When to Take Atorvastatin for High Cholesterol? Morning or Night

By Zina Semenovskaya, MD
Medically reviewed checkmarkMedically reviewed
August 3, 2022

Statin therapy can reduce the risk of heart disease, heart attack, stroke, and even death from cardiovascular disease by 25% or more.

Atorvastatin, also known as Lipitor, is one of the most commonly prescribed statin medications.

As a more long-acting statin medication, it has different timing and dosing recommendations than other statins you may have read about. 

In this article, I’ll explore when to take atorvastatin for high cholesterol.

I’ll start by explaining what atorvastatin is, including its uses, possible side effects, known interactions, and how long it lasts in the body. 

I’ll discuss what time of day to take atorvastatin and will describe how atorvastatin works alongside other strategies for reducing high cholesterol.

Lastly, I’ll explain when to seek medical attention when taking atorvastatin.

What is Atorvastatin?

Atorvastatin is a statin drug. Like all statins, it works by blocking a liver enzyme needed to produce cholesterol. 

This lowers your body’s overall levels of low-density lipoprotein (LDL) cholesterol levels, which are sometimes called bad cholesterol.

It also raises your levels of high-density lipoprotein (HDL), sometimes called good cholesterol.

Bad cholesterol can build up in your body’s arteries and form fatty deposits called plaque.

This can cause the arteries to narrow and become less flexible (a condition called atherosclerosis), which raises your risk for heart disease and stroke.

There are two main types of statin medication: low-intensity statins, including pravastatin and simvastatin; and high-intensity statins, such as rosuvastatin and atorvastatin. 

Generally speaking, higher-intensity statins lower your cholesterol more than lower-intensity statins.

Use

For many people, low-intensity statins are effective in lowering cholesterol levels back down to a healthy range.

But in some cases, they might not lower cholesterol levels quickly enough for your healthcare provider’s liking, especially if you have other risk factors for heart disease. 

In other cases, your initial cholesterol readings may be high enough that you may need to start with a higher-intensity statin.

Atorvastatin usually takes about six weeks to reach full effectiveness in your body. 

When your healthcare provider prescribes you a high-intensity statin like atorvastatin, they will usually schedule follow up lab work to be completed after about eight weeks of medication.

This will allow them to see if the atorvastatin is working as intended to lower your cholesterol levels.

Possible side effects

Side effects of taking atorvastatin may include:

  • Diarrhea
  • Heartburn
  • Gas
  • Joint pain
  • Forgetfulness or memory loss
  • Confusion
  • Pregnancy complications
  • Muscle pain and damage

These side effects can be mild or severe, and vary person to person.

Liver damage is a potential side effect that healthcare providers are especially vigilant about, as statins can increase enzyme levels that cause liver inflammation. 

If the increase is only mild, you can continue to take statins.

More severe symptoms of liver damage include:

  • Dark-colored urine
  • Loss of appetite
  • Pain in your upper abdomen 
  • Unusual fatigue or weakness
  • Yellowing of the skin or eyes

Another serious but rare side effect (i.e, affecting a few cases per million of those taking statins) is a condition called rhabdomyolysis. 

This is a life-threatening condition where the muscle tissue breaks down and releases proteins and electrolytes into the blood.

Symptoms include dark, tea-colored urine, fatigue and malaise, and extremely sore muscles.

Interactions

Certain health conditions, including thyroid disease, metabolic syndrome, and genetic mutations linked to mitochondrial dysfunction, increase the risk of side effects from statins. 

Additionally, medications used to treat these health conditions can also lead to side effects from drug interactions.

HIV protease inhibitors, oral contraceptives, cyclosporin, clarithromycin, and itraconazole are some of the drugs with known interactions with atorvastatin.

Consuming large quantities of grapefruit juice can increase the concentration of atorvastatin in your bloodstream and lead to negative side effects. 

Drinking too much alcohol can also interact negatively with atorvastatin and can lead to side effects including muscle pain and kidney problems. 

Short-acting vs fast-acting

Certain types of statins stay longer in your system than others. Short-acting statins like pravastatin and simvastatin begin to disappear from the body and decrease in effectiveness after a few hours. 

Long-acting statins like rosuvastatin and atorvastatin are still present and effective in the body for an entire day. These differences directly affect healthcare providers’ guidelines about when and how to take atorvastatin.

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When to Take Atorvastatin

Many statins come with strong guidelines around what time during the day to take them. 

Cholesterol production tends to be highest overnight, when the body is in a fasting state.

Because of this, the recommendation for patients taking short-acting statins has been to take them right before bed for maximum effectiveness, and many studies have shown that these short-acting statins are less successful at lowering cholesterol when taken at any other time of day.

By contrast, most studies have shown little or no variation in effectiveness based on when patients take atorvastatin. That’s because of its longer, more lingering presence (or half-life) in the body. 

What is important is consistency: choosing a time to take the pill each day, and sticking to it.

For this reason, your healthcare provider may recommend you take atorvastatin at the time that is easiest for you to commit to consistently, whether that’s in the morning or at night. 

If you do forget a day, just wait and take your same dosage the next day; never double up on your next dose when you’ve missed a pill. 

Which Atorvastatin Is Best for Me? 

Like most statins, atorvastatin is most often taken as a once daily pill. It’s typically available in 10, 20, 40, and 80 mg tablets. 

Your healthcare provider will decide on the appropriate dose based on your age, weight, and existing cholesterol levels.

Younger patients tend to start at lower doses, while adults requiring large cholesterol reductions may start at higher doses.

Other Ways to Lower Cholesterol

There are many strategies in addition to statins that you can use to increase your “good” cholesterol levels and decrease your “bad” cholesterol levels.

Regular exercise, including moderate aerobic exercise as well as resistance training, has been proven to increase “good” cholesterol and improve overall cholesterol levels. 

That’s important, because increasing your HDL or “good” cholesterol helps to absorb and eliminate the “bad” LDL cholesterol that leads to health complications. 

A diet that keeps trans fats in check and includes ample soluble fiber can also keep bad cholesterol levels lower. Reducing stress and quitting smoking can also help improve your cholesterol profile.

Other medications and supplements outside of the statin family have also been proven to reduce LDL cholesterol levels.

These include ezetimibe, niacin, and bile acid resins. Always talk to your healthcare provider before adding supplements to your regimen.

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When to Seek Medical Attention

If you think that you are experiencing side effects related to taking statins, speak with your healthcare provider immediately.

They may suggest altering your dosage or trying a different statin instead. However, if you are experiencing severe pain or concerning symptoms, seek emergency care. 

Your healthcare provider will especially want to know if you are experiencing any of the following:

  • Muscle or joint pain or tenderness
  • Weakness
  • Fever
  • Dark urine

Frequently Asked Questions

Why is atorvastatin better at night?
Most cholesterol is created at night, when the body is closer to a fasting state. Because atorvastatin is prescribed to block the production of excess cholesterol, it’s often recommended to be taken at night - though it will generally work if you take it during the day, too.
Does atorvastatin affect sleep?
Poor sleep is not a commonly recognized side effect of taking atorvastatin, but some side effects like muscle pain may make it harder to sleep on occasion.
What foods should be avoided when taking atorvastatin?
Grapefruit juice should be avoided when taking atorvastatin.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Zina Semenovskaya, MD

Dr. Semenovskaya specializes in emergency medicine, and received her medical degree from Weill Cornell Medical College. She is currently the medical director at Remote Emergency Medicine Consulting, LLC and splits her time working clinically as an emergency medicine attending in California and Alaska. She is the first of our doctors to be fluent in Russian.

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