Which statins should be taken at night

Although some cholesterol comes from dietary intake, a significant amount is produced endogenously. It was previously hypothesized that human cholesterol production may be cyclical in nature mimicking the confirmed pattern of cholesterol synthesis in animals.

Human trials then confirmed the fluctuation in cholesterol synthesis, noting the greatest cholesterol production from the liver during fasting states. The apparent circadian rhythm of cholesterol production sparked the recommendation that statins be dosed at bedtime to provide the greatest medication concentration when endogenous cholesterol production is the highest. Investigation of pharmacokinetic properties of individual statins disproved the need for all agents to be dosed at bedtime.

Simvastatin, fluvastatin, and lovastatin have a short elimination half-life compared to other drugs within the class. Agents with significantly shorter elimination half-lives require bedtime dosing to maximize efficacy - allowing the greatest statin concentration to be present while endogenous cholesterol synthesis is the highest. Alternatively, the longer half-lives of rosuvastatin, atorvastatin, pitavastatin, and pravastatin allow these agents to maintain a therapeutic drug concentration over a hour period and allow alternate administration times.

Even if properly counseled to take statins with a shorter half-life at bedtime, some patients do not comply which may result in decreased efficacy. Agents with longer half-lives allow for greater flexibility in administration time, which may improve compliance and ultimately result in greater LDL-C reduction and ability to achieve cholesterol goals.

About Us Disclaimer Contact Us. The most common side effects are headaches, feeling sick nausea , diarrhoea and cold-like symptoms. Do not take atorvastatin if you're pregnant, trying to get pregnant or breastfeeding. Keep taking atorvastatin even if you feel well, as you will still be getting the benefits. Most people with high cholesterol don't have any symptoms.

Atorvastatin is also called by the brand name Lipitor. Tell your doctor if you : have had an allergic reaction to atorvastatin or any other medicines in the past have liver or kidney problems are trying to get pregnant, think you might be pregnant, you're already pregnant, or you're breastfeeding have severe lung disease have previously had a stroke caused by bleeding into the brain drink large amounts of alcohol have an underactive thyroid have had muscular side effects when taking a statin in the past have had, or have, a muscle disorder including fibromyalgia Lipitor chewable tablets contain a substance called aspartame - check with your doctor before taking these if you have phenylketonuria a rare inherited disorder of protein metabolism.

Dosage The usual dose for adults is between 10mg and 80mg a day. What if I forget to take it? What if I take too much? Taking an extra dose of atorvastatin by accident is unlikely to harm you.

Common side effects These common side effects of atorvastatin happen in more than 1 in people. Keep taking the medicine, but talk to your doctor or pharmacist if these side effects bother you or don't go away: feeling sick nausea or indigestion headaches aches and pains in your back and joints nosebleeds sore throat cold-like symptoms, such as a runny nose, blocked nose or sneezing constipation or wind diarrhoea Report any unexplained muscle aches and pains, tenderness or weakness to a doctor straight away.

Serious side effects Serious side effects when taking atorvastatin are rare and happen in less than 1 in 1, people. Stop taking atorvastatin and call a doctor if you get: muscle pain, tenderness, weakness or cramps - these can be signs of muscle breakdown and kidney damage yellow skin or the whites of your eyes turn yellow, or if you have pale poo and dark pee - this can be a sign of liver problems a skin rash with pink-red blotches, especially on the palms of the hands or soles of the feet severe stomach pain - this can be a sign of pancreas problems a cough, feeling short of breath, and weight loss - this can be a sign of lung disease Serious allergic reaction In rare cases, it's possible to have a serious allergic reaction anaphylaxis to atorvastatin.

Information: You can report any suspected side effect using the Yellow Card safety scheme. Visit Yellow Card for further information. What to do about: feeling sick nausea or indigestion - stick to simple meals and do not eat rich or spicy food. It might help to take your atorvastatin after a meal or snack. If you continue to get symptoms of indigestion ask your pharmacist to recommend an antacid.

Contact your doctor if your symptoms continue for more than a few days or if they get worse. Do not drink too much alcohol.

Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking atorvastatin. Talk to your doctor if they last longer than a week or are severe.

You may need a blood test to check what might be causing it. You can also ask your pharmacist to recommend a painkiller. If the symptoms last longer than a week ask your pharmacist or doctor for advice. If the symptoms return when you stop taking the painkillers ask your doctor for advice.

Try to exercise more regularly, for example, by going for a daily walk or run. If this doesn't help, talk to your pharmacist or doctor. Watch this short video about how to treat constipation. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Atorvastatin and breastfeeding It's not known if atorvastatin gets into breast milk, but it may cause problems for your baby. Non-urgent advice: Tell your doctor if you're:.

Medicines that may not mix well with atorvastatin include: some antibiotics and antifungals some HIV medicines some hepatitis C medicines warfarin stops blood clotting ciclosporin treats psoriasis and rheumatoid arthritis colchicine a medicine for gout contraceptive pills verapamil, diltiazem , amlodipine for high blood pressure and heart problems amiodarone makes your heart stable If you're taking atorvastatin and need to take one of these medicines, your doctor may: prescribe a lower dose of atorvastatin prescribe a different statin medicine recommend that you stop taking atorvastatin for a while These are not all the medicines that can interfere with atorvastatin.

Mixing atorvastatin with herbal remedies and supplements St John's wort, a herbal medicine taken for depression , reduces the amount of atorvastatin in your blood, so it doesn't work as well. Important: Medicine safety Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. How does atorvastatin work?

How long do statins take to work? How long will I take atorvastatin for? Are statins safe? Is it safe to take atorvastatin for a long time?

Statins have been used for nearly 30 years to lower cholesterol. Is atorvastatin addictive? What will happen if I come off it? Does it help to take supplements together with statins? Will taking atorvastatin increase my risk of diabetes? How does it compare with other medicines for high cholesterol? There are several other statin medicines for lowering your cholesterol, including: fluvastatin pravastatin rosuvastatin simvastatin If you have a side effect with one statin, it may not happen with another.

Can I drive or ride a bike? Yes, you can drive or cycle while taking atorvastatin. Will it reduce my fertility? Will it stop my contraception working? If you have any side effects, talk to your doctor or pharmacist.

Can I drink alcohol with it? Yes, you can drink alcohol while taking atorvastatin. Is there any food or drink I need to avoid? Can lifestyle changes help? Mevalonic acid in human plasma: relationship of concentration and circadian rhythm to cholesterol synthesis rates in man. Evidence for diurnal periodicity in human cholesterol synthesis. J Lipid Res ; — Mevacor lovastatin package insert.

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Am J Health Syst Pharm. Pharmacodynamic effects and pharmacokinetics of a new HMG-CoA reductase inhibitor, rosuvastatin, after morning or evening administration in healthy volunteers.

Br J Clin Pharmacol. Time-of-intake morning versus evening of extended-release fluvastatin in hyperlipemic patients is without influence on the pharmacodynamics mevalonic acid excretion and pharmacokinetics.

Int J Clin Pharmacol Ther. The Expert Panel.