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why do statins have to be taken at night

Participants, methods, and results
We randomised adults stable on 10 or 20 mg of simvastatin at night for primary or secondary prevention of coronary heart disease, stroke, or peripheral vascular disease, to dosings in the morning or evening for a period of eight weeks. We measured fasting blood lipid profiles at baseline and at eight weeks. We sampled blood between 8 30 and 9 30 am. Patients randomised to dosing in the morning were told not to omit it on the day of the follow up blood sample. The primary outcome measure was change in fasting total cholesterol concentration between baseline and follow up. We also measured the concentration of high density lipoprotein, alanine transaminase, low density lipoprotein, and triglyceride. We checked compliance by counting the number of tablets taken between the two visits. We compared mean lipid concentrations between treatment groups in an intention to treat analysis using analysis of covariance with initial concentration as a covariate. We compared proportions with tests and means with unmatched t tests. The 5% level indicated statistical significance, and we analysed data in SPSS. To show a significant 4% change in mean cholesterol concentration with 80% power, assuming a mean coefficient of variation of 5. 5% among patients, we needed 60 patients.

A computer search identified 96 patients who took simvastatin. We excluded 13 because they already took simvastin in the morning. Of the 83 eligible patients, 60 (72%) accepted. We randomised the 27 men and 33 women of mean age 66 (range 44-82) to taking the drug in the mornings or in the evenings. Thirty six patients took 10 mg a day and 24 took 20 mg a day. Sex and daily dose did not differ between groups (P 0. 6). A total of 57 patients completed the trial; one withdrew and two defaulted. In the intention to treat analysis, we assumed that the lipid profiles of these patients did not change between baseline and follow up. Change in blood lipids was normally distributed and switching taking simvastatin from in the evening to in the morning resulted in statistically significant increases in total and low density lipoprotein cholesterol ( ).

Compliance did not differ between the groups (mean number of tablets 1, standard deviation 5 for both groups; P = 0. 9). Some statins have half-lives of less than six hours. These statins are best taken at night. Simvastatin is an example of a statin that works better if taken in the evening. Studies show that when simvastatin is taken at night, there s a greater reduction in LDL than when it s taken in the morning. Lovastatin should be taken with dinner. However, the extended-release version of lovastatin, Altoprev, should be taken at bedtime. Fluvastatin has a half-life of about three hours, so it should also be taken at night. Studies show that some of the newer statins can be just as effective when taken in the morning. HMG-CoA reductase inhibitors such as atorvastatin and rosuvastatin are more potent than older statins. They have half-lives of at least 14 hours. Extended-release fluvastatin, or Lescol XL, can be taken at any time of day. The most important thing you need to know is that statins aren t all the same. That s why you should thoroughly read the materials that come with your prescription.

Follow directions carefully for maximum effectiveness. 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. If time of day isn t an issue with your statin, choose the time you re most likely to remember to take it. Statins work best when taken at the same time each day. Once it becomes part of your routine, you re less likely to forget. 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. If your prescription label doesn t mention grapefruit juice, be sure to ask your doctor about it. 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. SOURCE: Healthline. com Regards, masso. -

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