Around-the-Clock (ATC) Medication

If you have been given a new medication by your healthcare provider, such as one for pain, you may see the abbreviation "ATC" on the prescription, especially if you have just undergone a surgical procedure or you have pain from cancer. You may be wondering what that means.

ATC stands for "around-the-clock." Around-the-clock (ATC) medication is defined as medication that is given at regularly scheduled intervals throughout the day. This can include a dose during the night.

Around-the-clock dosing is common for opioid medication to manage pain. In contrast to medication that is given only as needed (termed "pro re nata" or PRN), ATC medication is ordered by a physician to be given at specific intervals for maximum symptom control. ATC medication is long-acting and helps manage pain consistently.

This article discusses the meaning of the medical term ATC medication, when it is used, and its benefits.

Purpose of ATC Medication

Pain medication prescribed around the clock has the purpose of managing a patient's baseline pain, which is the average pain intensity the patient experiences. This is generally pain that is continuously experienced. This kind of pain can occur in cancer patients, as well as in patients who have just had surgery, such as 24 hours or more immediately following a procedure. An ATC prescription can ensure a steady presence of medication in the patient's system.

ATC and Breakthrough Pain Medication

In addition to ATC pain medication, a patient's pain management may also include medication for breakthrough pain. This is pain that "breaks through" the managed intensity of pain, and is also referred to as "supplemental" or "rescue." This is usually taken when needed and is often a short-acting opioid.

Patients under palliative care may be prescribed ATC analgesics alongside breakthrough medications to manage pain and improve the quality of life.

Over prolonged periods, the use of ATC medication can help reduce the ups and downs a patient can experience versus medication taken as needed. With as-needed pain medication, there is a period of relief, but with this is always the anticipation of the pain's return.

People can become "clock-watchers," stressed and fearful that the pain will return before another dose of the as-needed medication is permitted. This can be seen as the behavior of an addict, when, in fact, the person may not truly be addicted but instead exhibiting a pseudoaddiction caused by the as-needed treatment method.

Benefits of ATC Medications

The use of continuous pain medication can help prevent the undertreatment of pain. Some studies have shown that patients are more likely to stick to an ATC pain management regimen.

Also, the use of ATC medication of sufficient dosage and on a regular schedule not only helps reduce severe pain for patients but can also result in a lower dose of medication being needed overall, along with fewer side effects and better pain relief.

Are There Disadvantages to ATC Medication?

A 2015 systematic review found no significant differences in pain intensity between groups receiving analgesics administered ATC versus PRN, despite ATC patients taking more medication compared with the as-needed group.

People on ATC pain management express higher levels of concern regarding:

• Being preoccupied with opioids
• Their inability to control how much or how often opioids were used
• Possible dependence on or addiction to opioid pain medicines
• Family or friends' concerns about dependence on or addiction to opioid pain medicines

Quality of life concerns expressed more often by people using ATC dosing include:

• Opioids made it hard to think clearly.
• Opioids caused sleepiness or less alertness while performing activities requiring attention.

Summary

Around-the-clock analgesic dosing is a common practice to better manage pain. Unlike medication that is only given as needed, ATC medication is given at specific intervals during a 12-24 hour period for maximum pain management control. Advantages include the prevention of undertreatment of pain, while disadvantages include the loss of control over use and concerns about potential addiction.