atorvastatin, Lipitor

GENERIC NAME: atorvastatin BRAND NAME: Lipitor

DRUG CLASS AND MECHANISM: Atorvastatin is an oral drug that lowers the level of cholesterol in the blood. It belongs to a class of drugs referred to as statins, which includes lovastatin (Mevacor), simvastatin, (Zocor),fluvastatin (Lescol), and pravastatin (Pravachol). All statins, including atorvastatin, prevent the production of cholesterol in the liver by blocking HMG-CoA reductase, an enzyme that makes cholesterol. Statins reduce total cholesterol as well as LDL cholesterol in blood. LDL cholesterol is believed to be the "bad" cholesterol that is primarily responsible for the development of coronary artery disease. Reducing LDL cholesterol levels retards progression and may even reverse coronary artery disease. Atorvastatin also reduces the concentration of triglycerides in the blood and raises the concentrations of HDL ("good") cholesterol. High blood concentrations of triglycerides also have been associated with coronary artery disease. The FDA approved atorvastatin in December 1996. PRESCRIPTION: Yes GENERIC AVAILABLE: No PREPARATIONS: Tablets of 10, 20, 40, and 80 mg STORAGE: Tablets should be stored at room temperature, 2025C (68-77F). PRESCRIBED FOR: Atorvastatin is used for the treatment of elevated total cholesterol, LDL, triglycerides and to elevate HDL cholesterol. The effectiveness of atorvastatin in lowering cholesterol is dose-related, meaning that higher doses reduce cholesterol more.

Atorvastatin prevents angina, stroke, heart attack, hospitalization forcongestive heart failure, and revascularization procedures in individuals with coronary heart disease. Atorvastatin reduces the risk of myocardial infarction, stroke, angina and revascularization procedures in adults with multiple risk factors for coronary artery disease. Atorvastatin also prevents heart attacks and strokes in patients with type 2 diabetes with multiple risk factors for coronary artery disease. DOSING: Atorvastatin is prescribed once daily. The usual starting dose is 10-20 mg per day, and the maximum dose is 80 mg per day. Individuals who need more than a 45% reduction in LDL cholesterol may be started at 40 mg daily. Atorvastatin may be taken with or without food and at any time of day. DRUG INTERACTIONS: Decreased elimination of atorvastatin could increase levels of atorvastatin in the body and increase the risk of muscle toxicity from atorvastatin. Therefore, atorvastatin should not be combined with drugs that decrease its elimination. Examples of such drugs includeerythromycin (EMycin), ketoconazole (Nizoral), itraconazole (Sporanox),clarithromycin (Biaxin), telithromycin (Ketek), cyclosporine (Sandimmune),nefazodone (Serzone), and HIV protease inhibitors such as indinavir(Crixivan) and ritonavir (Norvir). Large quantities of grape fruit juice (>1.2 liters daily) also will increase blood levels of atorvastatin. Amiodarone (Cordarone), verapamil (Calan Verelan, Isoptin), cyclosporine (Sandimmune), niacin (Niacor, Niaspan, SloNiacin), gemfibrozil (Lopid) and fenofibrate (Tricor) also may

increase the risk of muscle toxicity when combined with atorvastatin. Atorvastatin increases the effect of warfarin (Coumadin) and the blood concentration of digoxin (Lanoxin). Patients taking atorvastatin and warfarin or digoxin should be monitored carefully. Cholestyramine (Questran) decreases the absorption of atorvastatin. Atorvastatin should be given at least two hours before and at least four hours after cholestyramine. PREGNANCY: Atorvastatin should not be taken during pregnancy because the developing fetus requires cholesterol for development, and atorvastatin reduces the production of cholesterol. Atorvastatin should only be administered to women of childbearing age if they are not likely to become pregnant. NURSING MOTHERS: It is not known if atorvastatin is secreted in breast milk. Because of the potential risk of adverse events, breastfeeding mothers should not use atorvastatin. SIDE EFFECTS: Atorvastatin is generally well-tolerated. Minor side effects include constipation, diarrhea, fatigue, gas, heartburn, and headache. Atorvastatin may cause liver and muscle damage. Serious liver damage caused by statins is rare. More often, statins cause abnormalities of liver tests, and, therefore, periodic measurement of liver tests in the blood is recommended for all statins. Abnormal tests usually return to normal even if a statin is continued, but if the abnormal test value is greater than three times the upper limit of normal, the statin usually is stopped. Liver tests should be measured before initiation, at 12 weeks following initiation of therapy and dose changes, and periodically thereafter. Inflammation of the muscles caused by statins can lead to serious breakdown of muscle cells called rhabdomyolysis.

Rhabdomyolysis causes the release of muscle protein (myoglobin) into the blood, and myoglobin can cause kidney failure and even death. When used alone, statins cause rhabdomyolysis in less than one percent of patients. To prevent the development of serious rhabdomyolysis, patients taking atorvastatin should contact their healthcare provider immediately if they develop unexplainedmuscle pain, weakness, or muscle tenderness.