or more, according to an analysis of data from clinical trials.

The approach, which might also work for other drugs, is based on the fact that certain foods can delay the breakdown of medications in the body. Doctors stress, however, that people should not yet attempt this cost-cutting method until studies demonstrate its safety.

In general, taking pills with food against the label’s advice can lead to an overdose. For example, drinking grapefruit juice can interfere with the body’s ability to handle cholesterol-lowering statin drugs.

For this reason, pharmaceutical companies must provide the US Food and Drug Administration (FDA) with information on how eating a meal can influence the absorption of their products.

This was the case when GlaxoSmithKline sought approval for its anticancer drug lapatinib (known as Tykerb in the US and Tycerb in Europe).

Higher blood levels

Pharmaceutical companies generally tell patients in early drug trials to take the medication on an empty stomach, as this helps reduce the variables between patients.

In this instance, when researchers later conducted the food-interaction experiments involving lapatinib, they found that taking it at mealtime raised blood levels of the drug far above those shown as safe in previous trials. This meant that the drug label would have to advise patients to take the pill on an empty stomach.

The FDA approved lapatinib in March 2007 to treat breast cancers that have not responded to other medications. Specifically, the drug fights breast cancers that contain an excess of a protein called “human epidermal growth factor receptor 2″ (HER2), and have spread through the body.

This subtype of breast cancer claims the lives about 8000 to 10,000 US women each year, according to the American Cancer Society. But this help does not come cheap. Lapatinib costs a patient roughly $2900 a month, a large sum, particularly for those who lack health insurance.

Ezra Cohen and Mark Ratain at the University of Chicago, Illinois, US wondered if taking advantage of changes in lapatinib absorption after eating could reduce this cost.

Based on clinical trial data submitted to the FDA, they calculated that taking the medication with a low-fat meal or high-fat meal could increase the amount of lapatinib circulating in the blood by 1.7 and 3.3 times, respectively. Adding grapefruit juice to the mix would reduce costs further still.

“We expect that one 250 milligram lapatinib pill accompanied by food and washed down with a glass of grapefruit juice may yield plasma concentrations comparable to five 250 milligram pills on an empty stomach,” Ratain says.

People who pop a pill with a meal, but no grapefruit juice, are calculated to get the equivalent effect of three pills, and would save around $1700 a month.

Experiment warning

“It’s kind of akin to pill splitting,” says Steven Pearson, of Harvard Medical School in Boston, Massachusetts US. But he thinks the approach is unlikely to be the first choice strategy for making medicines more affordable. Pearson is working to develop a review board that would examine ways to improve cost-effectiveness of drugs in the US.

Pearson says that more sweeping changes – such as providing universal health insurance and reaching a consensus on how much patients should have to pay for meds in the first place – should take top priority.

Pharmaceutical companies argue that high drug prices result from the huge investment required in research and development. But patient advocacy groups have countered that much of the extra money goes into the pockets of shareholders, rather than into such research. They say that there is lots of room for price cutting.

While this debate continues, Cohen urges people not to experiment with taking lapatinib with meals until more research demonstrates the safety of doing so. “This is not something that we suggest people try at home. This is something that should be studied,” says Cohen, adding that an overdose of lapatinib could perhaps cause a heart attack.

He says that these types of trials will only happen if the public demands them: “In part it has to come from patient advocacy groups who say this needs to be studied.”

Cohen adds that he and his colleagues are looking at whether taking other medications, such as the immune suppressant rapamycin, with food could possibly lower drug costs.

Taking High Blood Pressure Pills at Night May Be Better for Some

Taking a blood pressure pill at bedtime instead of in the morning might be healthier for some high-risk people.

New research suggests that simple switch may normalize patterns of blood pressure in patients at extra risk from the twin epidemics of heart and kidney disease.

Why? When it comes to blood pressure, you want to be a dipper. In healthy people, blood pressure dips at night, by 10 to 20 percent. Scientists don’t know why, but suspect the drop gives arteries a little rest.

People with high blood pressure that doesn’t dip at night — the non-dippers — fare worse than other hypertension sufferers, developing more serious heart disease. Moreover, heart and kidney disease fuel each other — and the 26 million Americans with chronic kidney disease seem most prone to non-dipping. In addition to heart problems, they’re at extra risk of their kidney damage worsening to the point of dialysis.

Most blood pressure patients need two or three medications. So Italian researchers performed an easy test: They told 32 non-dippers with kidney disease to switch one of those drugs from a morning to a bedtime dose. In two months, nearly 90 percent of these high-risk patients had turned into dippers. Their nighttime blood pressure dropped an average of 7 points, without side effects or increase in daytime blood pressure.

Better, a key sign of kidney function improved significantly, too, Dr. Roberto Minutolo of the Second University of Naples reports this month in the American Journal of Kidney Diseases.

It’s the latest research in the field of chronotherapy: How our bodies’ internal rhythms make certain diseases worse at certain times of the day, and in turn affect how to time treatments.

While the Italian study is too small for proof, similar studies from Europe also back a bedtime switch for non-dippers. The work is catching the attention of U.S. hypertension specialists, and now doctors at Baltimore’s Johns Hopkins University are planning a larger study to see if a bedtime switch really could give certain people healthier hearts and kidneys.

How big a problem is non-dipping?

“I think it’s huge,” says Hopkins’ Dr. Lawrence Appel. “This is our best lead” into why black Americans with kidney disease, in particular, tend to worsen despite treatment.

Appel found 80 percent of black kidney patients in a recent study were non-dippers. Most startling, 40 percent had nighttime blood pressure that was even higher than daytime levels.

Two-thirds of chronic kidney disease patients, and at least 10 percent of the general population, are estimated to be non-dippers, says Dr. Joseph Vassalotti of the National Kidney Foundation. One theory is that their bodies have trouble excreting salt.

Yet few patients have ever heard of the problem — and few doctors know who is affected. Most people get their blood pressure checked only during the day. A 24-hour blood pressure monitor can tell but is rarely used, partly because insurance seldom pays for the extra visit to download and diagnose the readings.

And most patients who take several once-a-day pills swallow them all in the morning, meaning they all start wearing off around the same time, says Dr. Gina Lundberg of St. Joseph’s Hospital in Atlanta.

“It does make good sense to take some in the morning and some in the evening,” says Lundberg, a spokeswoman for the American Heart Association.

Everyone has an internal clock, determined by genes, that affects health. Many of these biological rhythms are circadian, meaning they fluctuate on a 24-hour cycle.

Consider how that can affect the timing of treatments. Some older “statin” pills fight cholesterol best if taken at bedtime; they target a liver enzyme that’s most active at night. Asthma attacks are more frequent at night, and the stomach secretes more heartburn-causing acid at night, affecting some patients’ dosing requirements. Researchers even are studying how to better time certain cancer chemotherapies and allergy treatments.

The best-known example: Blood pressure jumps in the early morning hours, as the awakening body produces more stress hormones. That’s also why heart attacks and strokes are most common in the morning.

The nighttime dipping problem has gotten far less attention. The new Italian study marks an important advance, says Dr. Mahboob Rahman of the University Hospitals of Cleveland.

“We know now that you can change medication timing and lower blood pressure at night,” he explains.

That doesn’t mean everyone should switch willy-nilly to bedtime dosing. Morning may be best for people on just one drug, and no one yet knows if the switch truly gives non-dippers better overall health. “That’s the million-dollar question,” Rahman cautions.

Still, Lundberg says it’s worth asking your doctor how to time doses, saying one at night for someone taking multiple medicines couldn’t hurt.

Taking pills. Timing matters!

Tuesday, December 18th, 2007

PillsTaking a blood pressure pill at bedtime instead of in the morning might be healthier for some high-risk people.

New research suggests that simple switch may normalize patterns of blood pressure in patients at extra risk from the twin epidemics of heart and kidney disease.

Why? When it comes to blood pressure, you want to be a dipper. In healthy people, blood pressure dips at night, by 10 to 20 percent. Scientists don’t know why, but suspect the drop gives arteries a little rest.

People with high blood pressure that doesn’t dip at night — the non-dippers — fare worse than other hypertension sufferers, developing more serious heart disease. Moreover, heart and kidney disease fuel each other — and the 26 million Americans with chronic kidney disease seem most prone to non-dipping. In addition to heart problems, they’re at extra risk of their kidney damage worsening to the point of dialysis.

Most blood pressure patients need two or three medications. So Italian researchers performed an easy test: They told 32 non-dippers with kidney disease to switch one of those drugs from a morning to a bedtime dose. In two months, nearly 90 percent of these high-risk patients had turned into dippers. Their nighttime blood pressure dropped an average of 7 points, without side effects or increase in daytime blood pressure.

Better, a key sign of kidney function improved significantly, too, Dr. Roberto Minutolo of the Second University of Naples reports this month in the American Journal of Kidney Diseases.

It’s the latest research in the field of chronotherapy: How our bodies’ internal rhythms make certain diseases worse at certain times of the day, and in turn affect how to time treatments.

While the Italian study is too small for proof, similar studies from Europe also back a bedtime switch for non-dippers. The work is catching the attention of U.S. hypertension specialists, and now doctors at Baltimore’s Johns Hopkins University are planning a larger study to see if a bedtime switch really could give certain people healthier hearts and kidneys.

How big a problem is non-dipping?

“I think it’s huge,” says Hopkins’ Dr. Lawrence Appel. “This is our best lead” into why black Americans with kidney disease, in particular, tend to worsen despite treatment.

Appel found 80 percent of black kidney patients in a recent study were non-dippers. Most startling, 40 percent had nighttime blood pressure that was even higher than daytime levels.

Two-thirds of chronic kidney disease patients, and at least 10 percent of the general population, are estimated to be non-dippers, says Dr. Joseph Vassalotti of the National Kidney Foundation. One theory is that their bodies have trouble excreting salt.

Yet few patients have ever heard of the problem — and few doctors know who is affected. Most people get their blood pressure checked only during the day. A 24-hour blood pressure monitor can tell but is rarely used, partly because insurance seldom pays for the extra visit to download and diagnose the readings.

And most patients who take several once-a-day pills swallow them all in the morning, meaning they all start wearing off around the same time, says Dr. Gina Lundberg of St. Joseph’s Hospital in Atlanta.

“It does make good sense to take some in the morning and some in the evening,” says Lundberg, a spokeswoman for the American Heart Association.

Everyone has an internal clock, determined by genes, that affects health. Many of these biological rhythms are circadian, meaning they fluctuate on a 24-hour cycle.

Consider how that can affect the timing of treatments. Some older “statin” pills fight cholesterol best if taken at bedtime; they target a liver enzyme that’s most active at night. Asthma attacks are more frequent at night, and the stomach secretes more heartburn-causing acid at night, affecting some patients’ dosing requirements. Researchers even are studying how to better time certain cancer chemotherapies and allergy treatments.

The best-known example: Blood pressure jumps in the early morning hours, as the awakening body produces more stress hormones. That’s also why heart attacks and strokes are most common in the morning.

The nighttime dipping problem has gotten far less attention. The new Italian study marks an important advance, says Dr. Mahboob Rahman of the University Hospitals of Cleveland.

“We know now that you can change medication timing and lower blood pressure at night,” he explains.

That doesn’t mean everyone should switch willy-nilly to bedtime dosing. Morning may be best for people on just one drug, and no one yet knows if the switch truly gives non-dippers better overall health. “That’s the million-dollar question,” Rahman cautions.

Still, Lundberg says it’s worth asking your doctor how to time doses, saying one at night for someone taking multiple medicines couldn’t hurt.

See also:

Keep Timing the Tablets: Statistical Analysis of Pill Dissolution Rates Martin J. Crowder

Abstract

The way in which medicinal tablets, pills and capsules dissolve in liquid is important in the pharmaceutical industry, which collects and analyses data to assess the effects of different formulations of a medicine, different storage conditions, etc. The data usually comprise repeated measures, the record for an individual tablet consisting of either the fractions dissolved at a given sequence of time points or the times taken for given fractions to dissolve. (more…)