BMA Concise Guide to Medicine & Drugs

Atorvastatin

Brand name Lipitor

Used in the following combined preparations None

QUICK REFERENCE

Drug group Lipid-lowering drug

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Atorvastatin is a member of the statin group of lipid-lowering drugs. It is used to treat hypercholesterolaemia (high blood cholesterol levels) in patients who have not responded to other treatments, such as a special diet or lifestyle changes, and who have, or are at risk of developing, heart disease. Atorvastatin is also used in diabetic patients who are at high risk of heart attack or stroke. It blocks the action, in the liver, of an enzyme that is needed for the manufacture of cholesterol. As a result, blood levels of cholesterol are lowered, which can help to prevent coronary heart disease.

Rarely, atorvastatin can cause muscle pain, inflammation, and muscle damage.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses Once daily.

Adult dosage range 10–80mg; up to 80mg (inherited hypercholesterolaemia).

Onset of effect Within 2 weeks. Full beneficial effects are usually seen within 4 weeks.

Duration of action 20–30 hours.

Diet advice A low-fat diet is usually recommended. Do not drink more than 2 small glasses of grapefruit juice per day.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 8 hours, do not take the missed dose, but take the next one on schedule.

Stopping the drug Do not stop taking the drug without consulting your doctor. Stopping the drug may lead to a recurrence of the original condition.

Exceeding the dose An occasional unintentional extra dose is unlikely to cause problems. Large overdoses may cause liver problems. Notify your doctor.

POSSIBLE ADVERSE EFFECTS

The more common adverse effects of atorvastatin include nausea, constipation or diarrhoea, headache, dizziness, tiredness, insomnia, back pain, and joint pain. They are usually mild and transient but should be discussed with your doctor if they are severe. Other, rarer side effects include jaundice, rash, and muscle pain or weakness. Jaundice or a rash should always be reported to your doctor, and, if you have a rash, you should also stop taking the drug. Muscle damage is another rare possible side effect; if you develop muscle pain or weakness, you should notify your doctor immediately and stop taking the drug.

INTERACTIONS

Warfarin Atorvastatin may reduce the anticoagulant effect of warfarin. The dose of warfarin may need adjustment.

Macrolide antibiotics (e.g. erythromycin, clarithromycin), fusidic acid, and antifungals Taken with atorvastatin, these drugs may increase the risk of muscle damage.

Other lipid-lowering drugs Taken with atorvastatin, these drugs may increase the risk of muscle damage.

Ciclosporin and other immuno-suppressant drugs Atorvastatin is not usually prescribed with these drugs because of the increased risk of muscle damage.

Oral contraceptives Atorvastatin increases blood levels of ethinylestradiol and norethisterone. The dose of these drugs may need adjustment.

Digoxin Atorvastatin increases blood levels of digoxin.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have had liver problems.

· You have kidney problems.

· You are a heavy drinker.

· You have an underactive thyroid.

· You or a family member have a muscle disorder.

· You have had muscle problems or other reactions with other lipid lowering drugs.

· You are taking other medicines.

Pregnancy Not recommended. May affect fetal development. Discuss with your doctor if you are pregnant or intend to become pregnant.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Not recommended.

Over 60 No special problems.

Driving and hazardous work No special problems.

Alcohol Avoid excessive amounts. Alcohol may increase the risk of developing liver problems with atorvastatin.

PROLONGED USE

Long-term use of atorvastatin may affect liver function.

Monitoring Regular blood tests to check liver function are needed. Tests of muscle function may be carried out if problems are suspected.