From the Guidelines
Atorvastatin and rosuvastatin can be taken in the morning or evening due to their long half-lives, allowing for flexibility in dosing timing. According to the expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents, the choice of particular statin is a matter of preference, and clinicians are encouraged to develop familiarity with one of the statins, including dosage regimen and potential drug-drug interactions 1. Some key points to consider when taking statins like atorvastatin and rosuvastatin include:
- Starting with the lowest dose once daily, usually at bedtime, but atorvastatin and rosuvastatin can be taken in the morning or evening due to their long half-lives 1
- Measuring baseline CK, ALT, and AST, and instructing the patient to report all potential adverse effects, especially muscle cramps, weakness, asthenia, and more diffuse symptoms suggestive of myopathy 1
- Advising female patients about concerns with pregnancy and the need for appropriate contraception, and advising about potential future medication interactions 1 Patients should take their statins consistently at the same time each day to maintain steady blood levels and establish a routine that promotes adherence. If statin therapy causes side effects like muscle pain or sleep disturbances, changing the timing of administration might help mitigate these issues, but this should be discussed with a healthcare provider before making any changes to the medication schedule.
From the FDA Drug Label
Plasma atorvastatin calcium concentrations are lower (approximately 30% for Cmax and AUC) following evening drug administration compared with morning However, LDL-C reduction is the same regardless of the time of day of drug administration.
The statin atorvastatin (Lipitor) can be taken at any time of day, as the LDL-C reduction is the same regardless of the time of administration.
- The reason for this is that the LDL-C reduction is similar whether atorvastatin is given in the morning or evening.
- However, plasma concentrations of atorvastatin are lower when taken in the evening compared to the morning 2.
From the Research
Statin Administration Timing
The timing of statin administration is crucial due to the varying half-lives of different statins and their impact on cholesterol biosynthesis, which peaks at night 3.
Recommended Statins for Morning Administration
- Long-acting statins, such as atorvastatin (Lipitor) and rosuvastatin (Crestor), can be taken at any time of day, including morning, as their efficacy is not significantly affected by the timing of administration 3, 4.
- The choice of administration time for long-acting statins should be based on patient preference to improve adherence to the therapy 3.
Recommended Statins for Evening Administration
- Short-acting statins should be given in the evening to maximize their low-density lipoprotein (LDL)-lowering effects, as cholesterol biosynthesis peaks at night 3, 4.
- Atorvastatin, when given every other day, has been shown to be safe and effective in lowering total cholesterol, triglycerides, and LDL-c when taken before bedtime 5.
Factors Influencing Administration Timing
- The half-life of the statin: short-acting statins are more sensitive to administration timing than long-acting statins 3, 4.
- Patient adherence: allowing flexibility in the timing of statin administration can improve patient adherence to the therapy 3.
- Food intake: food can decrease the absorption rate of atorvastatin, but this does not necessarily affect the timing of administration 6.