A Drug Study on

Generic Name Atorvastatin

Brand Name Lipitor
Drug Classification HMG-CoA Reductase Inhibitors/Statins
Mode of Action Inhibits HMG-CoA reductase, which catalyzes first step
in cholesterol synthesis; this action reduces
concentrations of serum cholesterol and low-density
lipoproteins (LDLs), linked to increased risk of coronary
artery disease (CAD). Also moderately increases
concentration of high-density lipoproteins (HDLs),
associated with decreased risk of CAD.
Dose and Route  Hyperlipidemia And Mixed Dyslipidemia
PO: ADULTS, ELDERLY: Initially, 10–20 mg/day
(40 mg in pts requiring greater than 45% reduction
in LDL-C). Range: 10–80 mg/day
 Heterozygous Familial Hypercholesterolemia In
Pediatric Patients (10 Years To 17 Years Of Age)
PO: CHILDREN 10–17 YRS: Initially, 10 mg/day.
Maximum: 20 mg/day.
Indications &  Reduce the risk of MI, stroke, revascularization
Contraindications procedures, and angina in patients without CHD,
but with multiple risk factors
 Reduce the risk of MI and stroke in patients with
 type 2 diabetes without CHD, but with multiple
risk factors
 Reduce the risk of non-fatal MI, fatal and non-
fatal stroke, revascularization procedures,
hospitalization for CHF, and angina in patients
with CHD
 Reduce elevated total-C, LDL-C, apo B, and TG
levels and increase HDL-C in adult patients with
primary hyperlipidemia (heterozygous familial and
nonfamilial) and mixed dyslipidemia
 Reduce elevated TG in patients with
hypertriglyceridemia and primary
dysbetalipoproteinemia
 Reduce total-C and LDL-C in patients with
homozygous familial hypercholesterolemia
(HoFH)
 Reduce elevated total-C, LDL-C, and apo B
levels in boys and postmenarchal girls, 10 to 17
years of age, with heterozygous familial
hypercholesterolemia after failing an adequate
trial of diet therapy
Contraindicated to:
 Hypersensitivity to drug or its components
 Active hepatic disease or unexplained, persistent
serum transaminase elevations
 Pregnancy or breastfeeding

Side Effects/ Adverse Allergic reactions:

Effects  Hives; difficulty breathing; swelling of your face,
lips, tongue, or throat.
 Notify the physician if the patient have the following:
 Muscle weakness in your hips, shoulders, neck,
and back
 Trouble lifting your arms, trouble climbing or
standing;
 Liver problems - upper stomach pain, weakness,
tired feeling, loss of appetite, dark urine, jaundice
 Kidney problems - little or no urinating, swelling in
your feet or ankles, feeling tired or short of
breath.

Common atorvastatin side effects may include:

 Joint pain;
 Stuffy nose, sore throat;
 Diarrhea; or
 Pain in your arms or legs.

Adverse:
 Nasopharyngitis, arthralgia, diarrhea, pain in
extremity, and urinary tract infection

 Cytochrome P450 3A4 (CYP 3A4) Inhibitors

Drug Interactions Atorvastatin is metabolized by cytochrome P450 3A4.
The concomitant use of drugs that inhibit CYP 3A4
can result in increased concentrations of atorvastatin
in the blood.
 Cytochrome P450 3A4 Inducers
Efavirenz and rifampin are drugs with cytochrome
P450 3A4-inducing activity.
 Organic Anion Transporting Polypeptide 1B1
 (OATP1B1) Inhibitors
It is an uptake transporter, responsible for the hepatic
uptake of drugs from the blood. Atorvastatin and its
metabolites are substrates of the OATP1B1
transporter. Drugs such as cyclosporine are inhibitors
of the OATP1B1 and cause inhibition of hepatic
uptake of atorvastatin.
 Gemfibrozil It is a lipid-modifying drug that belongs
to the class of fibrates. Co-administration of
atorvastatin with gemfibrozil leads to decreased
metabolism of atorvastatin.
 NiacinThe use of atorvastatin with high doses of
niacin increases the risk of rhabdomyolysis – a
serious condition characterized by the breakdown of
skeletal muscle tissue.
 DigoxinCo-administration of atorvastatin and digoxin
leads to increased concentration of digoxin in the
blood.
 Colchicine
The co-administration of atorvastatin with colchicine
can lead to the increased bioavailability of
atorvastatin, predisposing to the occurrence of
myotoxicity such as rhabdomyolysis.
 Oral Contraceptives
Atorvastatin may increase the blood concentrations
of oral contraceptives such as norethindrone and
ethinyl estradiol.
Nursing
Responsibilities 1. Tell patient to take drug at the same time each day to
maintain its effects.
Rationale: Statins work best when taken at the same
time each day.
2. Advise patient that this medication should be used in
conjunction with diet restrictions, exercise, and
cessation of smoking.
Rationale: It can raise triglyceride levels and may
increase your risk of liver damage

3. Instruct patient to avoid taking Lipitor and alcohol at

the same time.
Rationale: There will be an increased risk of problems
with blood circulation to the brain.

4. Advise patient to avoid drinking grapefruit juice during

therapy.
Rationale: Grapefruit juice inhibits a system of enzymes
that helps break down dozens of medications. 

5. Instruct patient to notify health care professional

promptly if unexplained muscle pain, tenderness, or
weakness occurs, especially if accompanied by fever or
malaise.
Rationale: This may help avoid serious drug
interactions and it could be a sign of rare but serious
muscle side effects

6. Instruct female patients to notify health care

professional promptly if pregnancy is planned or
suspected or if breastfeeding.
Rationale: Lipitor is contraindicated in women who are
or may become pregnant. Serum cholesterol and
 triglycerides increase during normal pregnancy.
7. Monitor blood cholesterol and triglyceride levels at
intervals during therapy. After beginning treatment levels
are re-checked in 2-3 months
Rationale: It is to ascertain drug effectiveness

8. Instruct patient to follow the special diet.

Rationale: Dietary modification is continued along with
drug therapy.

9. Instruct patient to report immediately when there is

changes in vision.
Rationale: Drug may cause photosensitivity.

10. Arrange to have periodic blood tests while you are

taking this drug.
Rationale: In order to ensure that the liver is in good
condition.

References:
Kizior, R.J., Hodgson, K.J., & EBSCO Publishing. (2019). Lipitor. Saunders
nursing drug handbook 2019. St. Louis, Missouri: Elsevier

Kizior, R.J., Hodgson, K.J., & EBSCO Publishing. (2021). Lipitor. Saunders
nursing drug handbook 2021. St. Louis, Missouri: Elsevier

Rxlist (2020). Lipitor. Retrieved on August 19, 2021 from

https://www.rxlist.com/lipitor-drug.htm#overdosage