Dear Doctor: What exactly does “three times a day” mean on the prescription dosage instructions?


DEAR DR. ROACH: I’ve had many discussions with people about prescription dosage instructions and wonder if you could clarify. If a medicine says “three times a day”, to me it means every eight hours. If it’s “four times a day”, I take it every six hours, etc. Other people tell me that I am MUCH too specific, whether that means “morning, noon, evening” or even “breakfast, lunch, dinner”. I think it would be best to keep an even amount in his system throughout a 24 hour period, so I just set a timer so he didn’t run out. Comments ? –LL

ANSWER: You sound like a very specific person, and I’m sure your doctor is delighted with your medication compliance. Indeed, on prescriptions, “three times a day” (still abbreviated “tid” on a prescription, from Latin) means something other than “every eight hours” (“q 8h”). A medicine written three times a day has enough latitude in its dosing schedule that it can be taken morning/noon/evening at the convenience of the patient. In these cases, taking the medicine an hour or two earlier or later will not affect the effectiveness of the medicine. A medicine that needs exact timing would be written every eight hours, sometimes with specific instructions, like 7 a.m./3 p.m./11 p.m. Every six hours is not so easy to do for someone at home, and fortunately there are not many medications that require precise dosing every six hours.

DEAR DR. ROACH: I am a healthy 79 year old female who recently had total right knee replacement surgery. In a routine post-op X-ray there was an indication of early osteopenia in my long bones. I live in Montana and hike regularly in the summer months, but in the winter it’s harder. I have an exercise bike and can change the resistance level when I cycle. Is this the same as the “weight-bearing” exercise? Should I consider buying a treadmill or other type of indoor exercise equipment? I live in a rural area and prefer to exercise at home, but have little extra space for a lot of equipment. –KL

ANSWER: Before I even think about it, I would like to know if you have taken a bone density test, often called DEXA. Plain x-rays are not reliable indicators of osteopenia or osteoporosis. This information is essential in determining whether lifestyle changes like diet, exercise, and supplemental vitamin D are likely to be effective or whether you would benefit greatly from prescription medications. Vitamin D levels in someone living in Montana in the winter are very likely to be low unless they take a vitamin D supplement. The low energy of winter sunlight in the North makes supplementation a smart choice if you don’t already.

The best type of exercise is a matter of debate, but a review of several studies found that for people with osteoporosis in the long bones (like your femur, thigh bone which can break during hip fracture), strength training is very effective. . You can build strength by increasing the resistance of your exercise bike.

You don’t need specialized equipment to do weight-bearing exercises. Jumping rope, calisthenics-type exercises, and dancing are all choices that require little more than floor space.

Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can send questions to or mail to 628 Virginia Dr., Orlando, FL 32803.

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