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Week: 529.2 Guest: Dr. Michael Smolensky, Prof. Univ. Of Texas School of Public Health Topic: Future Promise in the field of Chronotherapy? Host: Steve Girard

NEMA: We talked recently with Dr. Michael Smolensky of the University of Texas School of Public Health about the field of chronotherapy, and found that researchers have found that the pain and symptoms of many ailments ebb and flow based on biologic rhythms, and those rhythms can also dictate when best to give medications for greatest effect and efficiency. Dr. Smolensky, you've told me the concept of chronotherapeutics is not entirely new....

Smolensky: It turns out the first product ever introduced into American medicine, based on biological rhythms and timings, was what we call medrol, which is a tablet formulation that's used to treat more severe inflammatory diseases. It was found that timing of this tablet formulation of steroid medications in the morning was best to reduce the side effect profile of this medication. So, medrol, introduced in the 1960's, was the very first chronotherapy of inflammatory diseases.

Now, more recently, we have the first chronotherapy of hypertension and escemic heart disease problems such as angina...known as Covera HS. This is a special designed product which gives more medication during the early morning hours of activity, and less drug available overnight. The purpose of this day/night variability in drug levels is to control blood pressure, which tends to be highest when they arise in the morning, and during our daytime activity, and helps them lower blood levels of the drug during the overnight period. Now, we also have to take into consideration, that people who suffer from eschemic heart disease, such as angina, that is chest pain related to eschemic, coronary vessel disease...generally have more problems with these symptoms during the first three to five hours of their activity period after arising from sleep, and this formulation, Covera HS, purposely gives more medication to combat this period of increased risk, during the first three to five hours of daily activity.

NEMA: From your perspective, where does the future of chronotherapeutics lie, and I understand it could be a great help in the treatment of cancer....

Smolensky: We know that normal cells of the body generally show a circadian rhythm, that is a 24 hour rhythm. Now, we know that when we use various kinds of cancer drugs, that they have their effect by attacking specific processes that occur at specific times during the cell cycle over the 24 hour period. Having this information, then we can find what we call a window in time during the 24 hours, when we can give these very potent, anti-cancer agents, to have an increased efficiency, and also decreased toxicity of the very potent treatments used for cancer management.

NEMA: Dr. Michel Smolensky of University of Texas School of Public Health says its important that the doctor be made aware of the temporal symptom patterns that may be known to the patient.. It will make a difference to the doctor in which types of medications are likely to be best for managing that particular condition. I'm Steve Girard.

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