Summary: Best time to take cardiovascular drugs


Release time:

2022-04-11

‍‍There are many kinds of cardiovascular diseases, and the corresponding treatment drugs are also numerous. When patients are faced with many drugs, it is easy to be puzzled by a question: when should this drug be taken? Today, we hereby summarize the best medication time for some cardiovascular drugs, hoping to be helpful to everyone.

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There are many kinds of cardiovascular diseases, and the corresponding treatment drugs are also numerous. When patients are faced with many drugs, it is easy to be puzzled by a question: when should this drug be taken? Today, we hereby summarize the best medication time for some cardiovascular drugs, hoping to be helpful to everyone.

 


antiplatelet drug


01. Aspirin


1) Medication time?


Aspirin is completely absorbed through the gastrointestinal tract after oral administration. It is rapidly degraded to the main metabolite salicylic acid after absorption. The peak time of aspirin and salicylic acid was 10-20 minutes and 20-120 minutes, respectively.


At present, aspirin enteric-coated tablets commonly used in clinical practice have anti-acid, which do not dissolve in acidic gastric juice but dissolve in alkaline intestinal juice. Aspirin enteric-coated tablets are delayed for 3-6 hours compared to ordinary tablets.


The antiplatelet effect of aspirin can last for 7 to 10 days (I. e., the entire life cycle of platelets) and is irreversible. So, in theory, it makes no difference when you take aspirin every day.


2) Before meals After meals?


Ordinary oral aspirin will have a strong stimulation to the gastric mucosa, easy to cause gastric mucosal damage, induced gastric bleeding. Therefore, aspirin is more suitable for taking after meals.


However, aspirin enteric-coated tablets are different. In the fasting state, the pH value in the stomach is about 1 to 2, which is a strong acid environment. Aspirin enteric-coated tablets do not dissolve; after reaching the duodenum, they begin to dissolve in the alkaline environment of the intestinal tract, so they will not directly stimulate and damage the gastric mucosa.


If taken after meals, it may increase the retention time of the drug in the stomach, causing some drugs to separate from the enteric film, thereby stimulating the gastric mucosa; in addition, food dilutes the strong acid environment in the stomach, causing the drug to dissolve in the stomach, increasing the risk of adverse reactions in the stomach. Therefore, aspirin enteric-coated tablets are best taken before meals.


Summary: Aspirin is used every day regardless of morning and evening, before meals and after meals according to the tablet process, ordinary aspirin is used after meals, and aspirin enteric-coated tablets are used before meals.


02. Clopidogrel


As far as clopidogrel itself is concerned, it is an irreversible combination with platelets. Only by metabolizing the combined platelet life cycle can it be eliminated. Therefore, there is no time limit for taking clopidogrel regularly. It can be taken at a fixed time, and the diet has little effect on it.

 

It should be noted that omeprazole or esomeprazole and clopidogrel taken together or at an interval of 12 hours will lead to a decrease in clopidogrel blood concentration, so it is recommended that the above two drugs need to be taken at intervals.


03. Ticagrelor


It is a new type of P2Y12 receptor antagonist, which is a non-precursor drug. It can directly act on platelet ADP receptor without liver metabolic activation, and has strong and reversible anti-platelet effect.


Compared with clopidogrel, ticagrelor has a shorter onset time of 0.5 to 4 hours. The average half-life was 7.2 h, and the active metabolite was 9 h. According to the half-life recommend, its usage was once a day, morning and evening, and was not affected by diet.


 

lipid-lowering drugs


The most important lipid-lowering drugs are statins, mainly including atorvastatin, rosuvastatin, fluvastatin, simvastatin, etc. These drugs inhibit HMG-CoA reductase and block the synthesis of liver cholesterol. It plays a role and can reduce the concentration of serum total cholesterol and low-density lipoprotein cholesterol.


Because statins mainly inhibit the rate-limiting enzyme of cholesterol synthesis, and this enzyme has the strongest activity at night, and the half-life of statins is generally short, it is generally necessary to take them before going to bed.

 

Atorvastatin, rosuvastatin, and pitavastatin have long half-lives and good lipid-lowering effects, and can be taken at any fixed time of the day.


Another common lipid-lowering drug is fibrates. It is usually used to lower triglycerides and is recommended to be taken with a meal.



antihypertensive drugs


Human blood pressure has obvious diurnal fluctuation characteristics. Most people are "dipper blood pressure", that is, nocturnal blood pressure decreased by more than 10% to 20% compared with daytime; on the contrary, if the nocturnal blood pressure drop waveform becomes shallow, the mean nocturnal blood pressure decreased by less than 10% compared with daytime, or there is no obvious nocturnal valley, and even nocturnal blood pressure is higher than daytime, which is called "non-dipper blood pressure 」.


General antihypertensive drugs take effect after 30 minutes, 2~3 hours to reach the peak, then the time of oral antihypertensive drugs will be with the whole day blood pressure waveform.


The blood pressure of patients with dipper type blood pressure generally peaks at 9-11 a.m. and 16-18 p. m. then it is recommended to take medicine at 7:00 a.m. and 14:00 p.m. the peak time of drug effect coincides with the fluctuation of blood pressure, effectively reducing blood pressure.


Patients with non-dipper blood pressure should take medicine about two hours before the peak of blood pressure according to the curve formed by ambulatory blood pressure monitoring to effectively reduce blood pressure.


Note that most antihypertensive drugs are currently controlled-release or sustained-release dosage forms. For such drugs, it is recommended to take drugs in the morning to stabilize and control blood pressure throughout the day. Alpha blockers such as terazosin can cause orthostatic hypotension, so they are usually taken at bedtime.

 

 

Digitalis


Digitalis is an important drug for the treatment of heart failure, but its own toxicity can not be ignored.


The peak concentration of digoxin in the morning was slightly lower, but the bioavailability and efficacy were the highest. Blood was collected from 14:00 to 16:00 in the afternoon, showing high peak blood concentration and low bioavailability. Digitalis drug sensitivity peaks at night and is prone to toxic reactions if used at conventional doses.


Therefore, it is recommended to take digoxin in the morning, not only to improve the efficacy, but also to reduce its toxic effects.

 

 

anti-angina drugs


The highest rate of angina attacks is due to sympathetic excitement in the morning. Therefore, anti-angina drugs such as calcium antagonists, nitrates, and beta blockers are generally recommended to be taken in the morning to dilate coronary arteries and improve myocardial ischemia.

 

Note: Some antianginal drugs, such as amlodipine, have a gentle onset of action and a long duration of action. The peak time of the blood drug is 6~12 h, which can be administered before going to bed, so that the peak blood drug will appear in the morning to fight angina pectoris.