Atorvastatin

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

  1. atherosclerosis
  2. cerebral vasospasm prophylaxis
  3. coronary artery disease prevention after heart transplantation
  4. heart failure
  5. hypercholesterolemia
  6. hyperlipoproteinemia
  7. hypertriglyceridemia
  8. myocardial infarction prophylaxis
  9. 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

  1. abdominal pain
  2. amnesia
  3. anaphylactoid reactions
  4. angioedema
  5. arthralgia
  6. blurred vision
  7. bullous rash
  8. chills
  9. cholestasis
  10. cirrhosis
  11. Co-Enzyme Q-10 deficiency
  12. confusion
  13. depression
  14. diabetes mellitus
  15. diarrhea
  16. dizziness
  17. drowsiness
  18. dyspepsia
  19. dyspnea
  20. elevated hepatic enzymes
  21. eosinophilia
  22. epistaxis
  23. eructation
  24. erythema multiforme
  25. fatigue
  26. fever
  27. flatulence
  28. flushing
  29. hemolytic anemia
  30. hepatic failure
  31. hepatic necrosis
  32. hepatitis
  33. hyperglycemia
  34. immune-mediated necrotizing myopathy
  35. infection
  36. insomnia
  37. interstitial lung disease
  38. jaundice
  39. leukopenia
  40. lupus-like symptoms
  41. malaise
  42. memory impairment
  43. musculoskeletal pain
  44. myalgia
  45. myasthenia
  46. myoglobinuria
  47. myopathy
  48. nausea
  49. nightmares
  50. pancreatitis
  51. peripheral neuropathy
  52. pharyngitis
  53. photosensitivity
  54. purpura
  55. renal failure (unspecified)
  56. renal tubular obstruction
  57. rhabdomyolysis
  58. Stevens-Johnson syndrome
  59. stroke
  60. tendon rupture
  61. thrombocytopenia
  62. tinnitus
  63. toxic epidermal necrolysis
  64. urticaria
  65. vasculitis
  66. 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
  • Conjugated Estrogens; Bazedoxifene
  • Cyclosporine
  • Daclatasvir
  • Dalfopristin; Quinupristin
  • Danazol
  • Daptomycin
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • 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
  • Glimepiride; Pioglitazone
  • grapefruit juice
  • Hydantoins
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Idelalisib
  • Imatinib
  • Indinavir
  • Isavuconazonium
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Istradefylline
  • 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
  • Ranolazine
  • Red Yeast Rice
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Riluzole
  • Ritonavir
  • Rivaroxaban
  • Sapropterin
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  • Sarilumab
  • Secobarbital
  • Segesterone Acetate; Ethinyl Estradiol
  • Siltuximab
  • Simeprevir
  • Sirolimus
  • Sodium Bicarbonate
  • Sofosbuvir; Velpatasvir
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Sorafenib
  • Spironolactone
  • St. John’s Wort, Hypericum perforatum
  • Streptogramins
  • Tacrolimus
  • Talazoparib
  • Telaprevir
  • Telbivudine
  • Telithromycin
  • Telotristat Ethyl
  • Temsirolimus
  • Teriflunomide
  • Thiopental
  • Tipranavir
  • Tocilizumab
  • Tolvaptan
  • Trandolapril; Verapamil
  • Vemurafenib
  • Verapamil
  • Voriconazole
  • Warfarin
  • Zonisamide
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