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I was wondering, if medications such as antibiotics are to be taken 4 times or more a day (so every 6 hours), what happens during the night with such a long gap in between (8 hours). I have heard that the impact of medication lessens if the dosage is delayed, so how come sleep through the night without medication is okay?

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    If the instructions say to take it three times a day, that means every 8 hours, or as close to 8 hours as you can. So sleeping time shouldn't be much longer than any of the other gaps. Or am I not understanding your question correctly? – Carey Gregory Nov 14 '15 at 3:02
  • @CareyGregory yes you got me right, but what about overnight affect. Supposedly it says every 5 hours. But night can be 8-10 hours. Doesn't it looses it affect taking it after 10 hour of gap. – Nofel Nov 14 '15 at 10:59
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There are very few (but there are some) medications that need to be taken at very strict time intervals; early drugs for AIDS needed to be taken even in the middle of the night.

No one expects four times a day to mean, literally, every 6 hours on the minute. The dose is calculated to cover that period of rest (sleep).

To understand this, you need to understand steady state pharmacokinetics and pharmacodynamics.

After a certain number of doses, a drug builds up in the body to a steady state - meaning it stays more or less in the same concentration in the blood between doses, or to put it another way, the amount being taken in and the amount being eliminated by the body are about equal.

It's not guesswork; researchers study the drug before it's even released to determine such things (see the second reference.) Pharmacokinetic studies determine the dosages at which the concentration of a particular drug/antibiotic is always high enough between doses such that serum levels don't fall below effective levels.

Say a drug under investigation is given every 12 hours. Blood is drawn at frequent intervals over a number of doses for to determine peak levels (the time at which the concentration in the blood is highest) and trough levels (the time when the drug is the lowest.) If at the trough level the drug is below that needed to be effective, the dosing interval decreases: the subject must take it more frequently, say every 8 hours. This cycle continues until the ideal dosage and dose interval is established. The final recommendation takes into account how long you can go without taking the drug and still have enough drug - how to take the drug such that the steady state is maintained - if you sleep.

If a drug falls below the effective dose quickly (say it is metabolized into an ineffective product), and a satisfactory prolonged serum level can't be arrived at, the prescribing physician will alert you to the fact that you must take it to as close to how it's prescribed as possible, and will tell you what to do if you miss a dose.

When the timing of administration of life-saving drugs is critical, it's not uncommon to hospitalize a patient to assure such administration.

I have heard that the impact of medication lessens if the dosage is delayed, so how come sleep through the night without medication is okay?

That has all been calculated so that there is adequate and continuous coverage. The bacteria have no opportunity to "develop resistance" while you sleep.

Pharmacokinetics and Pharmacodynamics of Antibacterial Agents
The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjects <- An example of how pharmacodynamics are determied.

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  • ♦ when you say The bacteria have no opportunity to "develop resistance" while you sleep. why? What is the science behind it? Does bacteria become inactive while we sleep? – Nofel Nov 15 '15 at 13:52
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    @Nofel - Is that a serious question? Why would the bacteria become inactive when we sleep? The answer is above. The antibiotic reaches a steady state, meaning it's still present in sufficient quantity to continue to kill the targeted bacteria while you sleep. It reaches a steady state. If you still don't how that happens after reading the edited answer above, read about pharmacokinetics. You'll understand better afterwards. But please don't just keep asking the question, or altering the dosing interval. – anongoodnurse Nov 15 '15 at 19:38
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    So all those times as a child when my mother woke my suffering, feverish self for a 2 AM dose of antibiotic drunk with a glass of hot raspberry compote were for naught? Thank you for clearing that up, and double thanks in the name of the children I might have someday! – rumtscho Nov 15 '15 at 23:36
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    @anongoodnurse thank you for the valuable answer, it helps a lot :-) – ABcDexter Nov 16 '15 at 4:58
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    @rumtscho, children often sleep for a lot longer then 8 hours and it depends on the antibiotic. Most of the time it is likely you had a virus anyway and the antibiotic was not needed at all.... – Ian Ringrose Nov 16 '15 at 17:41

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