How can I remember my tablets if I work shifts?

How to organise your doses when your hours change every week, which medicines need more care and which tools really help.

If you work shifts, the most reliable way to remember your tablets is to stop thinking in clock times and link each dose to a moment in your day: when you get up, with your main meal or before you go to sleep. Before you do so, ask your pharmacist which medicines in your treatment allow this flexibility.

Switching from early to late or night shifts upsets your sleep, your meals and, with them, the routines that helped you remember your medication. In this article we suggest a practical method so your treatment keeps working even if your hours change every week.

Do I have to take my tablets at exactly the same clock time?

Not always. For many once-a-day medicines, what matters most is a regular interval and stable conditions (on an empty stomach, with food, before bed), rather than a fixed clock time. That is why, if you work shifts, it usually works better to link each dose to a moment in your day, such as when you get up or before you go to sleep.

What does not change are the conditions in the leaflet. For example, the leaflet for levothyroxine (Eutirox) says to take it on an empty stomach, at least half an hour before breakfast; if your "morning" starts at five in the afternoon, your "breakfast" is the first meal after you wake up. Metformin, on the other hand, is taken with or after meals.

Before you move anything, ask your pharmacist which medicines on your list allow this flexibility and which do not. It is a quick question and saves you doubts every time your rota changes.

Which medicines need more care with timing?

With some medicines a few hours' delay really does matter, and you should not improvise. The NHS Specialist Pharmacy Service (SPS) lists them as groups that need individual advice when a dose is late or missed.

• Medicines for epilepsy.
• Oral contraceptives.
• Medicines for Parkinson's disease.
• Insulin.
• Once-weekly methotrexate.
• Warfarin and other anticoagulants with a strict schedule.
• Immunosuppressants and cancer medicines.

Anything that makes you drowsy also deserves attention: some anti-anxiety medicines, sleeping tablets, antihistamines or opioid painkillers. If you finish a night shift tired, their effect can add to your tiredness, especially if you drive. The New Zealand guide Healthify suggests starting medicines that can cause drowsiness on a day off, to see how they affect you, and keeping an eye on caffeine if you take medicines that also affect your heart or blood pressure. If in doubt, see our article on driving and medicines.

How do I make a dosing plan for each shift?

The simplest way is to draw up a table with your shifts in the rows and three "body clock" moments in the columns: when you get up, with your main meal and before you sleep. That way each medicine is tied to a moment in your day, not to a specific clock time.

The times are only an example: fill in the table with your own and take it to your pharmacy so they can confirm it fits your treatment. When your rota changes (for example, from early shifts to nights), also ask how to manage the switch: with some medicines you simply take the next dose at the new moment, and with others it is better to move it gradually.

• Note in the table whether each medicine is taken on an empty stomach, with food or before bed.
• Mark the ones that should not be moved without checking first.
• Stick a copy on the fridge and keep another on your phone.

Which tools help you remember your doses?

What works best is combining a cue (an alarm or a habit) with medication that is already prepared, so all you have to do is take it. If you also keep a small supply at work, a shift that runs late will not leave you without your dose.

• Named alarms: instead of "8:00", call it "blood pressure tablet, when I get up" and create a group of alarms for each shift. You will find ideas in alarms and apps so you never forget your medication.
• Anchor habits: your first coffee, brushing your teeth or packing your work bag. We explain it in how to link each dose to a daily habit.
• Medication prepared by dose: a weekly pill organiser or a personalised dosage system (SPD) prepared by the pharmacy lets you see at a glance whether you have already taken your dose.
• A supply in your locker or bag: a day or two of medication in its original box or a clearly labelled case.

If you still miss a dose, do not take a double dose. According to the SPS, for most medicines it is acceptable to take a dose up to 2 hours late; if more time has passed, follow the "If you forget to take" section of the leaflet or ask your pharmacy.

A practical example: Raúl rotates between early, late and night shifts

Take the case of Raúl, 52, who works in a factory with weekly rotating shifts. He takes a blood pressure tablet in the morning, metformin twice a day with meals and a statin once a day. With the shift change every Monday, he kept forgetting his end-of-day doses.

1. He asks his pharmacist which medicines he can link to his sleep pattern. The pharmacist confirms that the blood pressure tablet can be taken "when he gets up" and that metformin should go with two main meals.
2. He fills in a three-column table for each shift and sets up three groups of alarms on his phone.
3. In his week of nights, he takes the second metformin with the meal he has during his break.
4. He leaves a case with two days of medication in his locker in case a shift runs late.
5. For a month he notes down any missed doses and mentions them at his next check-up.

With this system, Raúl no longer depends on remembering an exact time: he just follows the column for the shift he is on.

How can IMA Health help if you work shifts?

When your hours change every week, having your medication already separated by dose takes one worry off your mind. At IMA Health we coordinate with a specialised pharmacy that prepares your medication by day and time of each dose, we deliver it to your home and we provide personalised follow-up so you can raise changes to your prescription or questions about timing.

If you would like to see how it works, read our article on the IMA Health service.

Sources

• NHS Specialist Pharmacy Service: What should people do if they miss a dose of their medicine?
• Healthify He Puna Waiora: Medicines and shift work
• CIMA (AEMPS): Eutirox 100 micrograms package leaflet (in Spanish)
• CIMA (AEMPS): Metformina Cinfa 850 mg package leaflet (in Spanish)

This article is for information only and does not replace advice from your doctor or pharmacist.