Regular dosing of a prescribed statin is important to its effective use, and extra doses can interfere with ideal use. Over-exposure to statins can result in an increased risk of adverse effects.1,2 While a single additional dose of a statin is not likely to be serious, higher-dose statins carry a greater risk of serious effects.3 Rhabdomyolysis has been reported in a patient after 18 days of inadvertent overdosing of simvastatin.4 Pharmacokinetics of statins may be altered in the elderly, who are also at greater risk, on average, of medication errors due to cognitive impairment,5 polypharmacy,6 and statin-associated myopathy.7
The elimination half-life of statins varies greatly by agent, from one to three hours for pravastatin, fluvastatin, and lovastatin, 12 hours for pitavastatin, 14 hours for atorvastatin, and 19 hours for rosuvastatin.8-13 Elimination half-life of simvastatin is unknown.14 The elimination half-life for extended release formulations is longer. Doubling up on doses is not recommended.
References
- Spence JD, Dresser GK. Overcoming challenges with statin therapy. J Am Heart Assoc. 2016;5(1). doi:10.1161/JAHA.115.002497
- Sirtori CR. The pharmacology of statins. Pharmacol Res. 2014;88:3-11. doi:10.1016/j.phrs.2014.03.002
- Huynh GA, Lee AJ. High-intensity atorvastatin-induced rhabdomyolysis in an elderly patient with NSTEMI: a case report and review of the literature. J Pharm Pract. 2017;30(6):658-662. doi:10.1177/0897190016674109
- Greve T. [Case of severe rhabdomyolosis after protracted overdose of simvastatin]. Ugeskr Laeg. 2008;170(38):2981.
- Piťha J, Topinková E, Bláha V, et al. Statin therapy in elderly patients. Vnitr Lek. 2018;64(11):1021-1027.
- Carroll C, Hassanin A. Polypharmacy in the elderly-when good drugs lead to bad outcomes: a teachable moment. JAMA Intern Med. 2017;177(6):871. doi:10.1001/jamainternmed.2017.0911
- Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S1-45. doi:10.1161/01.cir.0000437738.63853.7a
- Atorvastatin. Micromedex Solutions [database online]. Truven Health Analytics. http://www.micromedexsolutions.com. Accessed 3/22/2020.
- Pravastatin. Micromedex Solutions [database online]. Truven Health Analytics. http://www.micromedexsolutions.com. Accessed 3/22/2020.
- Fluvastatin. Micromedex Solutions [database online]. Truven Health Analytics. http://www.micromedexsolutions.com. Accessed 3/22/2020.
- Lovastatin. Micromedex Solutions [database online]. Truven Health Analytics. http://www.micromedexsolutions.com. Accessed 3/22/2020.
- Pitavastatin. Micromedex Solutions [database online]. Truven Health Analytics. http://www.micromedexsolutions.com. Accessed 3/22/2020.
- Rosuvastatin. Micromedex Solutions [database online]. Truven Health Analytics. http://www.micromedexsolutions.com. Accessed 3/22/2020.
- Simvastatin. Micromedex Solutions [database online]. Truven Health Analytics. http://www.micromedexsolutions.com. Accessed 3/22/2020.