What is the optimal time of day to administer a statin? According to a new study published in the Journal of Clinical Lipidology, the timing of administration depends on whether the statin is short-acting or long-acting.
Statins, or HMG-CoA reductase inhibitors, are considered a standard therapy for many types of dyslipidemia and are generally “administered in the evening because cholesterol biosynthesis peaks during the night and also because most of them (simvastatin, pravastatin, fluvastatin, and lovastatin) have short half-lives.” However, flexibility in choosing a time for administration may potentially improve patient compliance, especially for patients on complex drug regimens.
To get a better understanding of how the timing of administration affects lipid profiles, researchers searched several databases to identify studies where the effects of morning and evening administration of statins on total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) or triglycerides (TG) were compared.
Eleven studies (n=1034) were included in the analysis. While the pooled analysis for comparing these effects on TC, HDL-C, and TG were found not to be statistically significant, LDL-C lowering was found to be statistically greater in the evening-dose group (MD: 3.24mg/dL, 95% CI: 1.23–5.25; P=0.002). This effect on LDL-C was seen with both short half-life (MD: 9.68 mg/dL, 95% CI: 3.32–16.03; P=0.003) and long half-life statins (MD: 2.53mg/dL, 95% CI: 0.41–4.64; P=0.02), however with regards to long-acting statins, the authors write “that the difference between the groups is small and might not be clinically relevant”.
Compared to morning dosing, evening dosing of short-acting statins resulted in a larger decrease in TC (P=0.0005), however, with respect to HDL-C and TG both dosing regimens were found to be equivalent.
The authors conclude that “Based on the results of this meta-analysis, evening dosing appears to be important for short-acting statins, but in the case of statins with long half-lives, prescribing instruction should allow more patient-based choice.”
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