In medical care, ensuring patient safety is always a top priority. One commonly used medication, midazolam, helps patients relax before surgery and even causes temporary memory loss to ease anxiety. However, a new study from the University of Colorado suggests that when this drug is given may be just as important as how much is given.
Researchers analyzed data from more than 1.7 million patients who received midazolam before surgery. They found something surprising: patients who had surgery at night were at a higher risk of heart damage, especially those who were otherwise healthy. This suggests that the body responds differently to the drug depending on the time of day.
The key to this finding lies in a gene called PER2. This gene helps protect the heart and works in tune with the body’s natural 24-hour cycle, known as the circadian rhythm. The study revealed that midazolam lowers the activity of the PER2 gene, but this effect is much stronger at night. As a result, the heart becomes more vulnerable to injury during nighttime surgeries.
Midazolam works by increasing the activity of a brain chemical called GABA, which helps the body relax. But this same process also reduces PER2 levels when given at night, weakening the heart’s natural defenses.
The study, led by researcher Tobias Eckle and published in Frontiers of Cardiovascular Medicine, highlights the importance of timing when giving medications.
While doctors already consider time-of-day effects for some drugs—like blood pressure medication, which is often more effective at night—this research suggests that other medications, including midazolam, should also be timed carefully to avoid unwanted risks.
These findings could lead to new guidelines for when certain drugs should be given to keep patients safer. By adjusting medication schedules to align with the body’s natural rhythms, doctors may improve treatment effectiveness while reducing potential harm.
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