Efficacy of alternate day versus daily atorvastatin in reduction of low density lipoprotein cholesterol: a prospective, randomized, open labelled, parallel group study


  • Nishikant Nandlal Mankar Department of Pharmacology, Dr VMGMC, Solapur, Maharashtra, India
  • Vijay Ramkrishna Zad Department of Pharmacology, Dr VMGMC, Solapur, Maharashtra, India
  • Monali Pradeep Vakharia Department of Pharmacology, Dr VMGMC, Solapur, Maharashtra, India




Atorvastatin, Alternate day, LDL-C, CVD


Background: Cardiovascular disease (CVD) is the leading cause of death in India and worldwide. Hypercholesterolemia plays a pivotal role in atherogenesis which gave rise to universally accepted cholesterol diet-CVD hypothesis. Statins are the most potent and commonly used drugs for treating hypercholesterolemia. With atorvastatin, because of the long lasting active metabolites, half-life of HMG-CoA reductase inhibition reaches 20 to 30 hours. Thus, it is conceivable that alternate-day atorvastatin treatment might be effective in maintaining the lipid-lowering efficacy.

Methods: In this prospective, randomized, open labelled, parallel group study, 100 participants with serum low density cholesterol (LDL-C) level 100 mg/dL-190 mg/dL were recruited. Group A received 20 mg atorvastatin on alternate day and group B received 20 mg atorvastatin daily for 12 weeks. Follow up visits were scheduled at 6 and 12 weeks at which fasting serum LDL-C, serum TC, serum TG, serum HDL were estimated. Creatinine phosphokinase (CPK), aspartate transaminase (AST) and alanine transaminase (ALT) estimations were also done and participants were examined for occurrence of myalgia, jaundice or any other adverse effect.

Results: A statistically significant reduction in LDL-C, TC, and TG was seen in both the groups when compared to baseline. At 12 weeks, the LDL-C reduction in alternate day atorvastatin group was 34.63% whereas in daily atorvastatin group, it was 38.75.The reduction in levels of TC in alternate day and daily atorvastatin group was 24.64% and 25.85% respectively. Both the regimens were well tolerated.

Conclusions: The alternate-day dosing of atorvastatin is as efficacious and safe as that of its daily dosing.


Huffman MD. Coronary Heart Disease India. Available at http://sancd.org/CHD%20updated%20fact%20sheet%2014July2011%20PDF. Accessed on 3 November 2013.

Leeder S, Raymond S, Greenberg H, Liu H, Esson K. A race against time the challenge of cardiovascular disease in developing economies. Available at http://earth.columbia.edu/news/2004/images/raceagainsttime_FINAL051104.pdf. Accessed on 3 November 2013.

Bersot TP. Drug therapy for hypercholesterolemia and dyslipidemia. Brunton LL, Chabner BA, Knollmann BC, Editors. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 12th edition. McGraw Hill, New York. 2011;877-908.

Grundy SM, Balady GJ, Criqui MH, Fletcher G, Greenland P, Hiratzka LF, et al. Primary prevention of coronary heart disease: guidance from Framingham: a statement for healthcare professionals from the AHA task force on risk reduction. American Heart Association. Circulation. 1998;97(18):1876-87.

Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ. 2003;326(7404):1423.

Matalka MS, Ravnan MC, Deedwania PC. 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(4):674-7.

Hu M, Cheung BM, Tomlinson B. Safety of statins: an update. Ther Adv Drug Saf. 2012;3(3):133-44.

Juszczyk MA, Seip RL, Thompson PD. Decreasing LDL cholesterol and medication cost with every-other-day statin therapy. Prev Cardiol. 2005;8(4):197-9.

Rifaie O, Zahran A, Nammas W. Alternate-day versus daily atorvastatin in coronary artery disease: a randomized study. Anadolu Kardiyol Derg. 2012;12(2):90-6.

Roeschlau P, Bernt E, Gruber W. Enzymatic determination of serum cholesterol. Clin Chem Clin Biochem. 1974;12:226.

McGowan MW, Artiss JD, Strandbergh DR, Zak B. A peroxidise coupled method for the colorimetric determination of serum triglycerides. Clin Chem.1983;29:538-42.

Burstein M, Scholnick HR, Morfin R. Rapid method for the isolation of lipoproteins from human serum by precipitation with polyanions. J Lipid Res. 1970;11:583-90.

Lwanga SK, Lemeshow S. editors. Sample size determination in health studies. A practical manual. Genev, Switzerland: World Health Organisation; 1991.

Pramanik S, Das AK, Chakrabarty M, Bandyopadhyay SK, Ghosh M, Dalai CK. Efficacy of alternate-day versus everyday dosing of atorvastatin. Indian J Pharmacol. 2012;44(3):362-5.

Keleş T, AkarBayram N, Kayhan T, Canbay A, Sahin D, Durmaz T, et al. The comparison of the effects of standard 20 mg atorvastatin daily and 20 mg atorvastatin every other day on serum LDL-cholesterol and high sensitive C-reactive protein levels. Anadolu Kardiyol Derg. 2008;8(6):407-12.

Aghasadeghi K, Zare D. Efficacy of alternate day dosing of atorvastatin. Cent Eur J Med. 2008;3(2):163-6.

Jafari M, Ebrahimi R, Ahmadi-Kashani M, Balian H, Bashir M. Efficacy of alternate-day dosing versus daily dosing of atorvastatin. J Cardiovasc Pharmacol Ther. 2003;8(2):123-6.

Ghia CJ, Panda AS, Khobragade LR, Jha RK, Rambhad GS. Alternate day versus once daily atorvastatin for primary prevention of CHD in naïve patients of dyslipidemia. J Clin Diagn Res. 2014;8(3):27-31.

Piamsomboon C, Laothavorn P, Saguanwong S, Chatlaong B, Nasawadi C, Tanprasert P, et al. Efficacy and safety of atorvastatin 10 mg every other day in hypercholesterolemia. J Med Assoc Thai. 2002;85(3):297-300.




How to Cite

Mankar, N. N., Zad, V. R., & Vakharia, M. P. (2017). Efficacy of alternate day versus daily atorvastatin in reduction of low density lipoprotein cholesterol: a prospective, randomized, open labelled, parallel group study. International Journal of Basic & Clinical Pharmacology, 5(4), 1421–1424. https://doi.org/10.18203/2319-2003.ijbcp20162446



Original Research Articles