Summary : Endogenous cholesterol synthesis is cyclical in nature with the greatest production during fasting states. The elimination half-lives of statins determine if an agent should be dosed at bedtime. Explanation Hydroxymethylglutaryl coenzyme A HMG-CoA reductase inhibitors, more commonly known as statins, are recommended as first-line agents in the reduction of low-density lipoprotein cholesterol LDL-C.
References: Expert panel on the detection, evaluation, and treatment of high blood cholesterol in adults: executive summary of the third report of the National Cholesterol Education Program NCEP expert panel on detection, evaluation, and treatment of high cholesterol in adults adult treatment panel III. Plakogiannis R, Cohen H. Optimal low-density lipoprotein cholesterol lowering - morning versus evening statin administration. Ann Pharmacother. Evidence for diurnal periodicity in human cholesterol synthesis.
J Lipid Res. New York: McGraw-Hill; Principles of Medical Pharmacology. It is important that a person taking statins follows the advice of their prescribing doctor regarding the time of day to take them.
The recommended time, which is something that a person should discuss with their doctor, will vary depending on the type of statin. A systematic review found that short-acting statins worked best when people took them in the evening. The people who took these statins toward the end of the day had lower total cholesterol and LDL cholesterol levels compared with the people who took them in the morning.
Another review came to the same conclusion. Short-acting statins work better at night because the liver enzyme that produces cholesterol is more active at this time. Most short-acting statins have a half-life of 6 hours. It takes longer for the body to process long-acting statins, which may have a half-life of up to 19 hours.
The two reviews above noted that long-acting statins worked equally well whether a person took them in the morning or the evening. Therefore, people taking long-acting statins can choose which time of the day best suits them.
The authors recommend that people using long-acting statins take them at a time of day that is easy for them to remember. It is important to be consistent with the timing of doses, so if a person prefers to take statins in the morning, they should take them in the morning every day.
People who are taking statins may need to take them indefinitely. In many cases, when a person stops taking statins, their cholesterol levels increase again. Some people might be able to stop taking statins or reduce their dosage if they significantly lower their risk of heart disease. A person may do this by losing a significant amount of weight, quitting smoking , or making other major lifestyle changes that improve their health. Even in these cases though, a person should talk to a doctor before they stop taking statins or any other medications.
Statins come in a range of types and dosages. A person can discuss with their doctor which type of statin may work best for them. If a person has an increased risk of heart disease, their doctor may prescribe a higher dosage or a long-acting statin. Conversely, a person with less risk of heart disease may start on a lower dosage or a short-acting statin. Recent evidence suggests that many people can benefit from taking statins, even if they do not have high blood cholesterol levels.
The American Heart Association say that statins can benefit people who have an average risk of heart disease, especially when they take them in combination with medications to lower blood pressure. Statins do not cause serious side effects for most people. According to the American College of Cardiology , as many as 90 percent of people taking statins do not experience bothersome side effects.
For those who do experience side effects, these may include:. The Food and Drug Administration FDA state that the risk of these side effects is small and that the benefits of statins usually outweigh this risk.
Some reports have warned that statins can cause severe memory loss, but an investigation found inconsistent evidence of this side effect. Another review states that there is evidence to suggest that statins do not affect memory. In rare cases, a person taking statins may have serious side effects, such as liver damage or an allergic reaction. The following side effects require immediate medical attention:. Take this medicine only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it or for a longer time than your doctor ordered.
In addition to this medicine, your doctor may change your diet to one that is low in fat, sugar, and cholesterol. Carefully follow your doctor's orders about any special diet. Swallow the tablet whole.
Do not break, crush, or chew it. Take this medicine with or without food. Do not drink large amounts of alcohol with atorvastatin. This could cause unwanted effects on the liver. Tell your doctor if you regularly drink grapefruit juice. Drinking large amounts of grapefruit juice more than 1.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
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