Atorvastatin

What is atorvastatin?

Atorvastatin is used to lower the level of cholesterol (a type of fat) in your blood. When excess cholesterol collects in the walls of your blood vessels, it increases your chance of having a heart attack, or stroke. Lowering cholesterol reduces your risk of heart and blood vessel disease. 

Atorvastatin can also reduce your chance of heart disease if you have an increased risk of it, even if your cholesterol levels are normal. 

Atorvastatin works by blocking an enzyme that produces cholesterol in your liver and in this way slows the production of cholesterol in your body.

Atorvastatin belongs to a group of medicines called statins. Read more about statins and other frequently asked questions about statins. Also watch a video in which New Zealand’s Dr Sam Bailey talks about atorvastatin

Dose

The dose of atorvastatin will depend on your cardiovascular disease (CVD) risk, which is calculated by completing a heart risk assessment. Your doctor will discuss your CVD risk with you. As a guide, if you have:

• a CVD risk of 10–20%: the usual atorvastatin starting dose is 20 milligrams daily; this may increase depending on your response.
• a CVD risk greater than 20% : the usual atorvastatin starting dose is 20 – 40 milligrams daily; this may increase depending on your response.
• a cardiovascular condition, or you've had a stroke or heart attack in the past : the usual atorvastatin dose is 20 – 80 milligrams daily, depending on the highest dose you can manage.

How to take atorvastatin

Always take your atorvastatin exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much atorvastatin to take, how often to take it, and any special instructions.

• Take atorvastatin once a day, at around the same time each day.
• You can take atorvastatin with or without food.
• To reduce your cholesterol effectively, you must keep taking atorvastatin every day.
• If you forget your dose, take it as soon as you remember that day. But, if it is nearly time for your next dose, just take the next dose at the right time. Do not take double the dose.

Precautions – before starting atorvastatin

• Do you have liver or kidney problems?
• Do you have problems with your thyroid?
• Do you have diabetes?
• Are your trying to get pregnant, think you might be pregnant, you're already pregnant, or you're breastfeeding?
• Do you drink large amounts of alcohol?
• Have you had, or do you have, a muscle disorder?

If so, it’s important that you tell your doctor or pharmacist before you start atorvastatin. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

Precautions – when taking atorvastatin

• Having large quantities of grapefruit while taking atorvastatin can increase your risk of side effects. But, eating no more than half a grapefruit or drinking no more than a standard glass (250 mL) of grapefruit juice each day, should not be a problem if you are taking statins.
• Limit drinking alcohol while you are taking atorvastatin. Heavy drinking can increase your risk of serious side effects.

Possible side effects

Like all medicines, atorvastatin can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Muscle pain or weakness

Some people will have muscle pain or weakness when taking statins. This is rarely serious and often goes away with time. If your pain comes on shortly after you start your statin, or gets worse, see your doctor. Your doctor will check an enzyme called creatine kinase to see if the aches and pains are possibly being caused or made worse by the statins. If so:

• a lower dose or a different statin may be prescribed, or
• you may choose to continue living with the aches because of the benefits of the statin, or
• you may discuss stopping taking your statin with your doctor.

Your doctor will also want to check for a rare but serious condition called rhabdomyolisis and will check any other medicines you are taking. Rhabdomyolisis can be caused by an interaction between statins and some other medicines including antibiotics.

Increased risk of type 2 diabetes

There is a small chance that statins may increase your risk of getting type 2 diabetes. However, it is usually recommended that people at risk of diabetes do take statins if they are needed to help lower their cholesterol. This is because the overall benefit in health and wellbeing of taking statins and preventing a heart attack or stroke is seen to be greater than the problems from diabetes.

Other side effects

Interactions

Atorvastatin can interact with a few medications and herbal supplements, so check with your doctor or pharmacist before starting atorvastatin or before starting any new medicines or supplements.

Learn more

The following links have more information on atorvastatin.

Atorvastatin (Māori) New Zealand Formulary Patient Information
Lorstat ; Zarator Medsafe Consumer Information Sheets
StatinsHeart Foundation, NZ

References

1. Prescribing statins to reduce cardiovascular risk BPAC, 2017
2. Investigating myalgia in patients taking statins BPAC, 2014
3. Statins New Zealand Formulary
4. Atorvastatin New Zealand Formulary