Atorvastatin

Atorvastatin, what is it?

Atorvastatin is a medication prescribed by a doctor to help lower cholesterol levels of people who have been diagnosed with high cholesterol. Atorvastatin belongs to a class of lipid-lowering medications called Statins. Statins are medications that function by reducing the amount of cholesterol in the blood. The medication is meant for adults and children over the age of 10, whose cholesterol levels do not reduce enough with exercise and low-fat diets alone.

Atorvastatin has the ability to lower the risk of strokes, heart attacks, and chest pain in patients who have heart disease, have a history of heart disease, or have the risk factors for heart disease such as smoking, high blood pressure, age, or a history of heart disease in the family.

What is Atorvastatin used for?

Atorvastatin is used to treat high cholesterol. In some cases, you may be prescribed Atorvastatin even if your cholesterol level is not too high, but for the benefit of reducing your risk of heart attack or stroke. It is especially used to treat people who have head strokes or heart attacks in the past, because it can prevent new ones from happening.

How does Atorvastatin work?

Atorvastatin is an inhibitor of a naturally occurring enzyme in the body, HMG-CoA Reductase. When it inhibits this enzyme from working, the liver cannot create as much cholesterol as before. This helps lower LDL, or bad cholesterol. Atorvastatin also has some anti-inflammatory effects to the blood vessels which can help with artery disease (atherosclerosis).

How effective is Atorvastatin?

Depending on the dose (10mg to 80mg daily), people see a reduction of 38% to 54% in their LDL levels by taking Atorvastatin. 

Active ingredients

The active ingredient in Atorvastatin is: 10 mg, 20 mg, 40 mg, or 80 mg of Atorvastatin. This depends on the dose of Atorvastatin your doctor prescribes (moderate vs. high intensity)

Inactive ingredients

The inactive ingredients in Atorvastatin include:  Calcium carbonate, USP; candelilla wax, FCC; croscarmellose sodium, NF; hydroxypropyl cellulose, NF; lactose monohydrate, NF; magnesium stearate, NF; microcrystalline cellulose, NF; Opadry White YS-1-7040 (Hypromellose, polyethylene glycol, talc, titanium dioxide); polysorbate 80, NF; simethicone emulsion.

How to use Atorvastatin safely

If you are using this drug, you should avoid eating grapefruit or drinking grapefruit juice while they are still on this medication. You should only take grapefruit if instructed by your doctor to do so. You should also avoid other fruits related to grapefruit like bitter oranges, pomelos, tangelos, and Seville oranges.

Note: Grapefruit has the ability to increase the amount of this medication present in the bloodstream, which could increase your dose when you don’t intend to. Contact your doctor or pharmacist for more details.

If the patient taking this drug also takes other drugs that lower cholesterol (bile acid-binding resins such as Cholestyramine or Colestipol), Atorvastatin should be taken at least an hour before or at least 4 hours after these medications have been taken. These medications can prevent the full absorption of Atorvastatin into the bloodstream since they react with Atorvastatin.

Atorvastatin Dosage

You should always read the patient information leaflet received from your pharmacist before you begin the use of Atorvastatin and every time you go for a refill. You should direct any questions you have about the product to your doctor or pharmacist.

This medication can be taken by mouth with or without food, depending on the instructions your doctor gives you. You should follow the dosage instructions given to you by your pharmacist or doctor.

The dosage for this medication is usually once daily.

The dosage appropriate for your use would be based on your medical condition, response to treatment, age, and the other medications you are using in that period.

You should ensure that you inform your doctor or pharmacist about any product you use before using this drug (prescription, nonprescription, recreational and herbal drugs).

To reap the full benefit of this drug, you should ensure that you use it regularly, as directed. You should endeavor to take the drug at the same time every day. You should continue the use of this medication even if you feel well.

What should I do if I miss a dose?

You should take the missed dose as soon as you remember. However, if it has been more than 12 hours since you missed your dose, you should skip the missed dose and take the next dose at the normal time. You should never double the dose to make up for the missed one.

What should I do in case of an overdose?

In case of an overdose, you should immediately call the control helpline at 1-800-222-1222, or the equivalent of it in your area. If the victim has collapsed and cannot breathe, or cannot be awakened, you should immediately call emergency services at 911 or the equivalent in your area.

Precautions

Before you start using Atorvastatin, you should tell your doctor or pharmacist if you are allergic to any of the inactive ingredients, or if you have any other allergies. You should talk to your pharmacist for more details.

You should let your doctor know if you have ever had, or still have liver disease, kidney disease or any other medical conditions. You should talk to your doctor about your medical history and alcohol use before you start taking this medication.

You should avoid the use of alcoholic beverages once you have started using Atorvastatin, as combining alcohol with Atorvastatin increases your chance of developing a liver problem. Consult your doctor or pharmacist for more information.

Caution: You should avoid using this medication if you are pregnant. Atorvastatin can potentially harm an unborn child. Therefore, it is important to avoid getting pregnant while on this medication.

You should avoid taking red yeast rice products while you are on Atorvastatin as it may contain a statin called Lovastatin. Taking this medication and red yeast rice products at the same time can increase your chances of developing muscle and liver problems.

Atorvastatin side effects

Rare (less severe)

• A very small number of people experience mild memory problems and confusion after taking this medication.

You should consult your doctor if you experience this.

Common side effects (less severe)

• Constipation
• Diarrhea
• Nausea
• Fatigue
• Heartburn
• Headache
• Mild muscle pain

You should contact your doctor if you experience any of the symptoms above.

Common side effects (severe)

• Fever
• Dark Urine
• Increased thirst or hunger
• Drowsiness
• Jaundice (yellowing of the skin or eyes)
• Muscle breakdown
• Loss of appetite

If you experience any of the symptoms above, you should contact your doctor immediately.

Note: These lists do not represent all of the side effects that can be observed by a person using Atorvastatin. You should talk to your doctor if you notice any serious side effect even those not mentioned in the list above.

Contraindications

Atorvastatin is contraindicated in the following situations: 

• Active liver disease
• Allergy to any of the ingredients in Atorvastatin
• Pregnancy
• Breastfeeding

If any of these factors apply to you, you should let your doctor know before taking Atorvastatin.  

Drug interactions

Atorvastatin can interact with the following medications, either increasing the level of Atorvastatin or in the blood or the level of the other medication:

• Clarithromycin
• Protease inhibitors for HIV treatment
• Itraconazole
• Grapefruit juice (in excess consumption)
• Cyclosporine
• Rifampin
• Digoxin
• Oral contraceptives

Certain drugs such as those above may increase the risk of myopathy (muscle pain and muscle breakdown) from Atorvastatin.  

Atorvastatin vs Rousuvastatin

Both Atorvastatin and Rosuvastatin are “statin” medications, meaning they work the same way. Both are considered “high intensity” statins. Doctors may prescribe either one in people at high risk of cardiovascular disease or stroke. 

Atorvastatin 20mg vs 40mg

Your doctor may prescribe either Atorvastatin 20mg, or 40mg, and sometimes even 80mg. All three doses are effective at lowering cholesterol, however, the higher the dose, the stronger the effect. The 20mg dose is known as low-intensity treatment, and 40mg or 80mg are known as high intensity treatment. In general, people who have had strokes or heart attacks will be on at least 40mg. People who are taking Atorvastatin for the purpose of lowering cholesterol alone can be started on 10mg or 20mg.