Time sensitive medicines

Some medicines need to be given at a certain time to make sure they are safe or work effectively.

Examples of these include:

• medicines that should be given before or after food
• medicines containing paracetamol
• medicines prescribed to help mobility for people with Parkinson’s disease
• medicines that should be taken at the same time each day to maximise their effectiveness. For example, warfarin, oral contraception, antibiotics, insulin.

Before or after food

The stomach or intestinal contents can affect the absorption of some medicines. Some medicines need to be taken on an empty stomach. These medicines need to be absorbed before food enters the stomach at the next meal. Other medicines need food to be in the stomach. This protects the stomach lining against irritation.

Where you need to consider food when giving medicines, a warning will be specified on the medicines dispensing label. Examples include:

• take with or just after food, or a meal
• take 30 to 60 minutes before food
• take this medicine when your stomach is empty. This means an hour before food or two hours after food.

Make sure that people’s medicines records include when to give medicines in relation to food.

Staff must have the right skills and knowledge to support people to take their medicines safely. They should know what action to take if it is not possible to give medicines as prescribed, for example because the person has already eaten.

Bisphosphonates for osteoporosis

These medicines have very specific dose requirements relating to food and the time of administration. Examples of bisphosphonates include:

• alendronic acid
• risedronate
• ibandronic acid.

Administer these medicines according to the manufacturer’s instructions and refer to the patient information leaflet. There are important issues to consider:

• Administer bisphosphonates at least 30 minutes before the first food, beverage, or medicinal product of the day with a full glass (not less than 200ml) of plain water only (not mineral water). 
• Do not administer with other beverages, food or other medicinal products. These are likely to reduce the absorption.
• Bisphosphonates should be swallowed whole. People should not crush or chew the tablet or allow it to dissolve in their mouths. This could cause oropharyngeal ulceration.
• People taking bisphosphonates should not lie down until after their first food of the day. 
• They should not eat until at least 30 minutes after taking the tablet.

Medicine policies should include planning meals and times to administer medicines. Medicines care plans should reflect people’s differing mealtime routines and sleeping patterns.

Medicines containing paracetamol

Paracetamol is a mild painkiller and reduces fever.

It is often prescribed as 500mg tablets or dispersible tablets. It can be prescribed or given as a variable dose, which can be tailored to the individual’s needs. Paracetamol is also an ingredient in several combination painkillers. For example:

• co-codamol
• co-dydramol
• some over-the-counter cold and flu treatments.

Take particular care when administering more than one analgesic containing paracetamol.

Before administering paracetamol, make sure the gap between doses is long enough. You need to leave at least 4 hours between doses. Make sure the total dose given in the past 24 hours is within the prescribed range.

The dose is sometimes reduced in certain conditions. For example, people weighing less than 50kg might have a reduced dose. Refer to the care plans or ‘when required’ guidance. These will tell you when and how much paracetamol to administer. See PRN or 'when required' medicines.

Record the time you administer medicines that contain paracetamol. Where a variable dose is prescribed, record the dose given.

You should get immediate medical advice in case of an overdose. Even if the person feels well, there could be a risk of delayed, serious liver damage.

Treating symptoms of Parkinson’s disease

People with Parkinson’s disease classically present with the symptoms that affect their movement and mobility. Medicines are often prescribed to relieve symptoms and improve people’s quality of life.

People may experience the ‘on-off’ effect during treatment. During the 'on' phase, the medicine is working to decrease symptoms. In the ’off’ phase, the medicine is wearing off and symptoms become poorly controlled. Medicines should be given at the right time to keep symptoms under control.

People with Parkinson’s disease and their carers should receive information and support. This should include information about possible side effects and risks.

Stopping medicines for Parkinson’s disease suddenly can lead to severe side effects. These include:

• acute akinesia – the loss or impairment of the power to move voluntarily
• neuroleptic malignant like syndrome - a rare but serious condition with symptoms of fever, altered mental state, muscle rigidity, increased heart rate and blood pressure.

Poor absorption of the medicine from the gut can also cause these side effects. This could be, for example, because of vomiting, diarrhoea or surgery. You should work with healthcare professionals to reduce the impact of these side effects on the person receiving care.

Person centred care plans should show how people with Parkinson’s disease will receive their medicines safely and in a way that meets their needs. Timing of medicines will be based on individual needs. You should only adjust these medicines after discussion with a specialist in managing Parkinson’s disease. To help avoid sudden recurrence of symptoms, make sure that people:

• receive their medicine at the appropriate times. For example, their first dose will be when they wake up and not at a set medicines round. 
• are supported to self-administer where appropriate.