Atorvastatin Brand Name– Lipitor
What is Atorvastatin
Atorvastatin is a selective, competitive HMG-CoA reductase inhibitor. It is primarily used to lower cholesterol and triglycerides in patients with hypercholesterolemia and mixed dyslipidemia, and may also be used for homozygous familial hypercholesterolemia.
At the maximum recommended dosage, it has greater LDL-lowering efficacy relative to the maximum recommended dosage of other HMG-CoA reductase inhibitors; this may be explained by it’s unique structure, long half-life, and hepatic selectivity.
In a dose-dependent manner, atorvastatin lowers LDL cholesterol by as much as 60%; oral doses as low as 2.5 mg/day were as effective as lower doses of other HMG-CoA reductase inhibitors.
Doses of 10 to 80 mg daily result in mean LDL reductions ranging from 43—60%. Triglycerides are lowered in patients with hypertriglyceridemia by as much as 45% and HDL increases by as much as 12% with monotherapy.
Administration with colestipol produced a 10% greater reduction in LDL-cholesterol than atorvastatin alone, however, adverse reactions were greater and compliance was lower for the combination.
Clinical outcome trials have demonstrated benefits in various populations including the patients treated for the first several months following acute coronary syndromes (MIRACLE), high-risk hypertensives (ASCOT-LLA)
Indications
- atherosclerosis
- cerebral vasospasm prophylaxis
- coronary artery disease prevention after heart transplantation
- heart failure
- hypercholesterolemia
- hyperlipoproteinemia
- hypertriglyceridemia
- myocardial infarction prophylaxis
- stroke prophylaxis
NOTE: In pediatric patients (boys and postmenarchal girls 10 to 17 years of age), atorvastatin is FDA-approved for the treatment of heterozygous familial high cholesterol and is recommended for hyperlipidemia when either: 1) the LDL remains 190 mg/dL or more, or 2) the LDL remains 160 mg/dL or more and there is an increased risk for cardiovascular disease (e.g., positive family history of premature cardiovascular disease or two or more other risk factors are present).
For the treatment of hypercholesterolemia, including hyperlipidemia, hyperlipoproteinemia, or hypertriglyceridemia, as an adjunct to dietary control, for the purpose of reducing the risk of cardiovascular events (e.g., myocardial infarction prophylaxis, stroke prophylaxis)
Side Effects
- abdominal pain
- amnesia
- anaphylactoid reactions
- angioedema
- arthralgia
- blurred vision
- bullous rash
- chills
- cholestasis
- cirrhosis
- Co-Enzyme Q-10 deficiency
- confusion
- depression
- diabetes mellitus
- diarrhea
- dizziness
- drowsiness
- dyspepsia
- dyspnea
- elevated hepatic enzymes
- eosinophilia
- epistaxis
- eructation
- erythema multiforme
- fatigue
- fever
- flatulence
- flushing
- hemolytic anemia
- hepatic failure
- hepatic necrosis
- hepatitis
- hyperglycemia
- immune-mediated necrotizing myopathy
- infection
- insomnia
- interstitial lung disease
- jaundice
- leukopenia
- lupus-like symptoms
- malaise
- memory impairment
- musculoskeletal pain
- myalgia
- myasthenia
- myoglobinuria
- myopathy
- nausea
- nightmares
- pancreatitis
- peripheral neuropathy
- pharyngitis
- photosensitivity
- purpura
- renal failure (unspecified)
- renal tubular obstruction
- rhabdomyolysis
- Stevens-Johnson syndrome
- stroke
- tendon rupture
- thrombocytopenia
- tinnitus
- toxic epidermal necrolysis
- urticaria
- vasculitis
- weakness
Monitoring Parameters
- creatine phosphokinase (CPK)
- LFTs
- serum cholesterol profile
Contraindications
- alcoholism
- breast-feeding
- children
- cholestasis
- contraception requirements
- diabetes mellitus
- electrolyte imbalance
- endocrine disease
- females
- geriatric
- hepatic disease
- hepatic encephalopathy
- hepatitis
- hypotension
- hypothyroidism
- infants
- infection
- jaundice
- myopathy
- organ transplant
- pregnancy
- renal failure
- renal impairment
- rhabdomyolysis
- seizure disorder
- sepsis
- stroke
- surgery
- trauma
Interactions
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Aliskiren
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Aliskiren; Valsartan
- Alogliptin; Pioglitazone
- Aluminum Hydroxide
- Aluminum Hydroxide; Magnesium Carbonate
- Aluminum Hydroxide; Magnesium Hydroxide
- Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
- Aluminum Hydroxide; Magnesium Trisilicate
- Amiodarone
- Amobarbital
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Antacids
- Apalutamide
- Aprepitant, Fosaprepitant
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Atazanavir
- Atazanavir; Cobicistat
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Boceprevir
- Bortezomib
- Bosentan
- Brigatinib
- Butabarbital
- Calcium Carbonate
- Calcium Carbonate; Magnesium Hydroxide
- Calcium Carbonate; Risedronate
- Calcium Carbonate; Simethicone
- Carbamazepine
- Carvedilol
- Ceritinib
- Cimetidine
- Ciprofloxacin
- Clarithromycin
- Cobicistat
- Colchicine
- Colchicine; Probenecid
- Colestipol
- Conivaptan
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- Cyclosporine
- Daclatasvir
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- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Delavirdine
- Digoxin
- Diltiazem
- Dronedarone
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elbasvir; Grazoprevir
- Elexacaftor; tezacaftor; ivacaftor
- Eliglustat
- Eltrombopag
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Enzalutamide
- Erythromycin
- Erythromycin; Sulfisoxazole
- Eslicarbazepine
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Etravirine
- Everolimus
- Fenofibrate
- Fenofibric Acid
- Fluconazole
- Fosamprenavir
- Gemfibrozil
- Glecaprevir; Pibrentasvir
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- grapefruit juice
- Hydantoins
- Hydrochlorothiazide, HCTZ; Spironolactone
- Idelalisib
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- Indinavir
- Isavuconazonium
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
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- Itraconazole
- Ixabepilone
- Ketoconazole
- Lanthanum Carbonate
- Lasmiditan
- Ledipasvir; Sofosbuvir
- Leflunomide
- Letermovir
- Lomitapide
- Lopinavir; Ritonavir
- Lovastatin; Niacin
- Lumacaftor; Ivacaftor
- Magnesium Hydroxide
- Mephobarbital
- Mestranol; Norethindrone
- Metformin; Pioglitazone
- Methohexital
- Mifepristone
- Mitotane
- Nefazodone
- Nelfinavir
- Nevirapine
- Niacin, Niacinamide
- Niacin; Simvastatin
- Nicardipine
- Nilotinib
- Ombitasvir; Paritaprevir; Ritonavir
- Ombitasvir; Paritaprevir; Ritonavir
- Omeprazole; Amoxicillin; Rifabutin
- Omeprazole; Sodium Bicarbonate
- Oritavancin
- Oxcarbazepine
- Pazopanib
- Pentobarbital
- Pexidartinib
- Phenobarbital
- Pioglitazone
- Posaconazole
- Primidone
- Quinine
- Raltegravir
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- Red Yeast Rice
- Ribociclib
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- Sirolimus
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- Tolvaptan
- Trandolapril; Verapamil
- Vemurafenib
- Verapamil
- Voriconazole
- Warfarin
- Zonisamide
