Did you know that statins (cholesterol-lowering medicines) should generally be taken at night to maximize their effectiveness?
Jason Loo Siau Ee
PhD, MPharm, RPh
There are many medicines that doctors may prescribe for the treatment of high cholesterol, but the most popular and effective class of cholesterol-lowering medicines are known as statins. These include simvastatin (Zocor®), atorvastatin (Lipitor®), and rosuvastatin (Crestor)® among others. You may have heard that these medicines should be taken at night (some people might even find this inconvenient), but have you ever wondered why?
Statins are also known scientifically as HMG-CoA reductase inhibitors, meaning they work by blocking the action of HMG-CoA reductase. HMG-CoA reductase (which is actually an abbreviation of the really long name 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase) is an enzyme that is responsible for making cholesterol in your body. Studies have shown that the amount of cholesterol your body makes through your liver follows a pattern, with the greatest amount of cholesterol being made when you are fasting. We enter a fasting state when we sleep, as such your body actually makes the most cholesterol when you are sleeping. Hence, to ensure maximum effectiveness, statins need to be taken at night so they can stop your body from making more cholesterol when you sleep.
The amount of time statins stay in your body and block the synthesis of cholesterol varies with the type of statin. The newer statins such as atorvastatin and rosuvastatin actually have a long half-life, meaning they stay in your body a little longer than the older statins such as simvastatin. Therefore, atorvastatin and rosuvastatin can actually be taken at any time of the day, but for simplicity’s sake it is easier for most people to remember that cholesterol-lowering medications should always be taken at night.
- Plakogiannis R, Cohen H. Optimal low-density lipoprotein cholesterol lowering – morning versus evening statin administration. Ann Pharmacother. 2007;41:106-110.
- Expert panel on the detection, evaluation, and treatment of high blood cholesterol in adults: executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high cholesterol in adults (adult treatment panel III). JAMA. 2001:285:2486-2497.