Summary: Optimal time to take commonly used cardiovascular drugs

There are many types of cardiovascular diseases, and the corresponding therapeutic drugs are also numerous, and when patients are faced with many drugs, it is easy to make a difficult question: when should this medicine be taken? Today, the author hereby summarizes the best time to take some commonly used cardiovascular drugs, hoping to help everyone.

Antiplatelet drugs

01. Aspirin

1) How long to take the drug?

Aspirin is completely absorbed through the gastrointestinal tract after oral administration. After absorption, it is rapidly degraded to salicylic acid, the main metabolite. Peak time for aspirin and salicylate plasma concentrations is 10 to 20 minutes and 20 to 120 minutes, respectively.

At present, the commonly used clinical aspirin enteric-coated tablets have acid resistance, and the absorption of aspirin enteric-coated tablets is delayed by 3 to 6 hours in the insoluble acidic gastric juice and in alkaline intestinal fluids.

The antiplatelet effects of aspirin can last for 7 to 10 days (i.e., the entire life cycle of platelets) and are irreversible. So, theoretically, there is no difference between when and when to take aspirin every day.

2) Before and after meals?

Ordinary aspirin oral administration will have a strong irritation of the gastric mucosa, which can easily cause damage to the gastric mucosa and induce 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, and the aspirin enteric-coated tablets are not dissolved; after reaching the duodenum, they begin to dissolve in the alkaline environment of the intestine, so they will not directly stimulate and damage the gastric mucosa.

If taken after meals, it may increase the residence time of the drug in the stomach, resulting in the separation of some drugs from the enteric-coated membrane, thereby stimulating the gastric mucosa; in addition, the food dilutes the strong acid environment in the stomach, resulting in the dissolution of the drug in the stomach, which has increased the risk of adverse reactions in the stomach. Therefore, aspirin enteric-coated tablets are best taken before meals.

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

02. Clopidogrel

Clopidogrel itself, it and platelets are irreversible combination, to the end of the life cycle of the combined platelets metabolized, in order to eliminate the effect. Therefore, there is no time limit for regular taking clopidogrel. It can be taken at approximately the same time, and the diet does not have much effect on it.

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

03. Tigrelo

It is a novel P2Y12 receptor antagonist, a non-precursor drug that can be directly activated by liver metabolism, and acts directly on platelet ADP receptors, with strong and reversible antiplatelet effects.

Compared with clopidogrel, ticagrelor has a shorter onset of action, taking only 0.5 to 4 hours. The average half-life is 7.2 h, the active metabolite is 9 h, and its use is recommended according to the half-life at 1 time in the morning and 1 time in the morning and evening, regardless of diet.

Lipid-lowering drugs

The most important lipid-lowering drugs are statins, mainly including atorvastatin, rosuvastatin, fluvastatin, simvastatin, etc., which play a role by inhibiting HMG-CoA reductase, blocking the synthesis of liver cholesterol, and reducing the concentration of serum total cholesterol and LDL cholesterol.

Because his statins mainly inhibit the speed-limiting enzyme of cholesterol synthesis, and this enzyme is the most active at night, and the general statin has a short half-life, it is generally necessary to take it before bedtime.

Atorvastatin, rosuvastatin and pitvastatin have a long half-life and good lipid-lowering effect, and can be taken at any fixed time of day.

Another common lipid-lowering drug is fibrates. Usually used to lower triglycerides, it is recommended to take with meals.

Antihypertensive drugs

Human blood pressure has obvious diurnal fluctuations. Most people are "biliform blood pressure", that is, nocturnal blood pressure decreased by more than 10% to 20% compared with the daytime; conversely, if the waveform of the nocturnal blood pressure drop becomes shallow, the average nocturnal blood pressure decreases by less than 10% compared with the daytime, or there is no obvious nighttime valley, and even if the nighttime blood pressure is higher than the daytime, it is called "non-oleander-type blood pressure".

Generally, antihypertensive drugs take effect 30 minutes after taking, and peak in 2 to 3 hours, so the time of oral antihypertensive drugs depends on the blood pressure waveform throughout the day.

Patients with biasis blood pressure generally reach a peak of 9 to 11 a.m. and 16 to 18 p.m., so it is recommended to take the drug at 7:00 a.m. and 14:00 p.m. The time when the drug effect reaches the peak coincides with the fluctuation of blood pressure, effectively reducing blood pressure.

Patients with non-oleracea blood pressure should take the drug 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 of the current antihypertensive drugs are controlled-release or sustained-release dosage forms, and it is recommended to take them in the morning to stabilize and control blood pressure throughout the day. α receptor blockers such as terrazosin can cause orthostatic hypotension, so they are usually taken at bedtime.

digitalis

Digitalis drugs are important drugs for the treatment of heart failure, but their own toxicity cannot be ignored.

Digoxin peaks are slightly lower in the morning, but bioavailability and efficacy are greatest. Blood collection from 14:00 to 16:00 in the afternoon is manifested by high peak blood concentration and low bioavailability. Digitalis drug sensitivity peaks at night and is prone to toxicity if used at conventional doses.

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

Antianginal drugs

Due to sympathetic excitement in the morning, the incidence of angina is highest. Therefore, antianginal drugs such as calcium antagonists, nitrates, β receptor blockers are generally recommended to be taken in the morning, dilate the coronary arteries, and improve the effect of myocardial ischemia significantly higher than in the afternoon.

Note: Some antianginal drugs, such as amlodipine, have a gentle onset and a long duration of action, and their blood peak time takes 6 to 12 h, which can be administered at bedtime, so that the peak of the blood will appear in the early morning to fight angina.

Title image source: Stand Cool Helo