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

Reference:

• 1)Sikka P et al. Statin intolerance: now a solved problem. J Postgrad Med. 2011 Oct-Dec;57(4):321-8.
• 2) Matalka MS et al Is alternate daily dose of atorvastatin effective in treating patients with hyperlipidemia? The Alternate Day Versus Daily Dosing of Atorvastatin Study (ADDAS). Am Heart J 2002;144:674-7.
• 3) Backes JM et al. Effectiveness and tolerability of every-other-day rosuvastatin dosing in patients with prior statin intolerance. Ann Pharmacother 2008;42:341-6
• 4) Reinhart KM. Strategies to preserve the use of statins in patients with previous muscular adverse effects.Am J Health Syst Pharm. 2012 Feb 15;69(4):291-300.