Recently, I was put on a medication that I had to take 3 times a day. I was surprised at how much I struggled with this dosing schedule. I’ve been taking regular medications since I was a teen. I don’t usually forget to take medications because I’m so used to it.
This time, I wondered if I should have downloaded an app or set alarms to remember to take my doses on time. The 3 times a day really didn’t hit me right because it wasn’t at mealtimes. Morning, afternoon, and bedtime were the times I was supposed to take it.
Morning is no problem. But afternoon: I might be in a meeting, taking kids to activities, or deep into my work. So I would forget.
Now bedtime was also difficult and it didn’t make any sense. I would remember my other nighttime meds but forget this new one. More than once I woke up in the middle of the night, realized I didn’t take it, and took it then instead.
Can’t I Solve This Problem?
I know: wouldn’t setting an alarm help with this? No, because I know myself. I would shut the alarm off or snooze it 10 times in a row or get pissed off because I was in the middle of something and not take the dose anyway.
It made me realize that the 3 times a day is the worst dosing schedule for me. Once, twice, or 4 times a day I can do without much issue. But that 3 times: it got me.
It’s well understood that most people don’t want to take pills multiple times a day. That’s why some medications are extended release or become reformulated so that, for instance, they can be taken twice a day instead of 4 times a day.
What About Absorption?
But for those of us who have lost intestines to surgery, the multiple time a day dosing might be needed. It took almost a year for it to occur to me that extended release medications might not be as effective for me after having colectomy surgery. A very smart pharmacist clued me in and let me know that it’s something to consider if I’m taking, for instance, something routine like cold medicine or pain killers.
Or something really important like hormonal birth control! (Low dose oral contraceptives are probably absorbed in most women with IBD. But serious inflammation or having short bowel syndrome could be a problem. Check with your doctor and consider another form of birth control or adding a second form if there’s a concern.) (Sridhar)
If you’ve had surgery on your intestines, be sure to let all your healthcare providers know and see if you can enlist the help of a pharmacist. For the most part, drugs are probably absorbed well, even for people with a j-pouch or an ileostomy. (Santamaría)
But because we’re all different: always check with your providers.
What Do Patients Think?
This made me wonder: what do patients think about dosing? That’s why I decided to ask people who follow About IBD on Twitter and Instagram how they feel about medication dosing.
Which type of oral medication or supplement dosing do you find most difficult to follow?
Meaning: taking doses on time, not in regards to side/adverse effects.
- Once a day
- Twice a day
- Three times a day
- Four times a day
Here’s what people answered in my poll:
- Once a day —10%
- Twice a day — 5%
- Three times a day — 35%
- Four times a day —50%
- Once a day —6%
- Twice a day —10%
- Three times a day — 28%
- Four times a day —56%
More Context from Twitter
I invited people to reply to give more information and here were some of the responses.
“I have to set alarm reminders for anything other than twice a day. I’m very regimented about AM and PM meds but once it gets to 3 or 4 times a day alarms are the only way I stay on schedule.”
“Keep in mind IBD patients take more than just GI meds. So as more docs we see, keeping track of what dose when and with what, becomes THE challenge of med compliance.”
“I’m over here struggling with even the one I have to leave it out on the countertop so later in the day I get to look horrified about the fact I didn’t take it some days I even refuse to because I dun wanna.”
“Anything more than once a day. Also once a week is hard for people.”
Any poll has limitations. This poll is less than scientific because it’s only from people who follow About IBD and then further segmented by those who were shown the question via the algorithm and then who decided to engage with it.
In addition: this poll did not address all the challenges inherent in infusion or subcutaneous medication dosing (which could be every day, every few weeks, or every few months).
It seems that many of us have challenges when it comes to medication dosing. Turns out we’re all human, and even long-term patients can find it difficult.
In the IBD community we’re not so fond of unsolicited advice. There were very few responses that expressed an interest in receiving some kind of help in addressing the issue of remembering to take medication or in the mental reasons that we sometimes skip taking them.
But it does seem that perhaps this is a topic worth looking into more, and that solutions might be welcome for those who choose to engage with that content. If that’s you: my DMs are open! Let me know if you’ve solved the problem for yourself or if you would like to be pointed at some tips or tricks in how to do so.
Santamaría MM, Villafranca JJA, Abilés J, et al. Systematic review of drug bioavailability following gastrointestinal surgery. Eur J Clin Pharmacol. 2018;74(12):1531-1545. doi:10.1007/s00228-018-2539-9
Sridhar A, Cwiak CA, Kaunitz AM, Allen RH. Contraceptive Considerations for Women with Gastrointestinal Disorders. Dig Dis Sci. 2017;62(1):54-63. doi:10.1007/s10620-016-4383-z