Atorvastatin

Brand names

• Lipitor

Usage

To treat high cholesterol. Usually prescribed after the first lines of treatment-including diet changes, weight loss, and exercise-fail to reduce to acceptable levels the amounts of total and low-density lipoprotein (LDL) cholesterol in the blood.

How it works

Atorvastatin blocks the action of an enzyme required for the manufacture of cholesterol, thereby interfering with its formation. By lowering the amount of cholesterol in the liver cells, atorvastatin increases the formation of receptors for LDL, and thereby reduces blood levels of total and LDL cholesterol. In addition to lowering LDL cholesterol, atorvastatin also modestly reduces triglyceride levels and raises HDL (the so-called "good") cholesterol.

Side effects

Serious

Fever, chest pain, unusual or unexplained muscle aches and tenderness.

Common

Side effects occur in only 1 % to 2% of patients. These include constipation or diarrhea, dizziness or lightheadedness, bloating or gas, heartburn, nausea, allergic reaction, stomach pain, rise in liver enzymes.

Less common

Sleeping difficulty, skin rash.

Possible interactions

Other medicaments:

Atorvastatin may increase the effects of:

• clofibrate (Atromid-S) and other fibric acid derivatives-has been associated with increased risk of muscle damage (rhabdomyolysis).

Atorvastatin taken concurrently with:

• amprenavir (Agenerase) and ritonavir (Norvir) and perhaps other protease inhibitors may increase atorvastatin levels and the risk of muscle damage (myopathy).
• antacids decreases the amount of atorvastatin that gets into your body.
• azole antifungals (such as itraconazole or Sporanox) may increase the risk for muscle damage (myopathy).
• birth control pills (oral contraceptives) may increase the levels of the contraceptives (certain kinds) and may increase risk of adverse effects.
• colestipol (Colestid) results in lowered atorvastatin blood levels, but better lowering of LDL-C.
• cyclosporine (Sandimmune) may increase the risk for myopathy.
• digoxin (Lanoxin, others) can increase digoxin levels (and possibly lead to toxic effects).
• erythromycin (and perhaps other macrolide antibiotics) may increase the risk for myopathy.
• fluconazole (Diflucan) or itraconazole (Sporanox) or ketoconazole (Nizoral) will increase risk of myopathy. Extreme caution is advised.
• fosphenytoin (Cerebyx) and phenytoin (Dilantin) may blunt atorvastatin therapeutic effects.
• gemfibrozil (Lopid) may increase the risk of muscle damage (myopathy).
• medicines that change cytochrome P450 3A4 (inhibitors will increase atorvastatin levels and inducers will blunt atorvastatin therapeutic effects).
• nefazodone (Serzone) may lead to atorvastatin toxicity.
• niacin (various) may increase the risk for myopathy. Niacin may also increase homocysteine levels-a risk factor for heart disease.
• oral contraceptive (norethindrone and ethinyl estradiol) level increases are likely. Increased monitoring for adverse effects is prudent.
• quinupristin/dalfopristin (Synercid) may increase the risk for myopathy by increasing atorvastatin blood levels.

Foods:

Follow a standard low cholesterol diet.

Herbal medicines or minerals:

No data exist from well-designed clinical studies about garlic and atorvastatin combinations and cannot presently be recommended. Additionally, garlic may inhibit blood clotting (platelet) aggregation - something to consider if you are already taking a platelet inhibitor. Some products containing plant sterols (Benecol) may be useful as complimentary care. Soy (milk, tofu, etc.) contains phytoestrogens that have led to an FDA-approved health claim for reducing risk of heart disease (if they have at least 6.25 grams of soy protein per serving). Substituting soy for some of the meat in your diet can help avoid cardiovascular problems. Lastly, because atorvastatin can deplete coenzyme Q10, supplementation may be needed.

Beverages:

Do not take this medicine with grapefruit juice. Excessive blood levels and increased risk of muscle damage may occur. May be taken with water or milk.

Alcohol:

Excessive alcohol not recommended.

Discontinuation:

Do not stop this medicament without your doctor's knowledge and help. There may be a significant increase in blood cholesterol levels if this medicine is stopped.

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