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Time sensitive medicines

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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.

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 eaten at the next meal enters stomach. Other medicines need food in the stomach. This protects the stomach lining against irritation.

Where there is a consideration needed around food, this 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.

Bisphosphonates for osteoporosis

Examples of bisphosphonates include alendronic acid, risedronate and ibandronic acid.

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

Administer these medicines according to the manufacturer’s instructions. Refer to the patient information leaflet.

Administer bisphosphonates at least 30 minutes before the first food, beverage, or medicinal product of the day. Administer them 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. Patients 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.

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

Medicines containing paracetamol

Paracetamol is a mild analgesic and reduces fever.

Paracetamol is often prescribed as 500mg tablets or dispersible tablets. It has 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 and co-dydramol contain paracetamol.

A maximum dose of 1g (two 500mg tablets) should be taken at any one time. You should usually leave a gap of at least four hours between doses. The maximum dose in adults is no more than eight tablets in 24 hours. This is sometimes reduced in certain conditions. For example, people weighing less than 50kg might have a reduced dose. Take particular care when administering more than one analgesic containing paracetamol.

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 which contain paracetamol. Where a variable dose is prescribed, record the number of tablets given.

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

Seek 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 such as:

  • bradykinesia (slow movements)
  • rigidity
  • rest tremor (shaking)
  • postural instability (loss of balance)

Medicines are often prescribed to improve people’s quality of life.

People with Parkinson’s disease 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 ‘on time’ to maintain symptom control.

Information and support should be given to people and their carers. This should include information about possible side effects and risks.

Stopping antiparkinsonian medicines suddenly can lead to severe side effects. These include:

  • acute akinesia - the loss or impairment of the power of voluntary movement
  • 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 reoccurrence of symptoms, make sure that people:

  • receive their medicine at the appropriate times
  • are supported by self-administration where appropriate.

You might miss a dose of a person's time sensitive medicine for Parkinson’s disease. Medicines administration records (MARs) must show this. Staff should be able to explain what action they took. This might include contacting the person’s GP.

Last updated:
09 September 2020