Q:One of my colleagues said that the statin drugs for cholesterol lowering should always be administered in the evening but some of the references that I have looked at have conflicting information. Could you please clarify this? – RT, Salem, OR
This is an important question because so many people are taking a “statin” medication to lower blood cholesterol. My answer is a little complicated but I’ll try to make it as clear as possible. There is some evidence suggesting that all of the “statins” should be given in the evening or at bedtime for optimal efficacy in lowering Low Density Lipoprotein (LDL), (considered to be the “bad” cholesterol) since the rate of hepatic cholesterol synthesis is greatest at night. That being said, the dosing of statins depends partially on the half-life of the particular agent. The longer the half-life, the longer the medication stays in the system. Agents with the longest half-lives can be taken at any time of day according to the manufacturer’s labeling. These include Pravachol® (pravastatin)(half-life 77 hours), Lipitor® (atorvastatin)(half-life 20 hours), and Crestor® (rosuvastatin)(half-life 20 hours). Even though they have shorter half-lives, the remaining statins, with the exception of Mevacor® (lovastatin) can be given with or without food with no specification as to the time of day according to the products’ respective manufacturers. Mevacor® (lovastatin) tablet, is recommended to initially be given with the evening meal, but divided daily dosing in two doses is also allowed so obviously it can also be given earlier in the day. The extended release version of lovastatin, brand name Altoprev® is recommended for administration in the evening at bedtime. I have seen reference to some studies demonstrating a statistically significant advantage of administration of lovastatin in the evening but the clinical significance is not clear. I have also seen reference to other studies showing no difference in LDL cholesterol lowering when comparing evening and morning lovastatin administration. One factor that I think should be considered is whether the lovastatin is having a beneficial effect in the resident in question. If their LDL has been significantly decreased with the medication not being given in the evening, it could be argued that it is doing its job. A counter to that argument could be that evening administration might result in an even greater decrease in LDL. In summary, while there may be some benefit to administering the shorter half-life statins in the evening, the only statin carrying that recommendation is lovastatin, and even then, there is an allowance for divided dosing with that product.