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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 by the liver by blocking the enzyme
that makes cholesterol, HMGCoA reductase. They
lower total blood cholesterol as well as LDL
cholesterol levels. (LDL cholesterol is believed
to be the "bad" cholesterol that is primarily
responsible for the development of coronary
artery disease.) Lowering LDL cholesterol levels
retards progression and may even reverse
coronary artery disease. Unlike the other drugs
in this class, atorvastatin also can reduce the
concentration of triglycerides in the blood.
High blood concentrations of triglycerides also
have been associated with coronary artery
disease. Atorvastatin was approved by the FDA in
December of 1996.
PRESCRIPTION:
yes
GENERIC AVAILABLE:
no
PREPARATIONS: Tablets of
10, 20, and 40 mg.
STORAGE: Tablets should be
stored below or at room temperature,
15-30°C
(59-86°F).
PRESCRIBED FOR:
Atorvastatin is used for the treatment of high
cholesterol and triglyceride levels. High blood
cholesterol is first treated with exercise,
weight loss, and a diet low in cholesterol and
saturated fats. When these measures fail to
achieve enough cholesterol-lowering, medications
such as atorvastatin may be added. The National
Cholesterol Education Program (NCEP) has
published treatment guidelines for use of these
medications. These treatment guidelines take
into account the level of LDL cholesterol as
well as the presence of other factors that
increase the risk for coronary artery disease
such as diabetes, hypertension, cigarette
smoking, low HDL cholesterol level, and family
history of early coronary heart disease. The
effectiveness of atorvastatin in lowering
cholesterol is dose related, meaning that higher
doses reduce cholesterol more. Blood cholesterol
determinations are performed at regular
intervals during treatment so that adjustments
in doses can be made.
DOSING: Atorvastatin is
prescribed once daily. Starting doses are 10-40
mg. daily. It may be taken with or without food
and at any time of day.
DRUG INTERACTIONS: As with
other drugs in this class, the risk of muscle
breakdown (see "Side Effects," below) is
increased when atorvastatin is given together
with other medications such as cyclosporine
(Sandimmune), gemfibrozil (Lopid), erythromycin
and nicotinic acid.
PREGNANCY: It is not known
if atorvastatin affects the fetus if taken
during pregnancy. Atorvastatin may be used in
pregnancy if the physician feels that its
benefits outweigh the potential
risks.
NURSING MOTHERS: It is not
known if atorvastatin is secreted in breast
milk. Therefore, the physician must decide
whether to instruct a pregnant woman to continue
taking atorvastatin and nursing if the benefits
of treatment are judged to outweigh the
potential risks, or to discontinue either
nursing or atorvastatin if the potential risks
are judged to outweigh the
benefits.
SIDE EFFECTS: Atorvastatin
is generally well-tolerated, and side effects
are rare. Minor side effects include
constipation, diarrhea, fatigue, gas, heartburn,
and headache. Atorvastatin should be used with
caution in patients with alcohol or other liver
diseases. Persistently abnormal liver tests
during treatment are rare but may require
discontinuation of the medication. Rare cases of
muscle inflammation (myositis) and breakdown
have been reported with other drugs in this
class (HMGCoA reductase antagonists), and it is
assumed that this side effect also may occur
with atorvastatin. Muscle breakdown causes the
release of muscle protein (myoglobin) into the
blood and accumulation of the protein in the
kidney tubules, resulting in kidney failure.
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