Atorvastatin

What is atorvastatin?

Atorvastatin is a prescription medicine used to treat high cholesterol and to reduce the risk of heart attack, stroke, angina, and to decrease the chance that heart surgery will be needed in people who have heart disease or who are at risk of developing heart disease.

Atorvastatin helps lower LDL cholesterol (‘bad cholesterol’) and triglyceride levels, and increases HDL cholesterol (‘good cholesterol’) levels, to improve your overall lipid profile.

Atorvastatin calcium belongs to a class of medications called HMG-CoA reductase inhibitors, commonly referred to as statins.

Atrovastatin tablets are taken once daily with or without food. 

How does atorvastatin work?

Atorvastatin works by selectively blocking HMG-CoA reductase, the key enzyme the liver uses to produce cholesterol. By slowing this process, it reduces cholesterol production in the liver and increases the number of LDL receptors on liver cells, which helps remove more LDL (“bad”) cholesterol from the bloodstream. 

As a result, it lowers overall LDL levels, decreases the number of LDL particles, and improves the body’s ability to clear cholesterol.

What is atrovastatin used for?

Atorvastatin FDA-approved uses:

To reduce the risk of cardiovascular events in adults with:

• Multiple risk factors for coronary heart disease (CHD), but without established CHD.
  Use: to reduce the risk of myocardial infarction (MI), stroke, revascularization procedures, and angina.
• Type 2 diabetes and multiple risk factors for CHD, without established CHD
  Use: to help reduce the risk of MI and stroke.
• Adults with clinically evident CHD:
  Use: To reduce the risk of non-fatal MI, fatal and non-fatal stroke, revascularization procedures, hospitalization for congestive heart failure, and angina.

As an adjunct to diet to lower LDL-C:

• Adults with primary hyperlipidemia.
• Adults and pediatric patients (10 years and older) with heterozygous familial hypercholesterolemia (HeFH).

As an adjunct to other LDL-lowering therapies:

• For adults and pediatric patients (10 years and older) with homozygous familial hypercholesterolemia.

As an adjunct to diet for additional lipid disorders in adults:

• Primary dysbetalipoproteinemia.
• Hypertriglyceridemia.

How atorvastatin improves cholesterol and heart health

When cholesterol and fats build up along your artery walls, in a process called atherosclerosis, they narrow the blood vessels and reduce blood and oxygen flow to your heart, brain, and other parts of your body. By slowing cholesterol production, atorvastatin helps prevent this buildup to keep blood flowing more freely to vital organs.

Lowering your blood level of cholesterol and fats with atorvastatin may help prevent heart disease, angina (chest pain), strokes, and heart attacks.

Your healthcare provider will check your blood lipid levels regularly to assess how well your treatment is working. These measurements include:

• LDL-C: Low-density lipoprotein (“bad” cholesterol)
• HDL-C: High-density lipoprotein (“good” cholesterol)
• TG: Triglycerides (a type of blood fat)
• Total-C: Total cholesterol

Warnings

You should not take atrovastatin calcium if you have liver disease or cirrhosis.

Atorvastatin calcium can cause the breakdown of muscle tissue, which can lead to kidney failure. Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness, especially if you also have fever, unusual tiredness, or dark urine.

Serious drug interactions can occur when certain medicines are used together with atrovastatin calcium. Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using.

Avoid drinking more than 1.2 liters of grapefruit juice each day.

Avoid eating foods that are high in fat or cholesterol. Atrovastatin is often used in conjunction with a cholesterol-lowering diet.

Atorvastatin side effects

Common atorvastatin side effects

Common atorvastatin side effects may include pain in your bones, spine, joints, or muscles, muscle spasms, upset stomach, trouble sleeping, stuffy nose, runny nose, sore throat, diarrhea, nausea, or pain in your arms or legs, urinary tract infection with pain and burning when you urinate, painful urination. 

Serious atorvastatin side effects

Allergic reactions: Get emergency medical help if you have signs of an allergic reaction to atorvastatin (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

Myopathy and Rhabdomyolysis: Atorvastatin calcium can cause the breakdown of muscle tissue, which can lead to kidney failure. Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness, especially if you also have fever, unusual tiredness, or dark urine. This serious side effect is more likely in older adults and those who have kidney problems, thyroid problems, or take certain other medicines.

Other serious side effects may occur. Call your doctor at once if you have:

• muscle weakness in your hips, shoulders, neck, and back;
• trouble lifting your arms, trouble climbing, or standing;
• liver problems – loss of appetite, stomach pain (upper right side), tiredness, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
• kidney problems – swelling, urinating less, feeling tired or short of breath; or
• high blood sugar – increased thirst, increased urination, dry mouth, fruity breath odor.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects.

Warnings

You should not take atorvastatin if you have liver disease or cirrhosis.

Atorvastatin can cause the breakdown of muscle tissue, which can lead to kidney failure. Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness, especially if you also have fever, unusual tiredness, or dark urine.

Serious drug interactions can occur when certain medicines are used together with atorvastatin. Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using.

Avoid eating foods that are high in fat or cholesterol. Atorvastatin will not be as effective in lowering your cholesterol if you do not follow a cholesterol-lowering diet plan.

Atorvastatin is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely.

Before taking this medicine

You should not use atorvastatin if you are allergic to it, or if you have liver failure or cirrhosis.

To make sure atorvastatin is safe for you, tell your doctor if you have ever had:

• muscle pain or weakness;
• diabetes;
• stroke;
• a thyroid disorder;
• a habit of drinking more than 2 alcoholic beverages per day; or
• kidney disease.

Atorvastatin can cause the breakdown of muscle tissue, which can lead to kidney failure. This happens more often in women, in older adults, or people who have kidney disease or poorly controlled hypothyroidism (underactive thyroid).

Pregnancy

Tell your healthcare professional if you are pregnant, or plan to become pregnant, or become pregnant. Atorvastatin may harm your unborn baby. If you become pregnant, stop taking atorvastatin and call your healthcare provider right away.

Breastfeeding

Tell your healthcare professional if you are breastfeeding or plan to breastfeed. You and your healthcare provider should decide if you will take this medicine or breastfeed. You should not take atorvastatin if you breastfeed. Talk to your healthcare provider about the best way to feed your baby if you take LIPITOR.

How should I take atorvastatin?

Take atorvastatin tablet once daily with or without food. Many people ask when to take atorvastatin morning or night? It can be taken any time of the day, but try and take it at the same time each day. 

Take the liquid medicine on an empty stomach, at least 1 hour before a meal or 2 hours after a meal. Shake the oral suspension (liquid). Measure a dose with the supplied measuring device (not a kitchen spoon).

Take atorvastatin exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Do not change your dose or stop taking any of your medications without your doctor’s advice.

It may take up to 2 weeks before your cholesterol levels improve, and you may need frequent blood tests. Even if you have no symptoms, tests can help your doctor determine if this medicine is effective.

Your treatment may also include diet, exercise, weight control, and blood tests.

Store at room temperature away from moisture, heat, and light.

Throw away in the trash any unused liquid 60 days after opening the bottle.

Atorvastatin Dosing Information

Recommended Dosage in Adult Patients The recommended starting dosage of Lipitor is 10 mg to 20 mg once daily. The dosage range is 10 mg to 80 mg once daily. Patients who require a reduction in LDL-C greater than 45% may be started at 40 mg once daily.

Recommended Dosage in Pediatric Patients 10 Years of Age and Older with HeFH The recommended starting dosage of Lipitor is 10 mg once daily. The dosage range is 10 mg to 20 mg once daily. 

Recommended Dosage in Pediatric Patients 10 Years of Age and Older with HoFH The recommended starting dosage of Lipitor is 10 mg to 20 mg once daily. The dosage range is 10 mg to 80 mg once daily. 

Comments: Assess LDL-C when clinically appropriate, as early as 4 weeks after initiating Lipitor, and adjust the dosage if necessary.

This medicine is available as: atorvastatin 10 mg tablets, atorvastatin 20 mg tablets, atorvastatin 40 mg tablet, 80 mg tablets. 

The original brand name of atorvastatin was Lipitor, and now it is also available as a generic.
Atorvastatin calcium oral suspension is also available as the brand Aorvaliq 20mg/5ml.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if you are more than 12 hours late for the dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while taking atorvastatin?

Avoid eating foods high in fat or cholesterol, or atorvastatin will not be as effective.

Drinking alcohol may increase your risk of liver damage.

Grapefruit may interact with atorvastatin and cause side effects. Avoid consuming grapefruit products and drinking more than 1.2 liters of grapefruit juice each day.

What other drugs will affect atorvastatin?

Sometimes it is not safe to use certain medicines at the same time. Some drugs can affect your blood levels of other drugs you use, which can increase the risk of serious muscle problems or make the medicines less effective.

Tell your doctor about all your current medicines. Many drugs can interact with atorvastatin, especially:

• other cholesterol-lowering medicines – gemfibrozil, niacin, fenofibrate, fenofibric acid, and others;
• colchicine;
• antibiotic or antifungal medicine – rifampin, erythromycin, clarithromycin, itraconazole, ketoconazole, posaconazole, and voriconazole;
• birth control pills;
• medicine to prevent organ transplant rejection; or
• antiviral medicine to treat hepatitis C or HIV.