Your Health Checkup: Drugs and Daily Activity

“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

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Yesterday morning while exercising as usual, I inflamed an old biceps tendonitis that triggered pain whenever I moved my arm. I needed treatment with a nonsteroidal anti-inflammatory drug (NSAID).

While researching which drug to take, I came across an interesting article stating that administering NSAIDs during the daily activity period, i.e., in the morning for most people, resulted in better pain relief and healing than taking the NSAID in the evening prior to retiring.

The reason appears to be based on the body’s circadian rhythm; that is, the cyclical 24-hour period of human biological activity.

The mediators of most wound healing and connective tissue formation occur during the resting phase of the day, while pain and inflammation occur during the active period of the day. It follows that one would want the NSAID impact to occur during the period of pain and inflammation and not during the wound healing phase, hence the recommendation for taking the drug in the morning.

The opposite is true for blood pressure control. As I have written previously, the time to take blood pressure medication is in the evening, not the morning. Nighttime blood pressure is a stronger risk predictor of cardiovascular disease than is daytime blood pressure, and blood pressure control at night works better than control in the morning.

So, take NSAIDs in the morning and blood pressure medicines in the evening.

But here’s a drug you probably should avoid, if possible: azithromycin.

Azithromycin (AZ), an antibiotic in the same class as erythromycin, is one of the most commonly prescribed antibiotics in the U.S. despite an increased risk of cardiovascular death noted in some studies, perhaps related to changes in heart rhythm A recent study of almost 8 million antibiotic exposures (22 percent AZ; 78 percent amoxicillin) from January 1, 1998 to December 31, 2014, in patients with a mean age 51 years, and 62 percent women, found that AZ was associated with about a twofold increased risk of death during the first five days of exposure compared with amoxicillin. I would recommend that AZ be used with caution, particularly in patients who might be at increased risk, such as those with underlying heart disease, electrolyte abnormalities, or those taking other drugs that might affect the heart rhythm in a similar fashion.

Featured image: David Tonelson /