Atorvastatin

When you start taking atorvastatin, you should be on a cholesterol-lowering diet. If appropriate, a health care professional will discuss an individualized program of weight control and physical exercise with you.

The recommended starting dose of atorvastatin for adults is 10 mg or 20 mg daily, preferably in the evening, with or without food. Your doctor will do blood tests to tell how well this dose is working for you and may gradually increase the dose to get the desired response. The maximum recommended dose for adults is 80 mg taken once daily.

For children 10 to 17 years of age who are taking Atorvastatin to treat inherited cholesterol disorders, the recommended dose ranges from 10 mg to 20 mg daily. Doses greater than 20 mg have not been studied.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

For best results in lowering cholesterol, it is very important to closely follow the diet suggested by your doctor. It is also very important that atorvastatin be taken regularly and exactly as prescribed by your doctor.

If you miss a dose of Atorvastatin, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Atorvastatin at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause headaches; it may cause diarrhea or constipation, depending on the person; it may cause gas and bloating; it may cause muscle pain. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

Atorvastatin by Apotex is no longer being manufactured for sale in Canada. For brands that may still be available, search under atorvastatin. This article is being kept available for reference purposes only. If you are using Atorvastatin, speak with your doctor or pharmacist for information about your treatment options.

Do not take Atorvastatin if you:

• are allergic to atorvastatin or any ingredients of the medication
• are breast-feeding
• are pregnant or plan to become pregnant
• have active liver disease or unexplained increases in liver function tests
• are taking the medication glecaprevir/pibrentasvir

There may be an interaction between atorvastatin and any of the following:

• Aliskiren
• Amiodarone
• antacids (e.g., aluminum hydroxide, calcium carbonate, magnesium hydroxide)
• Apalutamide
• "azole" antifungal medications (e.g., itraconazole, ketoconazole, Voriconazole)
• Bicalutamide
• Bosentan
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• cancer medications (e.g., Daunorubicin, Doxorubicin, Etoposide, Methotrexate, Mitotane, Paclitaxel, Temsirolimus, Vinblastine, Vincristine)
• Carbamazepine
• Carvedilol
• Cholestyramine
• Cobicistat
• colchicines
• conivaptan
• Cyclosporine
• Cyproterone
• dabigatran
• Danazol
• daptomycin
• Deferasirox
• Dexamethasone
• Digoxin
• Dipyridamole
• dofetilide
• Dronedarone
• Eltrombopag
• Enzalutamide
• fibrates (e.g., Bezafibrate, gemfibrozil, fenofibrate)
• "gliptin" diabetes medications (e.g., Linagliptin, Saxagliptin, Sitagliptin)
• grapefruit juice
• Hepatitis C antivirals (e.g., daclatasvir, grazoprevir, ledipasvir, velpatasvir)
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• lumacaftor
• macrolide antibiotics (e.g., azithromycin, erythromycin, clarithromycin,)
• midazolam
• mifepristone
• Modafinil
• Nadolol
• niacin (nicotinic acid)
• niacinamide
• Phenobarbital
• Phenytoin
• primidone
• quinidine
• quinine
• raltegravir
• Repaglinide
• rifabutin
• rifampin
• St. John's wort
• siltuximab
• Spironolactone
• other "statin" anti-cholesterol medications (e.g., lovastatin, simvastatin)
• Tacrolimus
• tenofovir
• Ticagrelor
• Tocilizumab
• Tolvaptan
• tyrosine kinase inhibitors (e.g., Crizotinib, imatinib, Lapatinib, Nilotinib, Sunitinib)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Atorvastatin. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Atorvastatin.

Alcohol: People who drink large quantities of alcohol should be closely monitored by their doctor while they are taking Atorvastatin.

Cardiovascular: There is an increased risk of hemorrhagic stroke if atorvastatin is started within 6 months of having a stroke or Transient Ischemic Attack (TIA). If you have a history of stroke or have had a recent stroke, discuss with your doctor how Atorvastatin may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Atorvastatin, and whether any special monitoring is needed.

Diabetes: Atorvastatin may cause an increase in blood sugar levels and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using Atorvastatin.

If you have diabetes or are at risk for developing diabetes, discuss with your doctor how Atorvastatin may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Atorvastatin, and whether any special monitoring is needed.

Diet: Atorvastatin is not intended to be used alone to reduce high cholesterol levels. It is important that a cholesterol-reducing diet along with appropriate exercise be attempted before taking any medication and continued while taking medication.

Grapefruit juice: Taking atorvastatin and consuming grapefruit juice may result in an increased amount of atorvastatin in the body, and lead to side effects. If you regularly drink grapefruit juice, talk to your doctor or pharmacist about whether you should change your diet.

Kidney function: If you have decreased kidney function or a history of Kidney Disease, you may be at an increased risk of developing muscle effects while taking atorvastatin. The lowest effective dose of atorvastatin should be used and your doctor should follow you closely. If you have kidney problems, discuss with your doctor how Atorvastatin may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Atorvastatin, and whether any special monitoring is needed.

Liver function: Atorvastatin may reduce liver function and can cause liver failure. Atorvastatin should not be used by people with active liver disease or by people whose liver function tests are higher than normal. If you have liver problems, discuss with your doctor how Atorvastatin may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Atorvastatin, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking Atorvastatin.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Muscle effects: In rare cases, serious muscle pain, cramps, and weakness have been associated with the use of statin medications (i.e., cholesterol-lowering medications whose names end in "statin," such as atorvastatin, Fluvastatin, Lovastatin, Pravastatin, Rosuvastatin, or Simvastatin), especially at higher doses. Before taking Atorvastatin, tell your doctor or pharmacist if you:

• have kidney or liver problems
• are taking Niacin or a fibrate medication (such as Gemfibrozil, Fenofibrate)
• have an underactive Thyroid gland (Hypothyroidism)
• regularly drink more than 3 alcoholic drinks per day
• have had any past problems with muscles (pain, tenderness) after taking a statin such as atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, or simvastatin
• have a personal or family history of inherited muscle problems
• are more than 65 years old
• have undergone surgery or suffered any traumatic injury
• are frail
• do excessive physical exercise
• have diabetes

Report any unexplained muscle pain, tenderness, weakness, or cramps, or any brown or discoloured urine to your doctor immediately, particularly if you are also experiencing malaise (a general feeling of being unwell) or fever.

Pregnancy: Cholesterol is necessary for the development of an unborn baby. Taking atorvastatin during pregnancy reduces the amount of cholesterol reaching the developing baby and may cause harm to the baby. Atorvastatin should not be taken by pregnant women. If you become pregnant while taking Atorvastatin, stop taking it immediately and contact your doctor.

Breast-feeding: It is not known if atorvastatin passes into breast milk. If you are a breast-feeding mother and are taking Atorvastatin, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: There is limited experience with the use of Atorvastatin by children. Atorvastatin has only been studied for use by children aged 10 to 17 years who have inherited cholesterol disorders (also known as familial hypercholesterolemia).

Seniors: If you are more than 70 years old, you may experience more side effects. Your doctor will monitor you closely while you are taking Atorvastatin.

This medication is typically used only once a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. It must be used regularly and continuously to maintain its beneficial effects. Be sure to keep an adequate supply on hand. If you forget a dose, take it as soon as you remember -- unless it is almost time for your next dose. In that case, skip the missed dose. Do not double the next dose to catch up. This medication may be taken with or without food. Avoid grapefruit and grapefruit juice during your treatment. Grapefruit can seriously affect how this medication works. Avoid excessive alcohol consumption during treatment.