PREPARATIONS: Tablets of 10, 20, 40, and 80 mg
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:S
- 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 and should not be taken.
The following drugs also may increase the risk of muscle toxicity when combined with atorvastatin.
- amiodarone (Cordarone)
- verapamil (Calan Verelan, Isoptin)
- cyclosporine (Sandimmune)
- niacin (Niacor, Niaspan, Slo-Niacin)
- gemfibrozil (Lopid)
- fenofibrate (Tricor)
Atorvastatin increases the effect of warfarin (Coumadin) and the concentration in blood 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.
Rifampin increases breakdown of atorvastatin. To reduce the likelihood of this interaction both drugs should be given at the same time. Atorvastatin should not be given after rifampin.
PREGNANCY AND BREASTFEEDING SAFETY: 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.
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.
STORAGE: Tablets should be stored at room temperature, 20 C to 25 C (68 F to 77 F).
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