From the Guidelines
Taking statins twice a day is generally not recommended unless specifically prescribed by your healthcare provider. Most statins are designed for once-daily dosing, typically in the evening, based on the body's natural cholesterol production cycle, which peaks overnight 1. The choice of particular statin is a matter of preference, and clinicians are encouraged to develop familiarity and experience with one of the statins, including dosage regimen and potential drug-drug interactions 1.
Key Considerations
- Start with the lowest dose once daily, usually at bedtime, and measure baseline CK, ALT, and AST 1.
- Instruct the patient to report all potential adverse effects, especially muscle cramps, weakness, asthenia, and more diffuse symptoms suggestive of myopathy 1.
- If myopathy symptoms are present, stop the medication, assess CK, and determine the relation to recent physical activity 1.
- The threshold for worrisome levels of CK is 10 times above the upper limit of reported normal, considering the impact of physical activity, and the threshold for worrisome levels of ALT or AST is 3 times the upper limit of reported normal 1.
Dosage and Administration
- The recommended dosing schedule for statins is once daily, and splitting the dose could potentially increase side effects without providing additional benefits.
- If target LDL cholesterol levels are not achieved, the dose may be increased by 1 increment (usually 10 mg) and repeat the blood work in 4 weeks 1.
- If laboratory abnormalities are noted or symptoms are reported, temporarily withhold the medication and repeat the blood work in 2 weeks 1.
Alternative Strategies
- If you're struggling with side effects or feel your current regimen isn't effective, speak with your doctor about adjusting your medication rather than changing the dosing schedule yourself 1.
- Your doctor might consider switching you to a different statin, adjusting the dose, or recommending alternative cholesterol management strategies based on your specific health needs and response to treatment.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Take orally with or without food, at any time of day. Assess LDL-C when clinically appropriate, as early as 4 weeks after initiating rosuvastatin tablets, and adjust dosage if necessary. Adults:Recommended dosage range is 5 mg to 40 mg once daily.
The FDA drug label recommends taking rosuvastatin once daily, with no indication of taking HMG-CoA reductase inhibitors (statins) twice daily.
- Key points:
From the Research
Statin Dosing Frequency
- The standard dosing frequency for HMG-CoA reductase inhibitors (statins) is once daily 3.
- However, some studies suggest that alternate-day dosing or twice weekly dosing may be effective and tolerated in patients with statin intolerance 4, 5, 6.
- A study comparing daily atorvastatin administration with alternate-day dosing found that both regimens significantly reduced total cholesterol and low-density lipoprotein cholesterol, with no statistically significant differences between the two groups 6.
- Another study found that treating patients intolerant to statins with rosuvastatin every other day was tolerated by the majority of patients and reduced LDL-C 5.
Considerations for Twice Daily Dosing
- There is no direct evidence to support the use of statins twice daily 4, 7, 5, 3, 6.
- The available studies suggest that once daily or alternate-day dosing may be sufficient for achieving significant reductions in LDL-C and total cholesterol.
- Twice daily dosing may increase the risk of adverse effects, such as myalgias and elevated liver enzymes, although this is not explicitly stated in the available evidence.
Alternative Dosing Strategies
- For patients with statin intolerance, alternative dosing strategies such as alternate-day dosing or twice weekly dosing may be considered 4, 7, 5.
- Non-statin drugs, such as ezetimibe and/or bile acid sequestrants, may also be used as alternative treatments for patients who cannot tolerate statins 4, 7.