How many hours apart is 4 times a day? (+1 facts)
By
Ivan Kahwa
Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss ‘how many hours apart is 4 times a day’. We will also discuss if you always need to keep a 6-hour gap between the next dose while taking medicines 4 times a day.
How many hours apart is 4 times a day?
If your prescription says 4 times a day, it means you have to take your medication after every 6 hours. We simply divide 24 hours in a day with 4 times daily doses and we get an answer of 6 (24/4=6).
However, waking up the patient at night is difficult. Therefore, most of the doctors agree that 4 times a day does not necessarily mean after every 6 hours. You may take your medication after 4 or 5 hours after consulting your doctor.
4 times a day is medically denoted by QID which comes from the Latin word ‘quater in die‘. According to the patient’s convenience, a 4 times a day dose is taken after breakfast, lunch, supper, and dinner.
If you cannot take your medicine with food, then 4 times a day doses are taken in the morning (after waking up), afternoon, late afternoon, and at night (just before going to sleep). Always follow the instructions given by your doctor for safe and effective use of medicines.
What does 4 times in 24 hours mean?
4 times in 24 hours means that you should take your medicine after every 6 hours while being awake. However, you cannot stay awake for 24 hours just to take your medicine. Therefore, healthcare professionals often agree to make these hours flexible.
The 4 times a day medicines should preferably be taken at 06:00 am, 12:00 pm, 06:00 pm, and 11:59 pm. However, most of the patients are unable to comply with such a dosing schedule due to their sleeping patterns.
The dosage regimen and timings are decided by your doctor to get the maximum benefit from the treatment protocol. The dosing interval is often decided according to your sleeping pattern. Usually, an interval of 4 or 5 hours is kept between the next dose.
As an example, if you wake at 07:30 am and go to sleep at 10:30 pm, then you may take the medicine this way (1, 2):
- 08:00 am: before or after having breakfast.
- 12:00-01:00 pm: before or after taking lunch.
- 05:00-06:00 pm: before or after tea/snacks.
- 10:00-10:25 pm: after having dinner.
Does taking medicine earlier than 6 hours affects drug efficacy?
Taking medicines after 4 or 5 hours when it is prescribed 4 times a day may or may not affect the drug’s efficacy and onset of action. As an example, taking antibiotics 2 hours earlier than the prescribed time may not have a significant impact.
Some research studies state that underuse of antiasthmatic drugs like beclomethasone and albuterol does not worsen asthmatic severity when given 4 times a day (3). However, chances of non-compliance are also greater in a 4 times-a-day dosage regimen (4).
Nyquil is a cold and flu medicine that is given 4 times a day with an interval of 6 hours. However, it is recommended that you should not take it more than 4 times daily as it may cause side effects including anxiety, hallucinations, and respiratory depression.
What does research suggest?
In one of the clinical studies, asthmatic patients were asked to take inhaled flunisolide twice daily (BID, four inhalations) or QID (two inhalations). The group of patients (n=8) taking the QID dose showed non-compliance due to the dosing frequency (4).
In a randomized, blind crossover study, acetaminophen (1000 mg) given 4 times daily reduced postoperative swelling on the 3rd postoperative day more than naproxen (500 mg) which was given 2 times daily. Acetaminophen was given at 08:00, 12:00, 16:00, and 20:00 hours (1).
In another study, clinicians administered loteprednol etabonate (0.2% suspension) 4 times daily at 4-hour intervals for 15 days. Alternatively, olopatadine (0.1% solution) was given 2 times a day at 6-8 hour intervals for seasonal allergic conjunctivitis (2).
As a pharmacist, patients often complain about non-adherence to the dosage regimen when a drug is prescribed 4 times a day. Non-compliance with the dosage regimen may reduce the effectiveness of the medicine.
I always recommend to my patients that they should talk to their doctor if they are not comfortable taking their medicine 4 times a day. Your doctor may change the drug to the one which is given once or twice daily.
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References
1.-
Bjørnsson GA, Haanaes HR, Skoglund LA. Naproxen 500 mg bid versus acetaminophen 1000 mg qid: effect on swelling and other acute postoperative events after bilateral third molar surgery. The Journal of Clinical Pharmacology. 2003 Aug;43(8):849-58. https://accp1.onlinelibrary.wiley.com/doi/abs/10.1177/0091270003255361?casa_token=XpR3dmfQPt4AAAAA:oz4m2cC1ef-ybqhLTAlLYcz9SIe4N-GjyLXQQZDPqaIOePeYwRyB2cV_oQlDJxGMo1Z7hIdCoM7D-Q
2.-
Gong L, Sun X, Qu J, Wang L, Zhang M, Zhang H, Wang L, Gu Y, Elion-Mboussa A, Roy L, Zhu B. Loteprednol etabonate suspension 0.2% administered QID compared with olopatadine solution 0.1% administered BID in the treatment of seasonal allergic conjunctivitis: a multicenter, randomized, investigator-masked, parallel group study in Chinese patients. Clinical therapeutics. 2012 Jun 1;34(6):1259-72. https://www.sciencedirect.com/science/article/abs/pii/S0149291812002883
3.-
Mann MC, Eliasson O, Patel K, Zu Wallack RL. An evaluation of severity-modulated compliance with qid dosing of inhaled beclomethasone. Chest. 1992 Nov 1;102(5):1342-6. https://www.sciencedirect.com/science/article/abs/pii/S0012369216590527
4.-
Mann M, Eliasson O, Patel K, ZuWallack RL. A comparison of the effects of bid and qid dosing on compliance with inhaled flunisolide. Chest. 1992 Feb 1;101(2):496-9. https://www.sciencedirect.com/science/article/abs/pii/S0012369216337837
