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On call: Simvastatin in the morning?

Q. My doctor just started me on Zocor to lower my cholesterol. I have had just one side effect, forgetfulness. It’s not as bad as it sounds, since my memory remains excellent, except that I often forget to take my pill in the evening. So I’d like to know if it would be okay for me to take Zocor in the morning with my other pills, which I never forget.

A. Many people have trouble remembering to take medications; drugs that are administered several times during the day are particularly troublesome.

Like the other statin drugs, simvastatin (Zocor, generic) reduces the liver’s production of cholesterol, mainly by inhibiting a liver enzyme called HMG-CoA reductase (and that’s the short name!). The liver normally produces less cholesterol while the food you’ve eaten is releasing its cholesterol into your bloodstream. That means your liver churns out cholesterol fastest at night, when your stomach is empty. And since simvastatin is cleared from the blood rapidly, it makes sense to have it on board when it will do the most good.

That’s the theory — but does it really matter? A group of Norwegian scientists put the theory to the test by comparing the effects of morning and evening doses in 25 patients who were taking between 10 milligrams (mg) and 40 mg of simvastatin every day. Each volunteer took the medication in the morning or evening for six weeks and then switched to the other dosing schedule.

The scientists checked blood tests after each six-week period and found people who took their medication at night enjoyed nearly 14% lower LDL (“bad”) cholesterol levels than their early-bird peers. But the morning group may take some comfort in the fact that there were no significant differences in levels of HDL (“good”) cholesterol or C-reactive protein, a marker of inflammation that has been linked to heart attacks and strokes.

Like simvastatin, lovastatin (Mevacor, Altocor, generic) and fluvastatin (Lescol) are rapidly cleared from the blood and are best taken at night. In contrast, atorvastatin (Lipitor), rosuvastatin (Crestor), pravastatin (Pravachol, generic), and pitavastatin (Livalo) hang around longer and are fully effective when taken in the morning. Unfortunately, these three newer drugs are more expensive than the older generic statins.

It is important for you to take your medication as directed. If you simply cannot adjust to an evening dosage schedule, you might ask your doctor about giving you a higher dose of simvastatin in the morning or switching you to one of the longer-acting statins. However, before you ask for an increase in your simvastatin dose, you should know that the FDA has just issued a warning that the top dose, 80 mg, carries an increased risk of muscle injury. In any case, your doctor will monitor your blood tests to be sure the medication is doing its job effectively and safely.

I hope my answer will help you straighten out your medication schedule — and that your question will be a wake-up call for other people who forget to take their meds.

— Harvey B. Simon, M.D.
Editor, Harvard Men’s Health Watch

Posted by: Dr.Health

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