Best time to take cholesterol medication

Our circadian rhythm affects cholesterol levels, so it’s important to ask your provider when to take statins—morning or night?

Benefits of statins | When to take statins | Side effects | Best practices for taking statins

Statins are a drug class that are considered by many experts to be the best medications for preventing, treating, and lowering a person’s risk of heart disease. If heart attacks, strokes, or peripheral artery blockages have been a problem already or are a future concern of yours, statins have a lot to offer. 

RELATED: Signs of heart problems worth worrying about

Benefits of statins

Besides their well-known ability to lower cholesterol, statins stabilize cholesterol plaques, reduce inflammation in the circulatory system, promote blood vessel dilation, and reduce blood clotting factors. 

Having this myriad of mechanisms in your corner is of obvious importance if you have already experienced a heart attack or stroke or have been identified as having a blockage in an artery. If not, you could still stand to benefit if you have an increased risk of developing one of these issues. Your healthcare provider can help you to quantify your risk. By assessing your cholesterol blood tests, measuring to see if you have high blood pressure, and considering whether you smoke, have diabetes, or have a family history of cardiovascular disease, a healthcare professional can determine if taking a statin is worthwhile for you. 

If a statin is prescribed, the next step is to maximize its effectiveness and minimize the risk of adverse effects. Goals are based on sufficiently lowering the value of your low-density lipoprotein cholesterol or LDL cholesterol (high blood cholesterol), commonly referred to as bad cholesterol. This article will provide actionable steps to do so, focusing on what time of day to take a statin

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When to take statins

Our body’s internal functions differ depending on the time of day. The circadian rhythm, or 24-hour cycle of bodily mechanisms, may affect blood cholesterol levels. Production of cholesterol peaks overnight. HMG-CoA reductase is an enzyme involved in the bodily synthesis of cholesterol, and statins are HMG-CoA reductase inhibitors. To maximize your benefit from the statin and lower lipid numbers the most, you will want to block the overnight synthesis of cholesterol. Accordingly, statins with short half-lives (remain active in the body for less time) should be taken in the evenings, while statins with long half-lives can generally be taken at any time.

Which statins need to be taken in the morning?

The only instance when a statin must be taken in the morning is when a twice-daily dosing regimen is in use. In these cases, morning and evening doses are taken. This is not a common practice, because many once-daily statin options are available. The following statins can be taken once or twice a day and should include a morning dose if taken twice daily. Lovastatin has another important facet; it should be taken with food for maximal absorption.

Which statins need to be taken at night?

Statins with short half-lives need to be taken at night to best blunt the nocturnal spike in cholesterol production. These drugs have an average half-life of around two hours, meaning that most of the medication is eliminated or rendered inactive within 10 hours. If taken early in the day, they will miss the overnight cholesterol surge.

Statins you can take at any time

Within the statin drug class, three members have relatively long half-lives. This characteristic allows them to be taken at any time of day. They tend to be more potent as well.

• Crestor (rosuvastatin)
• Lipitor (atorvastatin)
• Livalo (pitavastatin)

RELATED: Lipitor dosage, forms, and strengths

Side effects are a common concern related to statins. The drug class is so commonly used, that you may know several people who take a statin and perhaps some who have had a side effect. Although there are some differences, the list of common adverse effects is consistent across the statin category:

• Myalgia (muscle pain)
• Headache
• Abdominal pain
• Constipation or diarrhea
• Elevated liver enzymes
• Elevated muscle enzymes
• Elevated glucose (blood sugar)
• Insomnia (sleep problems)
• Cognitive impairment (difficulty learning, remembering, or concentrating)

A pre-existing concern about adverse effects, particularly muscle aches, could contribute to a higher incidence of reported symptoms from statins. If you expect a side effect, you may be more likely to think you are experiencing one. When participants were not informed as to whether they were taking the active drug or a placebo (inactive pill), one large study of the potent statin atorvastatin showed no difference in muscle side effects. Those who do have an adverse effect from a statin may be able to tolerate a lower dose or an alternative member of the drug class.

RELATED: Lipitor side effects

Deciding to stop a statin should be a mutual determination between you and your healthcare provider. The experience or fear of common or serious side effects can be a motivating factor for discontinuation, but there are consequences that should be considered. Those who stop and remain off statins due to intolerance have been shown to have a higher rate of heart attack and coronary artery disease. Accordingly, it is imperative to know the adverse effects of these drugs and recognize that these ill effects are not prevalent.

RELATED: Lipitor (atorvastatin) alternatives

1. If you take Crestor, Lipitor, or Livalo, you probably have the leeway to choose the most convenient time of day for you to take your dose.
2. If you take Pravachol, Zocor, Leschol, or Mevacor once-daily, nighttime is the best time for you to take your statin. 
3. Leschol should be taken with food for best absorption.
4. No matter which statin you take, be sure to take the drug each day as it is prescribed.
5. Statins have several important drug interactions that could increase side effect risk. Zocor and Mevacor, and to a lesser extent Lipitor, may have more risk of interactions due to their metabolism by the CYP3A4 enzyme. Review your list of prescription medications, over-the-counter drugs, and supplements with your healthcare professional and pharmacist before and during statin therapy to ensure that these interactions are avoided.
6. Grapefruit juice inhibits CYP3A4, which can cause the drug to build up in your body, so it could possibly increase the risk of side effects of Zocor, Mevacor, and Lipitor. However, consumed at typical low levels, such as an 8-ounce daily amount or less, it does not appear to be a problem with Lipitor. 
7. Due to its higher risk of adverse muscle effects, Zocor dosing is typically limited to 40 mg per day, rather than the Food and Drug Administration’s (FDA) originally listed 80 mg maximum dose. In the setting of certain concurrent medications, like Norvasc, it may be best to limit Zocor to 20 mg or change to a different statin to avoid a drug interaction.
8. Chronic liver or kidney disease may heighten the risk of adverse effects of certain statins. Get medical advice about which statin is safe for you.
9. If you believe you are experiencing a statin side effect, talk to your healthcare provider about whether to stop the medication and whether you can start a different statin in its place.
10. Being on a statin does not mean that you can ignore your diet. Limiting meat intake, consuming a low-carbohydrate diet, and avoiding trans-fat can all be helpful dietary strategies for combating high cholesterol and in maintaining a healthy weight. 
11. Discuss potential blood test monitoring for cholesterol and liver enzymes with your prescribing provider.

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