Why does some medicine have extremely specific instructions? E.g. take one in the morning and one in the evening instead of simply taking two per day. Is it the time difference between the times taken or can the body somehow tell morning vs noon vs evening? And before vs after meals, why?
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It can be like you said, like when you step down Prednisone, your system can be messed up if you go cold turkey. Otherwise it can be to make sure you actually take the pill so you give them a reminder you can relate too. People are more likely to take their pills in the morning time if you ten or then to take them before breakfast instead of simply ‘morning’.
Medication dosing is usually designed around keeping a concentration of drug in your body that it will have an effect while not being dangerous to the patient (called the “therapeutic level”).
This means for example they may say to take one in the morning and one in the evening because the body will start clearing the drug from the blood throughout the day. By taking a second pill in the evening it tops off the amount of medication in the body to keep it in the necessary range. If they just said “Take two per day” then people would take two pills at the same time at some random time during the day, which isn’t going to keep the concentration where it needs to be. In fact you might have someone taking two pills at 11 PM and then another two pills at 1 AM since it is “the next day”! People are dumb.
As for taking them before or after meals, this often has to do with nausea. Some medications are very rough on the stomach and being able to dilute them across the mass of a meal and the time it takes to digest them can help people not feel terrible or even vomit up their medicines. Antibiotics I think are particularly prone to this effect and so are often given that instruction.
If a prescription instructs you to take one pill in the morning and one in the evening, and you decide to take two in the morning and be done with it, the problem you’ll experience is that you’ll have a diminished level of the medication in your body. For a prescription like that to be effective, the level needs to stay more consistent, and not fluctuate as it’s used and broken down.
Before versus after meals has to do with chemistry; the absorption rate of the medication changes with what your body’s doing, as well as some medication can cause discomfort if you take it on an empty stomach.
It depends. Some meds need dosing at specified intervals, other meds may be more flexible. The answer really depends on what studies have been done on dosing intervals, times, and amount. There may not have been comparative studies done (ie 6am and 6pm, vs noon and midnight). Some of this is up to the doc and what he/she writes on the prescription pad (or types in the computer or selects from a drop-down listing). Studies to answer your question for any specific med may never have been done. If you are super enthused, gift $10M to a local medical school with the proviso that they do the drug trial you desire!
BID or TID generally mean two times or three times per day, but it is interpreted to mean during the awake day, so BID might be 8AM and 5PM, for example. If the doc (or studies) suggest that it really should be taken around the clock irrespective of daylight/night, then the order may read Q12 hrs or Q8 hrs (every 12 or 8 hours). This may require dosing at inconvenient times ie when many persons will be asleep. Many docs will write BID or TID if the exact specific timing is not known to be critical, but Q8h or Q6h or Q12h if the timing is felt to be more critical – but some of this is subjective and up to the opinion of the prescribing MD.
Some meds really do work better if dosed at specific times during the day, when human studies have shown that hormonal surges occur or other circadian rhythm events occur or subside.
You may learn that less medical research thought goes into this question than you may have presumed.
Because ppl are stupid and we have to be specific otherwise people try to put pills in the wrong orifices. Source: was a pharm tech for 5 years
The meals one is primarily to do with nausea. I have several family members who have thrown their daily meds up because they didn’t take them with food, or didn’t take them with ENOUGH food.
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