Chronotherapy: Affecting diagnostics and therapy
It’s about time
The latest research shows that the time of day when drugs are given and tests are administered has an impact on the quality and even the cost of care. You’ve heard complaints from patients about being awakened from a sound sleep only to be given a sleeping pill. Now you have more than complaints to convince the clinicians in your facility about timing medication.
If attention is paid to chronotherapy, fewer drugs can be used, resulting in fewer side effects.
Michael Smolensky, MD, is a professor in the School of Public Health at the Health Sciences Center of the University of Texas-Houston. "The time diagnostic tests are done may determine what you find," Smolensky said at an AMA briefing recently. "And treatment needs to take this periodicity into account." He refers to a Gallup survey of more than 300 family physicians and internists that showed most primary care providers don’t know this. Paying attention to the body’s clock is routine at only a few hospitals: Hermann in Houston, Stratton in Albany, NY, the University of Toronto, and the University of Paris.
Chronotherapy applies to a wide range of diseases:
• Hypertensive patients often don’t take medication when they need it most the first hour or two following awakening. Blood pressure and heart rate rise then, and those are peak hours for myocardial infarction, hemorrhagic stroke, thrombotic infarction, and myocardial ischemia.
• Cardiovascular diseases like angina are routinely treated by applying nitroglycerine patches in the morning and removing them at night. Daytime angina can be better treated by beta blockers, and nighttime angina may be due to vasoconstriction, better treated by nitrates.
• Asthma attacks occur at night 100 times more often than during the day. Yet physicians typically give oral steroids once daily in the morning. Taking them at 3 p.m. would bring better results without increasing side effects.
• Allergies are most acute directly on arising from sleep. Medication given at bedtime is more effective than waiting till morning.
• Arthritis pain peaks in the morning, so onsteroidal anti-inflammatory drugs are most effective when taken late at night. Drugs for osteoarthritis, which peaks in the evening, should be given about noon.
• Cancer drugs taken in the late afternoon or evening have been shown to have threefold better efficacy than when taken at other times of day. Patients suffer fewer side effects when the drugs are given at certain times of day, as well. Each drug has its own schedule.
• Ulcers should be treated with acid reducers in early evening because stomach acidity peaks at 6 p.m.
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