Chronopharmacology is, variation in drug effects with regard to time of administration viz, seasonal changes, diurnal changes, circadian rhythms etc. It is evident that many a drug shows different responses when administered at different timings.
The term ''Chronopharmacology'' may be new in allopathy. However, the concept of chronopharmacology can be very well found in the practice of ayurvedic system but not in allopathic system.
Chronopharmacology can help in optimizing the therapy by synergistic potentiation of beneficial effects of drugs with descreased toxicities and minimum dosage. This article is intended to highlight the existing concepts of chronolopharmacology of ayurvedic formulations and explore the feasibility of adapting the same to allopathic formulations wherever possible.
Ayurveda considers the body as comprising of three important constituents i.e. ''Vata'', ''Pitta'' and ''Kafa'' which can be equated to their nearest English terms as''Air'' ''Bile / Acidity'' and ''Phlegm''. Any imbalance in them is considered as a causative factor for a particular disease. The different seasons of the year contribute to either their balance or imbalance in them. For example, Pitta is prominent in Varsha Ritu (July/Aug.) and maximum in Sharat Ritu (Sept/Oct.). Hence hyperacidity symptoms have to be treated with potent antacids than of other seasons, which can be cured, by mild antacids.
In ayurveda the seasons of a year are divided into six phases as, Vasanth, Grishma, Varsha, Sharat, Hemanth & Shishir Ritu. These can correspond approximately as beginning March till February, two months for each phase respectively. The environmental and seasonal influences, as per the literature is as follows:
nVasanth ritu (March / April)- ''Kafa'' dominance (Phlegm)nVarsha and Sharat (July to Oct.) - Pitta dominance (Hyperacidity)nVarsha -- (July / Aug.) ''Vata'' dominance (Inflammatory disorders)In other phases the intensities vary. Generally potent medicines are prescribed when a person complaints of complaints of complications in respective phases (acidity in July - Aug.) & with mild medicines during non-dominance phases. They are called as natural and unnatural occurrences in ayurveda (Prakruta & Aprakruta). Similarly ayurveda divides the energy levels of the body as ''balahina'' and ''balavriddhi'' phases i.e. Descending energy levels and Ascending energy levels -- Jan. to June as Descending energy levels and July to Dec. as Ascending energy levels due mainly to supportive environmental factors prevailing.
The ayurvedic system further recommends the type of diet to be consumed / not to be consumed during respective seasons which act as synergistic co-factors in preventing diseases naturally or curing them smoothly and more efficiently. For example, milk, and ghee (clarified butter) is recommended during Pitta Seasons (July - Oct.) as it reduces hyperacidity.
Bitter substances can be consumed during Vasanth ritu (March/April) such as bitter gourd, Neem flowers and tender leaves of Neem i. e. during Ugadi festival which falls during March. On the other hand bitter substances are recommended as harmful and cause inflammatory diseases or Vata dosha if consumes during its dominant season i.e. July-Aug.
All these concepts are very well inculcated in Ayurveda and all the traditional practitioners of ayurveda believe in this type of treatment and practice the same.
On the other hand in Allopathic systems this concept has not been explored to its full potential, still some examples can be quoted based on this concept.
Asthmatic attacks are more servere during nights compared to daytime, which may require different dosage in daytime and at night times. Variation in effect of Melatonin (seen in Jet lag). Since light inhibits and darkness stimulates its secretion from pineal gland. The amount of sedatives and hypnotics required during daytime is more that its requirements at night times. Purgatives produce servere action during cloudy days, than on sunny days. High altitudes decrease the metabolism of drugs by oxidation.
This concept can be very well tried with allopathy for other drugs also, wherein a thorough study can be made for testing the drugs in coming days, for example use of simple antacid gels during hyper acidity of non-dominant seasons and on the other hand use of potent antacids such as Ranitidine, Omeprezole may be recommended only during the season where, pitta intensity is maximum (Varsha) along with prohibition of intake of Tea / Coffee, Alcohol Etc.
During Vata season (July and Aug.), bitter chemicals, used in the form of drugs can be avoided for ailments at least wherever possible. The exact course of treatment would be best judged by the physician, taking into consideration the actual patients history and the feasibility of adopting these principles at least for patients with minor complaints. During Kafa season milk, ghee, fried foods are to be avoided. Antibiotics and bitter substances can be safely administered during this season.
By adopting these concepts initially, at least to certain categories of drugs, especially where the complications are non-risky and for drugs where the margin of safety is narrow, the above concept can be tested, which ensures more safety to the patients. This is the basic concept of therapeutic drug monitoring(TDM) in Western countries for allopathic formulations in individualization of drug therapy. The various drugs with a very narrow margin of safety include, Cardiovascular drugs, sedatives and hypnotics, antibiotics, anti-cancer drugs, anti-convulsants and immunosuppressants etc.
The application of Chronopharmacology concepts to allopathic medicines would help in
1. Minimizing the dosage of drugs.
2. Getting optimum benefits of drugs with minimum toxicities
3. Opening a new avenue in therapy of allopathic drugs.
4. Individualizing the medical treatment.
About the author:
The author is Asst. Professor, HKE College of Pharmacy, Gulbarga.