When you are prescribed a medication, the instructions on the bottle usually provide very generic instructions. “Take one pill once a day” is a typical directive. Rarely does the bottle (or the more detailed instructional pamphlet, for that matter) tell you exactly when or what time to take the drug. And it turns out, this actually matters more than you would think.

Taking drugs at very specific times of the day in an effort to maximize therapeutic benefit and minimize risk of side effects is called chronotherapy. It is a treatment technique most commonly associated with cancer therapy, but it has been shown beneficial for other diseases and medications, too.

Chronotherapy is based on the circadian rhythm—the natural, internal process that regulates the human sleep/wake cycle every 24 hours. It is your “master clock,” that keeps you in sync with the Earth’s cycle of lightness and darkness.

This master clock also directs a slew of smaller “peripheral clocks” inside your organs, tissues, and even your cells. These intricate, interconnected systems keep the circadian rhythm in pace. In turn, research shows that this “gives rise to rhythmic variations in the physiological status of the body’s systems.”¹

In simple terms, all body functions, including hormone release, cardiovascular function, behavioral functions, and more are controlled by the circadian rhythm. This helps explain why some health events are more common at certain times of the day. For example, heart attacks most typically occur between the hours of 6:00 AM and noon, and stroke risk tends to peak every 12 hours, between 6:00 and 8:00 every morning and night. Additionally, other diseases like arthritis, asthma, and ulcers often flare up and get more intense at very specific times of the day.²

Likewise, the circadian rhythm plays a role in how the body responds to medications. The time of day you take a particular drug can affect your body in different ways, in terms of both efficacy and side effects. Research is still evolving, but besides cancer, there are a few conditions for which chronotherapy appears to be especially important.

Rheumatoid Arthritis (RA)

This autoimmune disease is characterized by morning stiffness, which shows a 24-hour rhythm. Inflammatory markers linked to RA also exhibit a 24-hour rhythm and peak in the morning.

Research has found that, when various drugs (including prednisone and methotrexate) are taken at night, patients experience significant improvement in morning symptoms such as pain, stiffness, and inflammation.

Researchers in one study noted that, “The selection of an optimal dosing time associated with 24-hour rhythms in RA symptoms may lead to more effective and safer treatments for RA…”³

Cholesterol

The body ramps up cholesterol production when you haven’t eaten in a while, and also while you’re sleeping—with peak levels after midnight. Production tends to be lowest in the morning and early afternoon.

So in general, it appears that taking cholesterol-lowering statin medications before bedtime is most effective. Of course, talk to your doctor before making this change.

Hypertension

Blood pressure has a 24-hour rhythm—higher during the day and lower at night, especially during sleep. So, historically, medical professionals recommended taking blood pressure  drugs in the morning, to reduce daytime surges.

However, research reveals that “an absence of nocturnal dipping blood pressure is also associated with increased cardiovascular risk.”⁴ And the older you get—and especially after age 55—blood pressure doesn’t always exhibit this usual nighttime dip. This phenomenon, called non-dipping, is a big risk factor for stroke and heart attack.

For all these reasons, more and more research has supported bedtime dosing of hypertension meds. One study found that “nighttime administration of antihypertensives improved overall 24-h blood pressure profiles…”⁴

If you take diuretics for blood pressure, it’s still best to take those in the morning and everything else at bedtime. But if you take several blood pressure meds, talk to your doctor about whether or not you should split them up, taking some in the morning and the rest in the evening before bed.

Supplement Timing

It stands to reason that chronotherapy may apply to supplement timing too. Like medications, many supplements work differently in the body depending on when they’re taken.

If you have a supplement that you feel is not working, or you simply wish to test out the theory of chronotherapy, try taking it at a different time of the day or at night. Given the research, this may prove to be particularly helpful for supplements that lower cholesterol or blood pressure, like Newport Natural Health’s Cholesterol Solution or Complete Blood Pressure Solution (or Complete Cardio Solution which addresses cholesterol, blood pressure, inflammation and more!).

And of course, the most important thing to remember is consistency. Whether it’s a supplement or a drug, remember to take it around the same time, every day, in order for your body to gain optimal benefits. Set reminders on your phone or computer, or keep a daily log, to avoid missing doses. If you do miss a dose, don’t “double up.” Rather, wait until your regularly scheduled time the next day to resume your regimen.

References

1. Kaur G, et al. Timing of administration: for commonly-prescribed medicines in Australia. Pharmaceutics. 2016 Jun;8(2):13. Last accessed Dec. 16, 2019.
2. Richter HG, et al. The circadian timing system: making sense of day/night gene expression. Biol Res. 2004;37(1):11-28. Last accessed Dec. 16, 2019.
3. Author unknown. Chronotherapy for rheumatoid arthritis. 2016 August 3;2016(6):47-53. Last accessed Dec. 16, 2019.
4. Bowles NP, et al. Chronotherapy for hypertension. Curr Hypertens Rep. 2018 Sep 28;20(11):97. Last accessed Dec. 16, 2019.

Last Updated: January 15, 2020
Originally Published: December 26, 2019