Take Your medicine “One morning, One Evening” Here is What it Actually means?

Take your medicine “one morning, one evening” has become a household terminology for taking medicines but do you know what it really means?

Basic Information about your medicine that you need to know

Whenever you are given a medicine to take, there is basic information about the medicine that you need to know. Some of this basic information includes:

1. The strength of the medicine
2. The dose
3. The frequency of administration
4. The timing
5. The duration of treatment

All of these put together is referred to as the dosage regimen. Thus in simple terms, you have to appreciate the dosage regimen for each medicine that you take.

Let’s take them one by one so you understand what each truly means.

The name of the medicine: 

There are two sets of names that each medicine is likely to have. There is a common name called the brand or trade name and there is an internationally accepted name referred to as the generic name.

Brand vs. Generic Names of a drug

The trade name or branded name is a name that is given by the company that manufactured the particular product.

However, before any company makes the drug (except if they are the originators of that drug), there is a more scientific and internationally accepted name for the drug which is the same as the active ingredient of that medicine, and this is known as the generic name.

Once, they make their own then they brand it the way they want that is acceptable by the medicine regulatory agency in that country.

The strength of the medicine:

Most medicines contain a certain concentration of an agent that is active and responsible for the effect the medicine has. This active agent is referred to as the active pharmaceutical ingredient (API). 

What you will usually find is that the amount of the API in the drug has been written on it. So, for instance, if you take a box or pack of paracetamol and you see 500mg, it means that the actual amount of paracetamol in a single tablet is 500mg.

Hence you can say that the strength of the paracetamol is 500mg. 

Even though the strength is written on the primary package of the drug, it doesn’t mean that is the amount you need to take. So, the actual amount that you need to take at any particular time is known as the dose.

Dose

Basically, the dose refers to the amount of the drug that you need to take at any one time. So for instance, your doctor can tell you to take 1g of paracetamol three times daily.

In this case, the dose of paracetamol that you are taking is 1g equivalent to 2 tablets of the 500mg paracetamol.

The frequency

This refers to how often you are required to take the medicine. That is usually where you will hear things like ‘take this medicine three times daily” or “take one morning, one evening” or “one morning, one afternoon and one evening”.

This basically gives you an idea of how often you should take the medicine. However, is the saying “take one morning and one evening” the right way of expressing the frequency?

This is an absolute No. In fact, it is very wrong to just say “take one morning and one evening”. One morning one evening could literally mean any time of the day in the morning and evening that you feel like taking it.

So you could wake up at 11:00 am and take your morning dose and also take your evening dose at 6:00 pm that day. This is not right. How then should the frequency of medicines be expressed?

The essence here is that you should be able to interpret these frequencies for yourself so that if your healthcare provider does not make it clear to you, you will still get it done correctly.

A practical explanation of drug frequency

Basically, there are 24 hours in a day and we use the number of hours instead to space out the times to take the medicine. If a drug is to be taken three (3) times a day, it means dividing 24 hours into 3. 

24 divided by 3 gives 8 hours. Therefore, you should spread out the times to take your medicine by 8 hours. In other words, you will be taking your required dose every 8 hours. 

8 hours intervals are what people popularly refer to as morning, afternoon, evening.

If you are told to take medicine two times a day (morning and evening) then it will imply taking it at 12-hour intervals. With this, the easiest way to remember is that 12hours will mean the same time in the evening as in the morning.

So, if you take the medicine at 8 o’clock morning then you will need to take the next dose at 8 o’clock in the evening.

Healthcare professionals have symbolic representations which are actually Latin abbreviations of the instructions about the frequencies.

You don’t necessarily need to know them but in case you come across any of them, the meanings are spelled out below.

Terms and their Meanings for describing dosage regimen

Commonly used term	Frequency	Symbols used	Meaning
Take in the morning, afternoon, and the evening	3 times in a day	TID or TDS	Take the next dose after 8 hours
Take in the morning and evening	2 times in a day	BID or BDS or BD	Take the next dose after 12 hours
Take in the morning, afternoon, evening and at night	4 times in a day	QID	Take next dose after 6 hours
Take once a day	1 time in a day	OD	Take the next dose every 24 hours. For this, you have to pick a specific time of the day that will be comfortable for you. Then do well to take your medicine at that same time every day.
Nocte	Take only at night
Mane	Only in the morning

Does dosing frequency have an impact on treatment outcome?

My guess is that the answer to this question is very obvious. Treatment outcomes are greatly influenced by dosing frequencies and if not well adhered to, may cause toxicity and or treatment failure.

Not to get too technical, medicines have been studied and realized that the total amount in the body depletes with time.

Each medicine has a different pattern with regards to the time it takes them to leave the body. It has also been realized that for a medicine to be effective in the body, a certain concentration is needed.

Hence, at any point in time during your treatment, we strive to have that amount or even more of the drug in your body being careful not to exceed the maximum effective dose above which one may experience undesirable adverse effects.

Most of the time, the drug will become ineffective when the level in the body gets below the minimum required. So these frequencies are basically the times above which the level of the drug will go below the minimum required amount.

For instance, if a drug is to be taken every 8 hours, then it means, after 8 hours the level may be below the minimum required for it to work effectively.

As such, within every 8 hours, you are expected to take another dose to raise up the amount in the body to the required level (which will also last for about 8 hours) for effective treatment.

What should I do when I miss a dose?

Since you now know the importance of sticking to the prescribed regimen for your medicines, I believe you will do your best to adhere. However, as humans, as we are, you may at one point in time miss a dose at the specified time for whatsoever reason it may be.

So the question is what do you do in such a situation?

The general advice is that you have to consider how close you are to taking the next dose. If you are too close to the next dose then you should just forget about the missed one and take the next one when it is due. 

You aren’t supposed to add the missed one to the next one. When you do so, you may experience the effects of an overdose. However, if you remember the missed dose earlier such that you have a long while to take the next dose, then you can go ahead and take it as soon as you remember.

Here is a practical example.

Let’s assume you are to take a drug at 8 hours intervals. You took the morning dose at 7:00 am, meaning your afternoon and evening dose will be taken at 3:00 pm and 11:00 pm respectively.

If you missed your afternoon dose and remember it after a while, you have to assess how long it is before you take the 11:00 pm dose. So if you remember it about 2 hours to the next dose then you should forget about taking it and wait for the next dose. 

However, if you have about 4 or more hours to take the next dose then you can go ahead to take the missed dose. In such a situation, after you take your missed dose, you would still have to take your next dose at the exact time you were supposed to take it. 

As a rule of thumb, you can use the 50 – 50 rule where you take the missed dose if you haven’t exceeded 50% of the interval (not more than 4 hours to the next dose for an 8-hour interval) and vice versa.