Clinical Pharmacy

What is the Best Time to Take Statins!?

Aug 4th, 2020
best time to take statins

Morning, Afternoon, or Evening!?

What is the best time to take statins?

To answer this question, we need to understand a little bit more about these HMG-CoA reductase inhibitors. At the most fundamental level, statins are medicines used to lower blood cholesterol levels.

Indications of statins include:

  • Primary prevention of cardiovascular disease
  • Secondary prevention of cardiovascular disease
  • Primary hyperlipidemia

Statins are used because of their activity at HMG-CoA reductase; an enzyme involved in cholesterol production.

More specifically, statins inhibit this enzyme – the rate-limiting enzyme in the mevalonate pathway of cholesterol production. Statins are used to reduce levels of harmful LDL (low-density lipoprotein) cholesterol, whilst increasing the numbers of HDL (high-density lipoprotein) cholesterol – so-called “good cholesterol”.

Statins also have, through indirect means, the effect of reducing triglyceride levels – a harmful kind of lipid that is associated with increasing the risk of cardiovascular disease.

Taken together, statins are a highly effective means to reduce cholesterol levels and prevent the risk of serious cardiovascular events, such as myocardial infarction and stroke.

Are statins safe?

Broadly speaking, yes, statins are reliably safe medicines.

Side effects with statins include:

  • Myopathies – including rhabdomyolysis
  • Gastrointestinal disturbances
  • Headache
  • Elevation of liver enzymes
  • Type 2 diabetes (in at-risk patients)
  • Increased risk of cataracts

Rarely, drug-induced hepatitis can occur.

Best Time to Take Statins!?

The short answer is – it depends.

It depends on whether the statin is a short or long-acting drug.

Put simply, most cholesterol production occurs at night. That is why patients are routinely counseled to take statins at night; a time when cholesterol production is at its highest and when dietary intake of cholesterol is at its lowest.

Short-acting statins (which have half-lives around 6 hours) are therefore more effective when taken in the evening. These include:

  • Simvastatin (Zocor)
  • Pravastatin (Pravachol)
  • Fluvastatin (standard release)
  • Lovastatin (Mevacor)

By their very nature, long-acting statins exert effects over a longer period, and so can be taken either in the morning or evening. Long-acting statins tend to have half-lives 3-times longer than short-acting drugs. These include:

  • Fluvastatin (extended release)
  • Atorvastatin (Lipitor)
  • Rosuvastatin (Crestor)

Short-acting drugs are frequently reserved for patients with a low risk of CVD, whereas longer-acting statins are more often used for patients with higher risks of CVD.

What Statin is Preferred?

Again, it depends upon a variety of clinical factors.

Among these factors include:

  • Current cholesterol levels of the patient.
  • Whether they have a family history of CVD.
  • Whether they have concurrent illnesses, such as diabetes.
  • Lifestyle factors – such as alcohol and food consumption; smoking.
  • Polypharmacy.

Clinicians take these kinds of factors into consideration to determine the most optimum treatment for the patient – reducing the risk of long-term cardiovascular disease and the secondary conditions this can cause.

That’s it for our review on the best time to take statins. Check back to our pharmacy blog soon for even more on the must-know facts about drugs and medicines!