The difficulty with medication is knowing when to time them, and also when to give up from side effects. There’s always a risk to benefit ratio that you should consider.
For example, if you’re having trouble sleeping and wondering if it has something to do with a new medication, you’re totally right to think that through.
For example, maybe you’ve recently started taking sertraline (Zoloft) for depression at night and hydrocodone for pain, and you’ve been taking that one in the morning so you could work with more comfort.
Is that correct? I had a reader from New York write me once and ask me that.
He said, “The problem is that I feel like a zombie at work but I stay up all night. Is this typical?”
The answer is yes and no.
Yes, it’s typical if you’re taking these medications, but NO it’s not supposed to be like that!
It’s all about timing and his timing is backwards!
There’s a simple rule in pharmacy: Take energizing meds in the morning, and sedating ones at night! That would mean that the Zoloft be taken in the morning and the hydrocodone at night, generally speaking. If more pain medicine is needed for daytime use, perhaps a half dose of the hydrocodone or non-sedating med (acetaminophen or ibuprofen) could be taken in the day.
The reasoning behind this is to take advantage of the side effect profile of each drug. The Zoloft will create energy during the day. The hydrocodone will allow for more comfortable sleep.
In the example here, sertraline (Zoloft) is good at raising energy levels and increasing alertness. The reason this person is up all night is because he is taking an energizing medication at bedtime! Unless you enjoy informercials or like to tweet in the wee hours, I suggest that the timing be changed as I’ve described above. In fact, for all of you reading this, I think that the class of antidepressants in the SSRI category should always be taken in the morning or around lunchtime, unless for some weird reason you find them sedating.
Pain medications such as hydrocodone/acetaminophen (Lortab, Norco or Vicodin) or oxycodone, fentanyl, demerol, hydromorphone and others are notorious for causing one to feel drowsy, dizzy and relaxed so those are better at nighttime, for example after dinner, or maybe an hour before bedtime.
I usually recommend that pain meds be taken with food, or with a little snack to minimize any stomach discomfort and nausea.
FYI, prescription analgesics in the synthetic opioid category are known to slow down respiration and heart rate, and sensitive will notice this. Furthermore, for this reason, medications should never be combined with alcohol or other CNS depressants. Accidental fatalities have occurred by doing this.
The best time to take pain medications is at night so you can take advantage of the sedating side effects, and also stay safe on the road. You don’t want to be driving with these medications on board because intoxication can cause fatalities on the highway. Taking advantage of side effects (of any medication) allows you to enjoy the benefits of the drug, and minimize or avoid the problematic side effects.
If you are uncertain about when to take your particular medication, please ask your local pharmacist to weigh in, or look at a trusted medication side online.
Here are some general rules:
Sleeping medications- Take these 15 to 60 minutes before retiring. This rule of thumb goes for over-the-counter sleep aids like Sominex, Nytol and others, as well as prescribed sleepers like Ambien, Lunesta and Restoril. Never combine sleeping medications with alcohol or other benzodiazepines.
Thyroid Medication- Take drugs like Armour, Nature-Throid, Levothyroxine and Compounded T3 (and others) first thing in the morning, right after you wake up. This allows our system to take up the m medication during the day and provide energy.
Take them on empty stomach and away from dairy foods and calcium or iron supplements. Thyroid medications are intended to produce energy, burn fat, speed up metabolic and heart rate, and give you mental clarity. If you take them at night, you’re apt to get insomnia. If you have an interest in thyroid, CLICK HERE to read, How I Healed My Thyroid With Supplements.
Blood Pressure Meds- Generally speaking, these should be taken at bedtime because they often produce dizziness. So in the morning (or in the middle of the night if you get up to pee), make sure to get out of bed very slowly because they can cause “orthostatic hypotension” which is a sudden drop in blood pressure when going from a sitting position to standing.
Pancreatic Enzymes – Take enzymes with every meal or snack that you eat, specifically if it contains fat, like protein meat, dairy, bread and even some desserts. To take advantage of this medication, make sure you take it at the beginning of the meal, not at the end. It’s pretty useless at the end.
ADHD Drugs like Ritalin – This is a brand-name prescription stimulant medication that raises levels of dopamine and norepinephrine in the brain. It helps with deficiencies of these neurotransmitters which helps people with ADHD. The drug is generally taken about 30 to 45 minutes before a meal (ie an empty stomach). It’s not taken at bedtime.
The interesting thing is that there was a STUDY that was done in 2016, and published in the Journal of Developmental & Behavioral Pediatric where researchers evaluated methylphenidate (Ritalin) on sleep patterns in children. In their own words, they sought “To examine the effects of stimulant medication on the sleep functioning of children with attention-deficit/hyperactivity disorder (ADHD) and identify predictors of sleep problems as a side effect of taking stimulant medication.”
This study was able to show that higher doses of the drug may increase insomnia in kids that were smaller in terms of their BMI (weighed less). Interestingly, a substantial number of children with pre-existing sleep problems actually did better with higher doses. This is why we can’t easily conclude or guess what will happen to your particular child. There are mixed findings to date, so taking advantage of side effects with Ritalin is a little hard to do… I’d say it’s more trial and error.
Nasal Decongestants – Found in cough and cold aisle, these medications are useufl to fix a sinus headache, or un-stuff your nose and sinus cavities. These are energizing drugs, akin to a street drug like amphetamine or “speed” so take them during the day or you might get insomnia. Sustained-release formulas cause less of a energy ‘jolt’ but still provide long-acting relief.
Diuretics- These “water pills” lower blood pressure by making you urinate more which reduces blood volume. Take them in the morning so you are not racing to the potty all night!
Suzy Cohen, has been a licensed pharmacist for over 30 years and believes the best approach to chronic illness is a combination of natural medicine and conventional. She founded her own dietary supplement company specializing in custom-formulas, some of which have patents. With a special focus on functional medicine, thyroid health and drug nutrient depletion, Suzy is the author of several related books including Thyroid Healthy, Drug Muggers, Diabetes Without Drugs, and a nationally syndicated column.