For example, Lovastatin, 8 Fluvastatin, 9 and Simvastatin 10 all have half-lives less than six hours. Thus, in order to achieve maximal LDL lowering, it has been advised to administer statins in the evening in order to inhibit the enzyme while it is most active.
These statins have significantly longer half-lives 14 and 19 hours, respectively 12,13 than their older counterparts, therefore calling into question the importance of morning versus evening administration. As might be expected based on their slower metabolism, studies have in fact demonstrated that the LDL-lowering efficacy of Atorvastatin 14,15 and Rosuvastatin 16 is independent of the time of day of drug administration.
Similarly, the efficacy of extended-release Fluvastatin was also recently shown to be uninfluenced by the time of intake. Because treatment with statins is usually chronic, or even lifelong, compliance to therapy is essential.
Clinicians should therefore be aware that not all statins have similar pharmacodynamic and pharmacokinetic properties, and many statins can achieve equal LDL-lowering efficacy and arguably improved compliance when administered in the morning as compared with the evening. References: 1. Levy, RI. A quarter century of drug treatment of dyslipoproteinemia, with a focus on the new HMG-CoA reductase inhibitor fluvastatin.
Circulation ; 87 4 Suppl :III Comparative dose efficacy study of atorvastatin versus simvastatin, pravastatin, lovastatin, and fluvastatin in patients with hypercholesterolemia the CURVES study. Am J Cardiol ; Rosenson, RS. Rosuvastatin: a new inhibitor of HMG-coA reductase for the treatment of dyslipidemia. Expert Rev Cardiovasc Ther ; Randomised trial of cholesterol lowering in patients with coronary heart disease: the Scandinavian Simvastatin Survival Study 4S.
Lancet ; Knopp, RH. Drug Treatment of lipid disorders. N Engl J Med ; You can also lower your risk for heart disease by not smoking and maintaining a healthy weight. You may have heard that statins are bad for you. Learn more about the benefits and risks of statins. Statins are drugs that can help decrease your levels of LDL cholesterol. Read about the pros and cons of using statins. Nexletol and Nexlizet were both approved by the FDA late last month to be used alongside statins to help reduce high cholesterol.
High triglycerides can have many causes, including genetics. When it's an inherited condition, it's known as familial hypertriglyceridemia. HDL cholesterol removes extra cholesterol and plaque buildup in your arteries. High cholesterol often has no symptoms, but can lead to serious health issues. Having too many triglycerides in your blood can be harmful and lead to heart disease. Here are some natural ways to lower your triglycerides. Health Conditions Discover Plan Connect.
Medically reviewed by Deborah Weatherspoon, Ph. Statins and cholesterol. Available prescriptions. Statins that you should take at night. Statins you can take in the morning. What you need to know about taking statins.
Other ways to help reduce cholesterol. 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.
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