The Best Time to Take Statins

Bottom line: Anytime as long as it ensures compliance.

HMG-CoA reductase inhibitors, commonly known as statins, which are one of the most prescribed medicines to improve lipid profiles. Statins include simvastatin, atorvastatin, and pravastatin.

Many studies about the timing of statin intake to ensure higher efficacy. However, the investigations are short in duration (4-12 weeks, a maximum of 12 months).

Simvastatin Studies about Timing

Cholesterol synthesis is mainly at night between 12 midnight to 6 am. Thus it makes sense that some statins like simvastatin that have a short half-life will work better with night time intake.  The studies that support morning dosing of simvastatin are in the references below, (1), (2), (3), and (4).

There are two studies on simvastatin that support morning/evening dosing. (5)(6)

Cochrane Study

The Cochrane Group is an independent organization that puts together several studies to make more meaningful conclusions. Cochrane has a reputation for being unbiased and free from outside influence.

A meta-analysis was done by the Cochrane group (8) that included eight randomized controlled trials of 767 participants. It studied the outcomes between morning and evening doses. The tests used different lipid-lowering regimens with statins included ( lovastatin: two trials; simvastatin: three trials; fluvastatin: two trials; pravastatin: one trial).

The study showed no difference in total cholesterol, LDL, HDL, or triglycerides after 9 weeks of follow up. However, the study periods are short, and it did not include any data on primary cardiovascular events or deaths.

Did the intake of the statins in the morning or evening lower the incidence of heart attacks and strokes? That is much more meaningful than numbers that show lower cholesterol, LDL, and triglyceride levels and higher HDL.

More studies are needed in the future that also shows cardiovascular outcomes together with lipid profile changes.

Statins Can Cause Muscle Pain That Can Cause Insomnia.

In an article on the AARP  website,  10 Types of Meds That Can Cause Insomnia, Dr. Armon Neel, Jr listed statins as the number 10 reason for causing insomnia. This is because of the muscle pain that can interfere with sleep. Another reason given by Dr. Neel is quoted below:

Researchers have found that fat-soluble statins — which include Lipitor, Mevacor, Vytorin and Zocor — are more likely to cause insomnia or nightmares because they can more easily penetrate cell membranes and make their way across the blood-brain barrier, which protects the brain from chemicals in the blood.

In this situation, it has been recommended by some geriatricians to take the statins during the daytime if continuation is absolutely necessary.  

Take- Away Messages

• Statins can be taken anytime as long as it ensures compliance (7)
• Intermittent Fasting and exercise also work to decrease the triglyceride level and increase the HDL, respectively.

Thanks to Dr. BG-Y for the article idea.

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Don’t Get Sick!

Related Readings:

1. LDL: “Bad Cholesterol” is Not All Bad.
2. How to Do Intermittent Fasting
3. The Kaizen Way of Fasting
4. Early Time-Restricted Feeding is Intermittent Fasting In Sync with the Circadian Rhythm
5. 10 Unbelievably Easy Ways to Screw Up Intermittent Fasting!
6. How to be Active from Sedentary
7. How to Perform High-Intensity Interval Training
8. 21 Benefits of High-Intensity Interval Training
9. Physical Activity Correlates with Life Span
10. How Does Exercise Prolong Life?
11. The Benefits of Resistance Training

References:

1. Comparison between morning and evening doses of simvastatin in hyperlipidemic subjects. A double-blind comparative study. Saito Y, Yoshida S, Nakaya N, Hata Y, Goto Y Arterioscler Thromb. 1991 Jul-Aug; 11(4):816-26.
2. Taking simvastatin in the morning compared within the evening: a randomized controlled trial. Wallace A, Chinn D, Rubin G. BMJ. 2003 Oct 4; 327(7418):788.
3. Effect of morning versus evening intake of simvastatin on the serum cholesterol level in patients with coronary artery disease. Lund TM, Torsvik H, Falch D, Christophersen B, Skårdal R, Gullestad L. Am J Cardiol. 2002 Oct 1; 90(7):784-6.
4. Lipid-lowering efficacy between morning and evening simvastatin treatment: a randomized, double-blind study. Tharavanij T, Wongtanakarn S, Lerdvuthisopon N, Teeraaunkul S, Youngsriphithak P, Sritipsukho P. J Med Assoc Thai. 2010 Dec; 93 Suppl 7():S109-13.
5. Kim S.H., Kim M.K., Seo H.S., Hyun M.S., Han K.R., Cho S.W., Kim Y.K., Park S.H. Efficacy and safety of morning versus evening dose of controlled-release simvastatin tablets in patients with hyperlipidemia: A randomized, double-blind, multicenter phase III trial. Clin. Ther. 2013;35:1350–1360 e1. doi: 10.1016/j.clinthera.2013.06.020.
6. Yi Y.J., Kim H.J., Jo S.K., Kim S.G., Song Y.R., Chung W., Han K.H., Lee C.H., Hwang Y.H., Oh K.H. Comparison of the efficacy and safety profile of morning administration of controlled-release simvastatin versus evening administration of immediate-release simvastatin in chronic kidney disease patients with dyslipidemia. Clin. Ther. 2014;36:1182–1190. doi: 10.1016/j.clinthera.2014.06.005.
7. Grannell, Louise. “When should I take my medicines?.” Australian prescriber, vol. 42,3 (2019): 86-89. doi:10.18773/austprescr.2019.025
8. Izquierdo‐Palomares et al. Chronotherapy versus conventional statins therapy for the treatment of hyperlipidemia. Cochrane Database Syst Rev. 2016 Nov; 2016(11): CD009462. Published online 2016 Nov 26. doi: 10.1002/14651858.CD009462.pub2
9. Kaur, Gagandeep, et al. “Timing of Administration: For Commonly-Prescribed Medicines in Australia.” Pharmaceutics vol. 8,2 13. 15 Apr. 2016, doi:10.3390/pharmaceutics8020013

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