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Atorvastatin

Atorvastatin is widely used to lower cholesterol levels and reduce the risk of a heart attack.
Atorvastatin

Overview

Atorvastatin (Lipitor) is among the most popular of the statin drugs that widely prescribed for treating high cholesterol. All of these medications lower cholesterol levels by keeping the liver from manufacturing it.

This medication dramatically lowers LDL cholesterol and triglycerides.

Coronary artery disease is associated with certain risk factors, including high serum cholesterol, bad LDL cholesterol, elevated triglycerides and reduced levels of protective HDL cholesterol.

When diet, exercise and weight control are insufficient to control cholesterol, drugs like Lipitor may be important in reducing the risk of heart disease. Research shows benefit particularly in preventing a second or third heart attack in an individual who has already suffered one. Opinion is quite divided on whether atorvastatin makes sense for “primary prevention”-lowering the likelihood of an initial heart attack in an individual at average risk. You can read more about the controversy here.

Side Effects and Interactions

Some adverse reactions that may occur include headache, stomach ache, flatulence, constipation, diarrhea, indigestion, skin rash, and muscle or joint aches. Hives, mental fuzziness or diabetes are other potential side effects.

Muscle aches, tenderness or weakness are not uncommon, but in rare cases they could be a sign of a serious reaction called rhabdomyolysis or myopathy.  A test of kidney function (creatine kinase or CK) will show whether dangerous muscle breakdown is occurring. Kidney failure might be the outcome of untreated myopathy. Report any symptoms such as muscle pain or extreme weakness coupled with abdominal pain, nausea, fever, rapid heart rate or confusion to a physician immediately.

The danger of rhabdomyolysis or myopathy is increased when atorvastatin is combined with certain other drugs, particularly mifepristone used to terminate pregnancy or the antifungal drug posaconazole (Noxafil). These drugs should not be prescribed in combination with atorvastatin. Others, such as the transplant drug cyclosporine, antibiotics like erythromycin or clarithromycin (Biaxin), the heart rhythm regulator amiodarone, cholesterol-lowering medicines such as gemfibrozil (Lopid) or niacin, the gout medicine colchicine and antifungal drugs like ketoconazole or itraconazole, may also increase the risk of muscle damage and should be avoided if possible.

Other serious reactions include sun sensitivity, liver damage, pancreas inflammation and a very severe skin reaction known as Stevens-Johnson syndrome.

You can read more about statin side effects in this post.

Other Drugs That May Interact Badly with Atorvastatin

  • conivaptan
  • crizotinib
  • dabrafenib
  • danazol
  • delavirdine
  • diltiazem
  • fluvoxamine
  • imatinib
  • isonizaid
  • quinine
  • red yeast rice
  • telithromycin
  • verapamil

Atorvastatin may increase blood levels of the heart drug digoxin , so close monitoring is advised.

Blood levels of oral contraceptives may also be increased in patients on Lipitor.

Antacids such as Maalox and the cholesterol drug Colestid can reduce absorption of Lipitor if they are taken at the same time.

The herb St. John’s wort might speed elimination of Lipitor from the body, which could reduce its effectiveness.

There is a remote but untested possibility that peppermint could increase the effects of cholesterol-lowering drugs such as Lipitor. These agents work by inhibiting the enzyme HMG CoA reductase, and menthol has a similar action.

The herb gotu kola may raise cholesterol levels and should not be combined with cholesterol-lowering medications such as Lipitor.

Check with your physician and pharmacist to make sure Lipitor is safe in combination with any other drugs and herbs you take.

Special Precautions

Anyone with liver disease should not take atorvastatin. Liver enzyme changes have been reported in a small proportion of patients using this medicine, and may indicate serious problems. Liver function should be tested before anyone starts taking atorvastatin and periodically thereafter.

Because cholesterol is essential for the developing fetus and infant, pregnant or nursing women should not take atorvastatin.

Taking the Medicine

Lipitor is taken once a day, with or without meals, at any convenient time.

Grapefruit can increase blood levels of atorvastatin and should usually be avoided by those taking the medicine.

All statin drugs, including atorvastatin, lower body levels of Co-enzyme Q10, an essential compound for mitochondrial function. Most people taking a statin should take a supplement of CoQ1o of at least 100 mg/day.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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