Hydroxymethylglutaryl coenzyme A HMG-CoA reductase inhibitors, more commonly known as statins, are recommended as first-line agents in the reduction of low-density lipoprotein cholesterol LDL-C. There is known morbidity and mortality benefit associated with LDL-C reduction from statin therapy; therefore, it is vital that patients take the medication in a way that provides the greatest effect.
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. Your doctor knows your personal medical issues and is your best source for information. Always ask if your statin should be taken with food or at a specific time of day. Statins work best when taken at the same time each day. With some statins, drinking grapefruit juice, or eating grapefruit, is a bad idea. Grapefruit juice can cause that statin to stay in your body much longer, and the drug can build up.
This can increase the risk of muscle breakdown, liver damage, and even kidney failure. Statins can also interact with other medications, so tell your doctor about all the drugs you take. That includes supplements, over-the-counter medications, and prescription drugs. Statins can be effective in getting your cholesterol under control, but they come with risks. Some common side effects include muscle and joint aches, nausea, and headache. Serious risks include damage to your muscles, kidneys, and liver.
If you have type 2 diabetes, statins may increase your blood sugar levels. Sometimes, switching to another statin can help. While statins can be very effective in lowering LDL cholesterol, you can also manage your cholesterol using alternative treatments or through lifestyle modifications. Diet plays an important role in blood cholesterol levels.
Wilmington, DE: AstraZeneca; Pharmacodynamic effects and pharmacokinetics of atorvastatin after administration to normocholesterolemic subjects in the morning and evening. J Clin Pharmacol. Effects of morning versus evening administration of atorvastatin in patients with hyperlipidemia. 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. Arch Intern Med. Greenberg, RN. Overview of patient compliance with medication dosing: a literature review.
Clin Ther. Atorvastatin also has an active metabolite which has a half life ranging from 20 to 30 hours. And how can a morning dose improve compliance?
Some side effects may improve after the first few days, as your body gets used to the medicine. Keep taking the medicine, but talk to your doctor or pharmacist if these side effects bother you or don't go away:.
Report any unexplained muscle aches and pains, tenderness or weakness to a doctor straight away. Less than 1 in people may have some memory loss. Talk to your doctor or pharmacist if this side effect bothers you. It usually goes away after you stop taking the medicine. Serious side effects when taking atorvastatin are rare and happen in less than 1 in 1, people. In rare cases, it's possible to have a serious allergic reaction anaphylaxis to atorvastatin.
These are not all the side effects of atorvastatin. For a full list see the leaflet inside your medicines packet. Atorvastatin isn't recommended during pregnancy or breastfeeding, as there's no firm evidence it's safe. Talk to your doctor if you want to get pregnant. It's best to stop taking atorvastatin at least 3 months before you start trying for a baby. If you become pregnant while taking atorvastatin, stop taking the medicine and tell your doctor.
It's not known if atorvastatin gets into breast milk, but it may cause problems for your baby. Speak to your doctor about what's best for you and your baby while you're breastfeeding. It may be possible to delay starting or restarting atorvastatin until you've stopped breastfeeding completely.
Some medicines affect the way atorvastatin works and can increase the risk of serious side effects. If you're taking atorvastatin and need to take one of these medicines, your doctor may:. These are not all the medicines that can interfere with atorvastatin. For a full list see the leaflet inside your medicine packet or check with your pharmacist. 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.
Talk to your doctor if you're thinking about starting St John's wort, as it will change how well atorvastatin works. Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. Atorvastatin acts on the liver to stop it making cholesterol. This lowers your blood cholesterol level. For the first 12 months on this medicine, you'll be offered a couple of routine tests to make sure your liver is working normally.
Your cholesterol levels should drop noticeably within 4 weeks - if you take your medicine regularly, as prescribed. Usually, treatment with a statin such as atorvastatin is for life. The benefits will only continue for as long as you take it. If you stop taking atorvastatin without starting a different treatment, your cholesterol level may rise again. You may have read negative stories about statins, but they're thought to be very safe, effective medicines.
Statins are thought to have very few side effects. Sometimes the side effects that people report aren't related to their medicine. However, if you're concerned about the safety of statins, talk to your doctor. Atorvastatin is safe to take for a long time, even many years. In fact, it works best when you take it for a long time. No, there's no evidence that atorvastatin is addictive. You won't get any withdrawal symptoms when you stop taking it. You may want to stop atorvastatin if you think you're having side effects.
Talk to your doctor first to see if it really is a side effect of atorvastatin or an unrelated problem. Your doctor may decide to lower your dose or change your medicine. You won't get any withdrawal symptoms. However, stopping atorvastatin may cause your cholesterol to rise.
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