Should a Patient Take a Double Dose of Statin if They've Missed a Dose?
No, patients should not take a double dose of statin if they miss a dose—instead, they should skip the missed dose and resume with the next scheduled dose. 1
Clear Guidance from FDA Drug Labeling
The FDA-approved prescribing information for atorvastatin explicitly states: "If a dose is missed, advise patients not to take the missed dose and resume with the next scheduled dose." 1 This represents the definitive guidance that applies to all statins, as doubling doses increases the risk of adverse effects without providing meaningful additional benefit.
Why Doubling Doses Is Problematic
Statins have long half-lives that make dose-doubling unnecessary and potentially harmful:
- Atorvastatin has an elimination half-life ranging from 11 to 24 hours, with steady-state concentrations achieved by the third day of dosing 2
- The pharmacokinetic profile shows that atorvastatin peak concentration and area under the curve increase more than proportionally with dose, meaning doubling the dose more than doubles drug exposure 2
- This disproportionate increase in drug exposure significantly elevates the risk of myopathy and rhabdomyolysis 1, 3
Adherence Is the Real Priority
Rather than focusing on missed doses, guidelines emphasize the critical importance of overall adherence:
- The American College of Cardiology recommends assessing the number of missed statin doses per month and evaluating barriers to adherence as a routine clinical intervention 4
- Poor adherence is a more significant problem than occasional missed doses, and addressing systemic barriers to medication-taking is the appropriate clinical response 4
- Patients should be counseled that consistent daily dosing provides optimal cardiovascular risk reduction 4
Safety Considerations
The risk of adverse effects increases disproportionately with higher doses:
- Statins can cause myopathy and rhabdomyolysis, with risk increasing at higher doses 1
- Patients should be instructed to promptly report unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever 1
- The American College of Cardiology identifies higher statin doses as a specific risk factor for muscle symptoms 5
Common Pitfall to Avoid
Do not advise patients to "make up" missed doses by doubling the next dose. This practice contradicts FDA labeling and increases the risk of dose-dependent adverse effects without improving long-term cardiovascular outcomes. Instead, reinforce the importance of taking the medication consistently as prescribed and address any barriers to adherence.