intermittent statin treatment

Last edited 04/2020 and last reviewed 03/2023

Nondaily dosing regimens of statins

  • intermittent low-dose statins is an option for lipid lowering therapy in statin intolerant patients

  • atorvastatin and rosuvastatin, are longer acting
    • they are therefore useful for nondaily dosing regimens

  • alternate day, three times a week, twice a week, and once a week regimens have been tried and results are positive

  • evidence from a small double-blind, placebo-controlled trial of 35 patients receiving atorvastatin, 10 mg daily, versus alternate day regimen showed LDL cholesterol reductions of 38% and 35%, respectively, without any myopathy

  • use in statin intolerant patients
    • in a small study of 51 statin intolerant patients, who received rosuvastatin, 5 or 10 mg on alternate days, 80% of patients had no recurrence of myalgia
    • once weekly rosuvastatin, 5-20 mg, resulted in a mean LDL cholesterol reduction of 29% among 8 intolerant patients without any incidence of myopathy

  • non-daily rosuvastatin and atorvastatin seem tolerable - the use of non daily statin dosing may help lower LDL cholesterol levels in patients with statin intolerance

  • checking effectiveness of non-daily statin dosing
  • - with daily statin dosing the "steady state" of maximal effectiveness in lipid lowering is achieved after 4 weeks (90% effect after 2 weeks). However with non-daily statin dosing the "steady state" is achieved a a slower rate (dependent on the frequency of dosing) and so it is reasonable to wait until 12 weeks to evaluate effectiveness of a non-daily regime

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