Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: atorvastatin

BRAND NAME: Lipitor

DRUG CLASS AND MECHANISM: Atorvastatin is an oral drug that lowers the level of cholesterol in the blood. It belongs to a class of drugs referred to as statins, which includes lovastatin (Mevacor), simvastatin, (Zocor), fluvastatin (Lescol), and pravastatin (Pravachol). All statins, including atorvastatin, prevent the production of cholesterol in the liver by blocking HMG-CoA reductase, an enzyme that makes cholesterol. Statins reduce total cholesterol as well as LDL cholesterol in blood. LDL cholesterol is believed to be the "bad" cholesterol that is primarily responsible for the development of coronary artery disease. Reducing LDL cholesterol levels retards progression and may even reverse coronary artery disease. Atorvastatin also reduces the concentration of triglycerides in the blood and raises the concentrations of HDL ("good") cholesterol. High blood concentrations of triglycerides also have been associated with coronary artery disease. The FDA approved atorvastatin in December 1996.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Tablets of 10, 20, 40, and 80 mg

STORAGE: Tablets should be stored at room temperature, 20°-25°C (68°-77°F).

PRESCRIBED FOR: Atorvastatin is used for the treatment of elevated total cholesterol, LDL, triglycerides and to elevate HDL cholesterol. The effectiveness of atorvastatin in lowering cholesterol is dose-related, meaning that higher doses reduce cholesterol more.

Atorvastatin prevents angina, stroke, heart attack, hospitalization for congestive heart failure, and revascularization procedures in individuals with coronary heart disease.

Atorvastatin reduces the risk of myocardial infarction, stroke, angina and revascularization procedures in adults with multiple risk factors for coronary artery disease.

Atorvastatin also prevents heart attacks and strokes in patients with type 2 diabetes with multiple risk factors for coronary artery disease.

DOSING: Atorvastatin is prescribed once daily. The usual starting dose is 10-20 mg per day, and the maximum dose is 80 mg per day. Individuals who need more than a 45% reduction in LDL cholesterol may be started at 40 mg daily. Atorvastatin may be taken with or without food and at any time of day.

DRUG INTERACTIONS: Decreased elimination of atorvastatin could increase levels of atorvastatin in the body and increase the risk of muscle toxicity from atorvastatin. Therefore, atorvastatin should not be combined with drugs that decrease its elimination. Examples of such drugs include erythromycin (E-Mycin), ketoconazole (Nizoral), itraconazole (Sporanox), clarithromycin (Biaxin), telithromycin (Ketek), cyclosporine (Sandimmune), nefazodone (Serzone), and HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir).

Large quantities of grape fruit juice (>1.2 liters daily) also will increase blood levels of atorvastatin.

Amiodarone (Cordarone), verapamil (Calan Verelan, Isoptin), cyclosporine (Sandimmune), niacin (Niacor, Niaspan, Slo-Niacin), gemfibrozil (Lopid) and fenofibrate (Tricor) also may increase the risk of muscle toxicity when combined with atorvastatin.

Atorvastatin increases the effect of warfarin (Coumadin) and the blood concentration of digoxin (Lanoxin). Patients taking atorvastatin and warfarin or digoxin should be monitored carefully.

Cholestyramine (Questran) decreases the absorption of atorvastatin. Atorvastatin should be given at least two hours before and at least four hours after cholestyramine.

PREGNANCY: Atorvastatin should not be taken during pregnancy because the developing fetus requires cholesterol for development, and atorvastatin reduces the production of cholesterol. Atorvastatin should only be administered to women of childbearing age if they are not likely to become pregnant.

NURSING MOTHERS: It is not known if atorvastatin is secreted in breast milk. Because of the potential risk of adverse events, breastfeeding mothers should not use atorvastatin.

SIDE EFFECTS: Atorvastatin is generally well-tolerated. Minor side effects include constipation, diarrhea, fatigue, gas, heartburn, and headache. Atorvastatin may cause liver and muscle damage. Serious liver damage caused by statins is rare.

From the Doctors at MedicineNet.com

Statins - Explains Statin medications. Statins are drugs used for preventing and treating atherosclerosis that causes chest pain, heart attacks, strokes, and intermittent claudication in individuals who have or are at risk for atherosclerosis. Source:MedicineNet Cholesterol - Learn about cholesterol and how to lower LDL cholesterol. Read in-depth cholesterol information on a low cholesterol diet, normal ratio (levels), treatment for high cholesterol and more. Source:MedicineNet pravastatin, Pravachol - Depicts the medication pravastatin (Pravachol), a drug used for the reduction of total and LDL cholesterol as well as triglycerides and to increase HDL cholesterol. Pravastatin reduces the occurrence of heart attacks, strokes and death caused by coronary artery disease. Source:MedicineNet Read 73 more atorvastatin related articles ... FDA Panel Considers Toll-Free Number for TV Drug Ads Research Shows Why Statins Don't Work for Everyone Cholesterol-Lowering Drugs May Ease Irregular Heartbeat Triglycerides Linked to Coronary Disease Risk Statins for All Adults With Diabetes? Celebrex Plus Lipitor Could Fight Prostate Cancer Statins Can Boost Brain Hemorrhage Risk After Stroke Vytorin Study to Get FDA Review Cholesterol Drug Change May Be Risky Statin Drugs May Help the Healthy