Medicine time, or is it?


lots of pills with an antibiotic capsule on top

Consumer info on the right time to take medicines not up to scratch, experts say

Information available to consumers and health professionals about the optimal time to take medications is lagging behind the latest evidence, Australian researchers say.

A review of 27 research studies found that while there was evidence of circadian-based optimal administration time for some medicines, for others evidence was sparse.

The review, undertaken by researchers from the Faculty of Pharmacy, University of Sydney, along with other academics, was aiming to investigate time of administration recommendations for commonly-prescribed medicines in Australia.

In 56% of the studies they examined the therapeutic effect of the medicine varied with the time of administration – supporting the concept of chronotherapy, or administration in coordination with circadian rhythms.

For the 30 most commonly-prescribed medicines in Australia there was some evidence regarding optimal time of administration for ACE-inhibitors, angiotensin receptor blockers and statins, the authors said.

However, the dissemination of ‘time of administration’ recommendation information into drug administration sources such as CMI and PI was lagging behind the available evidence, the authors said.

In clinical trials where medicine administration at two different circadian times was compared for effectiveness results supported chronotherapy in eight of the 30 medicines.

Only simvastatin and perindopril had CMI and PI information outlining the timing of drug administration. The authors said the lack of such information in other medicines was potentially due to it not being requested by regulatory authorities such as the TGA as part of the standard approval process.

It’s absence in many medicines did mean there was often a gap between the published literature and the approved ‘time of administration’ as recommended in Australian consumer information, said the authors, who included Professor Andrew McLachlan and Bandana Saini.

“Most of the reviewed studies compared morning vs. bedtime/evening administration, perhaps out of concern for patient compliance/adherence issues,” they said.

“It is unknown if the choice of other times, such at midday or afternoon, would reveal greater therapeutic effects and outcomes. Given this limitation, it may be stated that the true assessment of the best time to administer a medication in most cases has not been appropriately and comprehensively explored”.

“Preliminary screening of new drugs for their chronotherapeutic potential is a way of enhancing the research and development in pharmaceutical industries,” the authors recommended.

“Elucidating the role of the molecular clock and circadian molecular pathways could provide a major advance in treatment options for patients”.

The study was published in the journal Pharmaceutics.

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