Is aspirin taken at night time better than morning?

Recently a friend of mine asked about whether is it rationale to change aspirin recommendation to be taken at night than morning? What do you think :

"Aspirin taken at bedtime compared with on awakening significantly diminished 24-hour plasma renin activity and excretion of cortisol, dopamine, and norepinephrine in 24-hour urine. Decreased activity of these pressor systems forms a biologically plausible explanation for the finding that aspirin at night may reduce blood pressure, whereas aspirin at morning does not. "

Snoep JD, Hovens MMC, Pasha SM, et al. Time Depedent Effects of Low-Dose Aspirin on plasma renin activity, aldosterone, cortisol and catecholamine.Hypertension 2009; 54: 1136.

"This prospective trial documents a significant administration time-dependent effect of low-dose ASA on BP in untreated hypertensive patients. The timed administration of low-dose ASA could provide a valuable approach, beyond the secondary prevention of cardiovascular disease, in the added BP control of patients with mild essential hypertension. "

Hermida RC, Ayala DE, Calvo C, et al. Aspirin Administered at Bedtime, But Not on Awakening, Has an Effect on Ambulatory Blood Pressure in Hypertensive Patients. Journal of the American College of Cardiology. 2005; 46: 975-83

& you may check out these 2 sites more for information :

Commentary from Yip HL et al, based on a reply from Kriszbacher I et al on the possible of aspirin for stroke prevention taken in the evening? http://stroke.ahajournals.org/cgi/content/full/35/12/2760

Snoep JD et al. Time Depedent Effects of Low-Dose Aspirin on plasma renin activity, aldosterone, cortisol and catecholamine.Hypertension 2009; 54: 1136. & Commentary from Black HR on this article,published in Medscape Cardiology: Available online http://www.medscape.com/viewarticle/716196

Drugs to be Taken on Empty Stomach

Drugs to be taken on empty stomach should be taken either 1 hour before or 2 hours after meals. However, in the hospital scenario, in order not to confuse patients, we usually cancel the 'selepas' for the label to read 'sebelum makan'.

Here are some common examples of drugs to be taken on empty stomach and the reasons for doing so.

where the oral bioavailability of the drug is reduced by more than 20% by food

• 6-mercaptopurine


• alendronate


• atenolol


• azithromycin


• captopril


• ferrous fumarate


• indinavir (heavy/large meals only)


• d-penicillamine (take with food if GI upset)


• dicloxacillin


• didanosine


• erythromycin base (erythromycin estolate, erythromycin stearate: take with food as drugs may cause a signicicant incidence of gastric side effects)


• flucloxacillin


• gemfibrozil


• isoniazide


• perindopril


• rifampicin


• tacrine


• tetracycline


• lansoprazole
  

As gastric acid secretion is maximally stimulated by food ingestion, maximal efficacy of proton pump inhibitors (e.g. omeprazole, pantoprazole, lansoprazole) should be achieved when they are taken before a meal.


where the presence of food reduces the effectiveness of the preparation but is unrelated to absorption

• bismuth subcitrate


• sucralfate (theoretical)

where the rate of absorption of the drug is significantly reduced by food and clinical effect is related to rapid absorption

• bumetanide

References:

1. The Dispensing Guide 2001, The Pharmaceutical Society of New Zealand


2. http://www.medscape.com/viewarticle/531605