Atorvastatin (Generic Lipitor): Uses, Dosage & Side Effects
A package and pill of atorvastatin 40mg (Lipitor).
Credit: Creative Commons

Atorvastatin is a prescription medicine used to treat high cholesterol. It is marketed as a calcium salt under the brand name Lipitor (atorvastatin calcium), produced by Pfizer. It is also available as a generic medicine. 

Atorvastatin is one of the most popular medicines for treating high cholesterol. Tens of millions of people use it, said Ken Sternfeld, a New York-based pharmacist. Atorvastatin is a member of the drug class HMG-CoA inhibitor (statin). Statins are typically used to help patients with high cholesterol. Since there are many statins, "it's important to test patients to find out which is the best one for them," Sternfeld said. He recommends a simple swab test that can determine which drugs a patient can best metabolize.

Atorvastatin, and other statins, work by potentially decreasing the production of cholesterol in the body through blocking the cholesterol-producing enzyme in the liver. Consequently, the amount of cholesterol (a fat-like substance) that collects in the arteries may be reduced. "Statins are drugs you take for the rest of your life," Sternfeld said. "Though the dosing could change and perhaps you take it once a day or every other day."

"Cholesterol has a useful purpose in the body when it's doing what it's supposed to do," says Dr. Stephen Neabore, a primary care doctor at the Barnard Medical Center in Washington, D.C. "It helps keep the cell membrane somewhat soft, which is necessary for movement. But our bodies make all the cholesterol that we need. The recommended daily allowance is 0." 

Excessive cholesterol in arteries may block blood flow to the heart, brain and other parts of the body, leading to heart attack, stroke, chest pain, and other problems. Significant improvement often depends on combining a medicine, such as atorvastatin, with lifestyle changes. 

"We try to really promote a lifestyle that can make a big difference in cholesterol management," said Neabore. "We try to get people to consume less cholesterol. It's essentially only found in animal products. Animals need it to help keep their cells soft like we do. A plant-based diet has been shown in many studies to be the most effective for promoting overall health."

Atorvastatin would likely still work if a patient did not change his or her lifestyle, but there would be much more improvement if they did, said Neabore. 

Atorvastatin calcium's potency is dosage-related, meaning that the higher the dose, the more cholesterol is inhibited. Typical doses are 10, 20, 40, or 80 mg daily, and the usual starting dose is 10-20 mg daily. Doctors may increase dosages gradually. Dosage should not be increased more than once every two to four weeks.

To find the proper dosage and help determine if a statin is the right choice, Neabore looks at risk calculators created by the American Heart Association. "We look at things like blood pressure, diabetes, and other conditions to get an estimated risk for patients for heart attack or stroke," he said. Statins can cause severe side effects. "But if a patient scores over a certain percentage on the risk calculator we believe that that the benefits of a drug like this are worth it." 

Atorvastatin calcium comes in an oral tablet that is usually taken once a day. It should be taken at the same time every day, and can be taken with or without food. The tablet should not be crushed or chewed. It is important that patients continue to take atorvastatin even if they feel well.

If a dose is missed, it should be taken as soon as remembered unless there are less than 12 hours until the next scheduled dose. In this case, the missed dose should be skipped. Patients should not take a double dose to make up for a missed one.

"One of the side effects of statins is that they can cause muscle cramping and weakness," said Sternfeld. If experienced, a patient should see a doctor immediately. "Doctors and pharmacists have to work together to balance out the importance of keeping cholesterol low and cramping. It's important to find the right balance because people take these drugs for the rest of their lives."

The NIH lists the following additional side effects as less serious, though a doctor should be consulted if they persist or become severe:

  • diarrhea
  • constipation
  • gas
  • headache
  • joint pain
  • forgetfulness or memory loss
  • confusion

The NIH lists the following symptoms as serious. If a patient experiences any of them, a doctor should be consulted immediately:

  • muscle pain, tenderness, or weakness
  • lack of energy
  • fever
  • chest pain
  • nausea
  • extreme tiredness
  • unusual bleeding or bruising
  • loss of appetite
  • pain in the upper right part of the stomach
  • flu-like symptoms
  • dark colored urine
  • yellowing of the skin or eyes
  • rash
  • hives
  • itching
  • difficulty breathing or swallowing
  • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • hoarseness

It is important for patients taking atorvastatin calcium to maintain a low-fat, low-cholesterol diet. If a diet or exercise plan is prescribed by a doctor or dietician, it should be followed. 

Alcohol intake should be limited, as it may increase the risk of liver problems when combined with atorvastatin. The NIH recommends telling a doctor if you drink more than two alcoholic beverages per day, and warns that drinking alcohol can "increase the risk of serious side effects." No more than one quart of grapefruit juice should be consumed per day while taking atorvastatin.

Women who are breast-feeding or pregnant should not take atorvastatin. The NIH warns that taking atorvastatin while pregnant may harm the fetus. If a woman is planning to become pregnant, she should tell her doctor before taking atorvastatin, and if she becomes pregnant while taking the medicine, she should stop taking it immediately.

It is very important that patients tell their doctors and pharmacists what prescription and non-prescription medicines they are taking before beginning an atorvastatin prescription, said Sternfeld. Antifungal medications, birth control pills, and other cholesterol-inhibiting medications should especially be noted. Patients should tell their healthcare providers if they have any history of liver, kidney, or thyroid disease; diabetes; or seizures. Adverse drug reactions involving atorvastatin can be serious and doctors and pharmacists have different areas of expertise when it comes to drug reactions and interactions. "Healthcare is about collaboration. No one has all the answers. People need to take ownership of their own health. The only way the health care industry can help them is if they collaborate, tell their health care providers, so they can collaborate," he said.