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GENERIC NAME: atorvastatin


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 choleste
rol in blood. LDL cholesterol is believed to be the "bad" cholesterol that is pr
imarily responsible for the development of coronary artery disease. Reducing LDL
cholesterol levels retards progression and may even reverse coronary artery dis
ease. Atorvastatin also reduces the concentration of triglycerides in the blood
and raises the concentrations of HDL ("good") cholesterol. High blood concentrat
ions of triglycerides also have been associated with coronary artery disease. Th
e FDA approved atorvastatin in December 1996.
PREPARATIONS: Tablets of 10, 20, 40, and 80 mg
STORAGE: Tablets should be stored at room temperature, 20°-25°C (68°-77°F).
PRESCRIBED FOR: Atorvastatin is used for the treatment of elevated total cholest
erol, LDL, triglycerides and to elevate HDL cholesterol. The effectiveness of at
orvastatin in lowering cholesterol is dose-related, meaning that higher doses re
duce cholesterol more.
Atorvastatin prevents angina, stroke, heart attack, hospitalization for congesti
ve heart failure, and revascularization procedures in individuals with coronary
heart disease.
Atorvastatin reduces the risk of myocardial infarction, stroke, angina and revas
cularization procedures in adults with multiple risk factors for coronary artery
Atorvastatin also prevents heart attacks and strokes in patients with type 2 dia
betes 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 tha
n 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 o
f atorvastatin in the body and increase the risk of muscle toxicity from atorvas
tatin. Therefore, atorvastatin should not be combined with drugs that decrease i
ts elimination. Examples of such drugs include erythromycin (E-Mycin), ketoconaz
ole (Nizoral), itraconazole (Sporanox), clarithromycin (Biaxin), telithromycin (
Ketek), cyclosporine (Sandimmune), nefazodone (Serzone), and HIV protease inhibi
tors such as indinavir (Crixivan) and ritonavir (Norvir).
Large quantities of grape fruit juice (>1.2 liters daily) also will increase blo
od levels of atorvastatin.
Amiodarone (Cordarone), verapamil (Calan Verelan, Isoptin), cyclosporine (Sandim
mune), niacin (Niacor, Niaspan, Slo-Niacin), gemfibrozil (Lopid) and fenofibrate
(Tricor) also may increase the risk of muscle toxicity when combined with atorv
Atorvastatin increases the effect of warfarin (Coumadin) and the blood concentra
tion of digoxin (Lanoxin). Patients taking atorvastatin and warfarin or digoxin
should be monitored carefully.

atorvastatin (cont.)

Cholestyramine (Questran) decreases the absorption of atorvastatin. Atorvastatin

should be given at least two hours before and at least four hours after cholest
PREGNANCY: Atorvastatin should not be taken during pregnancy because the develop
ing fetus requires cholesterol for development, and atorvastatin reduces the pro
duction of cholesterol. Atorvastatin should only be administered to women of chi
ldbearing age if they are not likely to become pregnant.
NURSING MOTHERS: It is not known if atorvastatin is secreted in breast milk. Bec
ause of the potential risk of adverse events, breastfeeding mothers should not u
se atorvastatin.
SIDE EFFECTS: Atorvastatin is generally well-tolerated. Minor side effects inclu
de constipation, diarrhea, fatigue, gas, heartburn, and headache. Atorvastatin m
ay 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. Abnorma
l tests usually return to normal even if a statin is continued, but if the abnor
mal 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 wee
ks following initiation of therapy and dose changes, and periodically thereafter
Inflammation of the muscles caused by statins can lead to serious breakdown of m
uscle cells called rhabdomyolysis. Rhabdomyolysis causes the release of muscle p
rotein (myoglobin) into the blood, and myoglobin can cause kidney failure and ev
en death. When used alone, statins cause rhabdomyolysis in less than one percent
of patients. To prevent the development of serious rhabdomyolysis, patients tak
ing atorvastatin should contact their healthcare provider immediately if they de
velop unexplained muscle pain, weakness, or muscle tenderness.
Reference: FDA Prescribing Information


BRAND NAME(S): Lipitor
Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions |
Overdose | Notes | Missed Dose | Storage
USES: Atorvastatin is an enzyme blocker (HMG-CoA reductase inhibitor), also know
n as a "statin". It is used along with a proper diet to help lower cholesterol a
nd fats (triglycerides) in the blood. In general, this drug is prescribed after
non-drug treatment options have not been fully successful at lowering cholestero
l (e.g., diet change, increase in exercise, weight loss if overweight). Reducing
cholesterol and triglycerides help prevent strokes and heart attacks. Atorvasta
tin is used in adults and children (10 years of age and older). Young girls must
have had their first menstrual period before starting this medication.
HOW TO USE: Take this medication by mouth usually once daily with or without foo
d, or as directed by your doctor. This drug is best taken in the evening. Dosage
is based on your medical condition, response to therapy, and use of certain int
eracting medicines. Many of the drugs listed in the Drug Interactions section ma
y increase the chances of muscle injury when used with atorvastatin. Consult you
r doctor or pharmacist for more details. Avoid eating grapefruit or drinking gra
pefruit juice while being treated with this medication unless your doctor instru
cts you otherwise. Grapefruit juice can increase the amount of certain medicatio
ns in your bloodstream. Consult your doctor or pharmacist for more details. If y
ou also take certain other drugs to lower your cholesterol (bile acid-binding re
sins such as cholestyramine or colestipol), take atorvastatin at least 2 hours a
fter these medications. Use this medication regularly in order to get the most b
enefit from it. Remember to use it at the same time each day. It may take up to
4 weeks before the full benefit of this drug takes effect. It is important to co
ntinue taking this medication even if you feel well. Most people with high chole
sterol or triglycerides do not feel sick