atorvastatin calcium

(ah tor' va stah tin)

Lipitor

 

Pregnancy Category X

 

Drug classes

Antihyperlipidemic

HMG-CoA inhibitor

 

Therapeutic actions

Inhibits HMG-CoA, the enzyme that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs (associated with increased risk of CAD), and increases serum HDLs (associated with decreased risk of CAD); increases hepatic LDL recapture sites, enhances reuptake and catabolism of LDL; lowers triglyceride levels.

 

Indications

        Adjunct to diet in treatment of elevated total cholesterol, serum triglycerides, and LDL cholesterol in patients with primary hypercholesterolemia (types IIa and IIb) and mixed dyslipidemia, primary dysbetalipoproteinemia, and homozygous familial hypercholesterolemia whose response to dietary restriction of saturated fat and cholesterol and other nonpharmacologic measures has not been adequate

        To increase HDL-C in patients with primary hypercholesterolemia and mixed dyslipidemia

        Adjunt to diet to treat elevated serum triglyceride levels

        Adjunct to diet in treatment of boys and postmenarchal girls ages 10–17 with heterozygous familial cholesterolemia if diet alone is not adequate to control lipid levels and LDL-C levels are > 190 mg/dL or if LDL-C level is > 60 mg/dL and there is a family history of premature CV disease or the child has two or more risk factors for the development of coronary disease

        Prevention of CV disease in adults without clinically evident coronary disease but with multiple risk factors for CAD such as age > 55 yr, smoking, hypertension, low HDL-C, family history of early CAD; to reduce the risk of MI and risk for revascularization procedures and angina

 

Contraindications and cautions

        Contraindicated with allergy to atorvastatin, fungal byproducts, active liver disease or unexplained and persistent elevations of transaminase levels, pregnancy, lactation.

        Use cautiously with impaired endocrine function.

 

Available forms

Tablets—10, 20, 40, 80 mg

 

Dosages

ADULTS

Initially, 10 mg PO once daily without regard to meals; for maintenance, 10–80 mg PO daily. May be combined with bile acid-binding resin.

PEDIATRIC PATIENTS 10–17 YR

Initially, 10 mg PO daily. Maximum, 20 mg/day.

 

Pharmacokinetics

Route

Onset

Peak

Oral

Slow

1–2 hr

 

Metabolism: Hepatic and cellular; T1/2: 14 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Bile

 

Adverse effects

        CNS: Headache, asthenia

        GI: Flatulence, abdominal pain, cramps, constipation, nausea, dyspepsia, heartburn, liver failure

        Respiratory: Sinusitis, pharyngitis

        Other: Rhabdomyolysis with acute renal failure, arthralgia, myalgia

 

Interactions

        Possible severe myopathy or rhabdomyolysis with erythromycin, cyclosporine, niacin, antifungals, other HMG-CoA reductase inhibitors

        Increased digoxin levels with possible toxicity if taken together; monitor digoxin levels

        Increased estrogen levels with hormonal contraceptives; monitor patients on this combination

        Decreased metabolism and risk of toxic effects if combined with grapefruit juice; avoid this combination.

 

Nursing considerations

CLINICAL ALERT!

Name confusion has been reported between written orders for Lipitor (atorvastatin) and Zyrtec (certirizine). Use extreme caution.

Assessment

        History: Allergy to atorvastatin, fungal byproducts; active hepatic disease; acute serious illness; pregnancy, lactation

        Physical: Orientation, affect, muscle strength; liver evaluation, abdominal exam; lipid studies, liver and renal function tests

 

Interventions

        Obtain liver function tests as a baseline and periodically during therapy; discontinue drug if AST or ALT levels increase to 3 times normal levels.

        WARNING: Withhold atorvastatin in any acute, serious condition (severe infection, hypotension, major surgery, trauma, severe metabolic or endocrine disorder, seizures) that may suggest myopathy or serve as risk factor for development of renal failure.

        Ensure that patient has tried cholesterol-lowering diet regimen for 3–6 mo before beginning therapy.

        Administer drug without regard to food, but at same time each day.

        Atorvastatin may be combined with a bile acid–binding agent. Do not combine with other HMG-CoA reductase inhibitors or fibrates.

        Consult dietitian regarding low-cholesterol diets.

        WARNING: Ensure that patient is not pregnant and has appropriate contraceptives available during therapy; serious fetal damage has been associated with this drug.

 

Teaching points

        Take this drug once a day, at about the same time each day, preferably in the evening; may be taken with food. Do not drink grapefruit juice while taking this drug.

        Institute appropriate dietary changes.

        Arrange to have periodic blood tests while you are taking this drug.

        Alert any health care provider that you are on this drug; it will need to be discontinued if acute injury or illness occurs.

        Do not become pregnant while you are on this drug; use barrier contraceptives. If you wish to become pregnant or think you are pregnant, consult your health care provider.

        You may experience these side effects: Nausea (eat frequent small meals); headache, muscle and joint aches and pains (may lessen over time).

        Report muscle pain, weakness, tenderness; malaise; fever; changes in color of urine or stool; swelling.

 

Adverse effects in Italic are most common; those in Bold are life-threatening.