The Right Time to Take 15 Daily Medications
When it comes to your medications for depression, allergies, heartburn, and more, timing is everything.
Many prescription instructions say “take once a day”
But because of your circadian rhythm—the biological clock that governs sleep, hormone production, and other processes—your body doesn’t respond to medications in the same way at different times of the day. “Some drugs are not as effective or as well tolerated if they’re taken at the wrong biological time,” says Michael Smolensky, adjunct professor of biomedical engineering at the University of Texas at Austin. “It’s not that they’re not effective at all, but they’re certainly much less effective or tolerated.”
Now a cutting-edge field called drug chronotherapy advocates syncing your medication regimen with your circadian rhythm to maximize effectiveness and minimize side effects. Here we describe the best times to take meds based on chronotherapy and other factors. Note: Before you alter a current drug routine, be sure to first talk to your doctor or pharmacist. Diverging from your prescribed med schedule is just one of the everyday medication mistakes that can make you sick.
Best in the morning: Depression meds
Disrupted sleep is a common side effect of some SSRIs (selective serotonin reuptake inhibitors), such as Prozac and Paxil, which is why experts often recommend that patients take them when they wake up.
Best in the morning: Osteoporosis meds
Your body doesn’t easily absorb bisphosphonate drugs, such as Boniva and Fosamax. So doctors advise taking them on an empty stomach first thing in the morning with a glass of water, then waiting 30 to 60 minutes before eating, drinking, or taking other drugs or supplements.
Best first thing in the morning: Thyroid meds
To do their best work regulating your body’s hormones and metabolism, a thyroid med like levothyroxine needs to be the star of the show and make its daily debut in your stomach before you eat or drink anything else. “When taken on an empty stomach, thyroid medication does not compete with anything else to be absorbed,” says Eric M. Ascher, DO, a family medicine physician at Lenox Hill Hospital. He advises taking it approximately one hour prior to eating—and definitely before having any dairy. In fact, you should avoid calcium- and iron-rich roods—including milk, yogurt, and green, leafy vegetables—for four hours before or after taking the medication, since they can interfere with absorption and, as a result, make your dosage less effective. Thyroid meds also happen to be one of the medications you should never stop taking abruptly.
Best in the morning: ADHD meds
Taking your ADHD meds when you wake up won’t just start your day off right—it will also end your day just right. That’s because ADHD drugs, such as Adderall and Ritalin, are stimulants that work to increase alertness and energy levels. “If taken in the afternoon or nighttime, you may have difficulty sleeping,” says Dr. Ascher, “as common side effects are irritability, restlessness, and insomnia.” For that reason, Dr. Ascher says it’s best to take these meds when you first wake up, at least 45 minutes prior to eating.
Best in the morning: Diuretics
Often prescribed to patients with high blood pressure or congestive heart failure, diuretics (aka water pills) help your kidneys remove excess water from your body. How? By making you pee… a lot. For that reason, doctors often suggest taking them in the morning, so that you can get uninterrupted sleep at night.
Best around dinnertime: Heartburn meds
Your stomach produces the most acid in the evening up until around midnight, according to research published in the journal Pharmaceutics. If you’re on an acid-reducing H2 medication such as Pepcid or Zantac, take it 30 minutes before dinner. This controls stomach acid during the overnight period, when secretion reaches its peak. Plus, watch out for the over-the-counter medications you could be using all wrong.
Best in the evening: Allergy meds
Hay fever typically worsens at night and feels most severe in the morning, when levels of symptom-triggering histamine are highest. Once-daily antihistamines, such as Claritin, reach their peak eight to 12 hours after you take them, so using them at dinnertime or before bed means better control of morning symptoms. Take twice-a-day antihistamines in the morning and evening—which is exactly the kind of question it’s good to ask your pharmacist or doctor about before taking prescription medications.
Best in the evening: Cholesterol meds
Your liver’s peak time for the production of cholesterol is in the late afternoon and evening, according to the Pharmaceutics study; production dips in the morning. Take statins that your body can breakdown quickly—such as Zocor—in the evening so they can work their magic while cholesterol levels peak. Timing is less critical for statins that stay in your system longer, such as Lipitor and Crestor.
Best two hours before bedtime: Nerve-pain meds
When you’re dealing with chronic nerve pain, you don’t want to trade one set of problems for another. And when it comes to medications like gabapentin and pregabalin, you could be doing just that if you take them during the day. “Common side effects of medications for nerve pain include drowsiness, confusion, and unsteadiness, which is why it’s good to take these medications prior to bedtime,” says Dr. Ascher. “Many patients also complain that their nerve pain will keep them up at night, so I tell my patients to take them two hours before they are ready to go to sleep.” Dr. Ascher additionally cautions against taking other prescription pain or antidepressant meds at the same time, as they can increase side effects. He also recommends avoiding antacids two hours before and after your dosage because they can affect absorption and efficacy.
Best before bedtime: Blood pressure meds
Blood pressure is typically higher in the day and lower during sleep. But many people with high blood pressure don’t exhibit this nighttime dip, especially as they get older. This is a risk factor for stroke, heart attack, and kidney disease. That’s why experts advise taking certain blood pressure-lowering drugs at bedtime, to normalize daily blood pressure rhythm and decrease these risks. ACE inhibitors and ARBs are most effective when taken before you sleep.
Best at night: Rheumatoid arthritis meds
The problem with taking a steroid-based pain reliever like prednisone when you wake up is that most arthritis sufferers experience joint stiffness and pain in the morning. If you take your medication at night—ideally, a low-dose, delayed-release formula that takes effect around 3 a.m.—it can curb the inflammation that happens while you’re sleeping and ease those morning symptoms. That’s what Italian researchers found: They say this timing takes the body’s circadian rhythms into account and can help tamp down inflammatory substances like cortisol and cytokine that can peak during the night. Other research suggests taking nonsteroidal anti-inflammatories such as Motrin and Aleve at night may also reduce pain symptoms before they really kick in.
Best at night: Aspirin
For years a low daily dose of aspirin was recommended to “thin the blood” and lower your risk of heart attack and stroke, but recent guidelines now say it’s unnecessary, except for in those who have had heart attacks or stent procedures. But if you’re in the latter group and your doctor recommends continuing, be sure to take your dose at night instead of in the morning. According to Dutch researchers, a nighttime dose drops platelet levels in the morning when they naturally surge—and when cardiac incidents are three times more likely to occur.
Best at night: Once-a-day inhaled asthma meds
That was the finding of a recent study published in the Annals of Allergy, Asthma & Immunology, which reported that participants who took their once-a-day inhaled corticosteroids for asthma at night experienced mild improvement in lung function. However, cautions Tania Elliott, MD, a New York City-based allergist, the study was small and did not show a difference when it came to general symptoms or when patients needed to use a rescue inhaler. She says that it’s much more important to remember to actually take your medication every day, ideally at the same time every day—whenever that is. “The goal is to have a steady amount of medication in the lungs to prevent asthma symptoms from occurring,” Dr. Elliott explains. “If you require the use of your rescue inhaler (albuterol) more than twice a week during the day, or twice a month at night, this means your asthma is not well controlled and you are at risk for an asthma attack.”
Timed to symptoms: Osteoarthritis meds
According to the research published in Pharmaceutics, osteoarthritis pain peaks in the late afternoon and evening, so it’s best to start NSAIDs, such as naproxen and ibuprofen—the most widely used meds for osteoarthritis—before noon, so they’ll kick in at the appropriate time. If you’re prone to afternoon pain, take meds between mid-morning and noon; for evening pain, schedule them for mid-afternoon; and for nighttime pain, take them with your evening meal.
Best at the same time every day: Birth-control pills
While doctors will generally encourage you to take your medications at the same time every day, this is especially important when it comes to progestin-only birth-control pills, also known as mini-pills. According to Healthline, if you take a progestin-only pill more than three hours later than you normally do, it won’t be fully effective—which means that you’re not fully protected and could risk pregnancy. On the other hand, combination pills, which also contain estrogen, should be fully effective as long as they’re taken within the same 12-hour window every day. Discover these additional 13 things you must know about birth control pills if you don’t want to get pregnant—or do!