atorvastatin, Lipitor (cont.)

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Large quantities of grape fruit juice (>1.2 liters daily) also will increase blood levels of atorvastatin and should not be taken.

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 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.

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. Liver tests should be performed at the beginning of treatment then as needed thereafter. Inflammation of the muscles caused by statins can lead to serious breakdown of muscle cells called rhabdomyolysis. Rhabdomyolysis causes the release of muscle protein (myoglobin) into the blood, and myoglobin can cause kidney failure and even death. When used alone, statins cause rhabdomyolysis in less than one percent of patients. To prevent the development of serious rhabdomyolysis, patients taking atorvastatin should contact their health care professional immediately if they develop unexplained muscle pain, weakness, or muscle tenderness.

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