Shift work is an established practice in the contemporary way of life, particularly in health, IT, transport, security, and manufacture. However, there is also an undesirable side effect of irregular sleep cycles, they can considerably change the way the body reacts to medications. This contributes to making shift workers a special but frequently neglected group in clinical pharmacology.
Dysrupted sleep-wake circadian rhythms disrupt internal clock- circadian rhythms the metabolism, hormone release, enzyme activity and immune defense circadian rhythms controlling circadian rhythms. These biological processes determine the drug absorption, distribution, metabolism and elimination, thus circadian disruption may cause unexpected results of any drug.
Indicatively, low nighttime melatonin, disturbed cortisol rhythms, and irregular feeding schedules may alter on the efficacy of such drugs as antihypertensives, antidiabetics, antidepressants, stimulants, tranquilizers, and even painkillers. Due to the frequency of shift work, shift workers are either more likely to have stronger side effects, slower acting or reduced therapeutic effect of the drug depending on when they took it based on their irregular schedule.
More so, tiredness, micro-sleeps and changes in the alertness level may further increase the risk factors in the sedation medication or stimulants and lead to a higher probability of drug-dose errors or accidents. Long-term circadian dysfunction in chronic shift workers can also decrease drug tolerance, weaken immunity and increase metabolic stress.
With shift-based work being more popular, the necessity to create the individual dosing schedule and attentively monitor the sleep cycle emerges. Harmonizing drugs with the biological rhythms of a person, who might not necessarily follow the day-night schedule, would be of great help in terms of safety and effectiveness of the treatment.
Do medication instructions need to be changed when dealing with shift workers to minimize risks and enhance therapeutic benefits?
MBH/PS