Many practitioners do not explain to the patient, when to take the medicines. The common situation is when I find that the patient of hypothyroidism is not responding to a particular dose of Eltroxin. On questioning I find that the patient is swallowing the pill along with Iron, Calcium and other drugs at the same time. This hampers the absorption of Eltroxin. Eltroxin should be taken early morning separately.

The doctors should remember that quite often a 30-40 year old female patient is taking on an average 3-4 drugs, while an average middle aged or an elderly male patient is often taking 5-6 medicines, specially if he is a diabetic, hypertensive or has ischaemic heart, which is a common combination of illnesses. I would like to illustrate few examples to stress the point :-

1. Iron preparation should be taken “after” a meal to avoid GI side effects.
2. Calcium tablets should be taken “during” the meals to avoid any possibility of kidney stone formation.
3. Omeprazole should be given early morning before breakfast.
4. For patients having reflux oesophagitis a big dose of antacid should be taken at night just before going to bed.
5. Alendronate often prescribed for osteo-porosis should be taken early morning on empty stomach and the patient should avoid lying down for ½ an hour after taking the tablet.
6. All the anti-tuberculous drugs should be taken together early morning “before” breakfast in order to give maximum benefit to the patient.
7. Steroids must be given after meals to avoid hyperacidity.
8. Statins for patients having ischaemic heart disease should preferably be given after dinner because of their relationship to biliary absorption.
9. Aspirin in patients having IHD should be given after breakfast but never on empty stomach.
10. Patient of angina should place GTN tablet under the tongue while sitting (to avoid dizziness and fainting due to postural hypotension) just before starting the exertion.
11. Chloroquine tablets often cause vomiting and are not retained by the patient. So they should be given only after the attack of fever with rigors subsides. Thus anti-pyretic tablets and Tepid sponging should be given first. A glass of tea or milk should precede the dose of Chloroquine tablets.

I have quoted only a few examples of common drugs and common mistakes which are done by the practitioners.