How does it work?
Lipitor tablets and Lipitor chewable tablets contain the active ingredient atorvastatin, which is a type of medicine called a statin. It works by reducing the production of cholesterol by the liver. Atorvastatin is also available without a brand name, ie as the generic medicine.
For the sake of simplicity, there are two sorts of cholesterol; a 'bad' sort called low density lipoprotein (LDL) and a 'good' sort called high density lipoprotein (HDL). LDL is deposited in the arteries and increases the risk of heart disease by clogging and narrowing the arteries (atherosclerosis), while HDL actually protects the arteries against this.
Atorvastatin decreases the production of LDL cholesterol by blocking the action of the enzyme in the liver (called HMG-CoA reductase) that is responsible for its production. This decreases the amount of cholesterol in the liver cells, which causes them to take up LDL cholesterol from the blood. The decreased cholesterol production and increased removal of LDL cholesterol from the blood ultimately results in lowered blood cholesterol levels.
Atorvastatin also causes a small decrease in the production of other 'bad fats' in the blood called triglycerides, and a small increase in the level of HDL cholesterol. This results in lowered levels of 'bad fats' and raised levels of 'good fats' in the blood.
Statins have an important role in the prevention of coronary heart disease. They reduce the risk of excess cholesterol being deposited in the major blood vessels of the heart. Any blockage in the blood vessels limits the amount of blood and therefore oxygen being carried to the heart muscle. This can cause chest pain (angina) and in severe cases can result in a heart attack (myocardial infarction).
Statins also reduce the risk of stroke by decreasing the risk of excess cholesterol being deposited in the blood vessels leading to the brain. These fat deposits can cause blockage and therefore limit blood and oxygen supply to certain parts of the brain.
Atorvastatin is used to lower cholesterol and other bad fats in people who have high levels either due to genetics (familial hypercholesterolaemia) or as a result of diet and lifestyle. This helps to reduce the risk of hardening of the arteries (atherosclerosis) and the problems described above.
Atorvastatin can also be used to reduce the risk of these problems in people who have normal cholesterol levels, but are at high risk of heart disease for other reasons. It has been shown to reduce the risk of needing procedures to improve blood supply to the heart, such as a balloon dilation of an artery or a heart bypass graft. It also reduces the risk of heart attack, stroke and death from heart disease.
It is important to continue to follow a cholesterol-lowering diet and exercise regime while taking atorvastatin. Discuss this with your doctor.
What is it used for?
- Lowering high levels of total cholesterol, LDL cholesterol and other fats (called triglycerides and apolipoprotein B) in the blood in adults and children over 10 years with primary hypercholesterolaemia, familial hypercholesterolaemia or mixed hyperlipidaemia. This medicine is used when a low-fat diet and lifestyle changes such as increased exercise have not reduced cholesterol enough.
- Preventing cardiovascular events such as angina, heart attacks, strokes or needing heart bypass surgery, in people with a high risk of heart disease, for example smokers, people who are overweight or obese, or people with diabetes, high blood pressure or a close family history of heart disease. The medicine can be used for this purpose even if your cholesterol levels are normal.
How do I take it?
- You will need to take atorvastatin every day on a long-term basis (unless otherwise directed by your doctor). This is because if you stop taking it, your body will start to make cholesterol again and your cholesterol levels will start to rise again.
- Atorvastatin tablets should be taken once a day. They can be taken at any time of day, either with or without food.
- The dose of this medicine that is prescribed (how many tablets to take and what strength) will vary from person to person depending on your cholesterol levels, amongst other things. It is important to follow the instructions given by your doctor. These will be printed on the the dispensing label that your pharmacist has put on the packet of medicine.
- It is important that you continue to eat healthily and do regular exercise while you are taking this medicine. Discuss this with your doctor.
- You should avoid drinking grapefruit juice or eating grapefruit while taking this medicine. This is because grapefruit can affect the metabolism of atorvastatin and could increase the amount of the medicine in your blood, thus increasing the risk of side effects.
- It is recommended that you avoid drinking excessive amounts of alcohol while taking this medicine, because this may increase the risk of liver problems or side effects on the muscles (see below).
- This medicine may rarely cause liver problems. For this reason your doctor will want you to have blood tests to monitor your liver function (liver function tests) before starting treatment and regularly throughout treatment with this medicine. Consult your doctor promptly if you develop unexplained itching, yellowing of the skin or whites of the eyes (jaundice), unusually dark urine, nausea and vomiting, abdominal pains, loss of appetite or flu-like symptoms while taking this medicine, as these could be signs of a liver problem.
- This medicine may rarely have side effects on the muscles that may very rarely progress to cause kidney problems. For this reason you should inform your doctor immediately if you experience any muscular symptoms while taking this medicine, for example muscle pain, tenderness, cramps, or weakness, particularly if you also have a fever or feel generally unwell. Your doctor may need to check for side effects on the muscles by taking a blood test to measure the level of a compound called creatinine kinase in your blood. If this is the case, the test should not be done following strenuous exercise.
- Statins may very rarely be associated with a type of lung disease. For this reason, you should consult your doctor if you experience shortness of breath or difficulty breathing, a non-productive cough and deterioration in your general health (eg weight loss, fever, fatigue) while taking this medicine.
- This medicine is not licensed for children under 10 years of age. There is currently only limited experience of the long-term safety of the medicine in children aged 10 to 18 years. If you are concerned about your child taking this medicine you can ask your doctor or pharmacist for more information and advice.
Use with caution in
- People aged over 70 years.
- People with decreased liver function or a history of liver disease.
- People who drink large amounts of alcohol.
- People with decreased kidney function.
- People with an underactive thyroid gland (hypothyroidism).
- Personal or family history of hereditary muscle disorders.
- People who have previously experienced muscular side effects while taking a statin or fibrate medicine.
- People who have ever had a stroke caused by bleeding in the brain (haemorrhagic stroke).
- Hereditary blood disorders called porphyrias.
Not to be used in
- People with active liver disease.
- People with unexplained raised results in liver function tests.
- Lipitor tablets contain lactose and are not suitable for people with rare hereditary problems of galactose intolerance, Lapp lactose deficiency or glucose-galactose malabsorption.
- Lipitor chewable tablets contain aspartame, which is a source of phenylalanine. They are not suitable for people with an inherited disorder of protein metabolism called phenylketonuria.
This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine should not be used during pregnancy because it may be harmful to a developing baby. Pregnancy should also be avoided for one month after stopping treatment. Women who could get pregnant should use an effective method of contraception to prevent pregnancy both during treatment with this medicine and for one month after stopping treatment. Talk to your doctor straight away if you think you could be pregnant while taking this medicine, or want to try for a baby.
- It is not known if this medicine passes into breast milk. However, because it has the potential to cause serious side effects in a nursing infant, the manufacturer states that it should not be taken by women who are breastfeeding. Women who need to take this medicine should not breastfeed their babies and use formula instead. Seek further medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
Common (affect between 1 in 10 and 1 in 100 people)
- Disturbances of the gut such as diarrhoea, constipation, feeling sick, flatulence (wind) or indigestion.
- Runny or stuffy nose.
- Sore throat.
- Pain in the muscles, joints, back or extremities.
- Muscle spasms.
- Joint swelling.
- Skin reactions such as rash and itch.
- Raised level of sugar (glucose) in the blood (hyperglycaemia).
- Abnormal results in liver function tests.
Uncommon (affect between 1 in 100 and 1 in 1000 people)
- Abdominal pain.
- Feeling weak, tired or generally unwell.
- Decreased sensitivity to touch or pain, pins and needles sensations.
- Rash, itching or hives.
- Hair loss (alopecia).
- Difficulty sleeping (insomnia).
- Memory loss.
- Blurred vision.
- Sensation of ringing or other noise in the ears (tinnitus).
- Taste changes.
- Loss of appetite.
- Weight gain.
- Decreased level of sugar (glucose) in the blood (hypoglycaemia).
- Swollen ankles or feet (peripheral oedema).
- Chest pain.
- Inflammation of the pancreas (pancreatitis).
- Inflammation of the liver (hepatitis).
Rare (affect between 1 in 1000 and 1 in 10,000 people)
- Muscle problems such as inflammation of the muscles (myositis) or muscle breakdown (rhabdomyolysis) - see warning section above for symptoms to look out for and report to your doctor.
- Swelling of the legs and ankles due to excess fluid retention (peripheral oedema).
- Decrease in the number of blood cells called platelets in the blood (thrombocytopenia).
- Serious skin conditions such as Stevens-Johnson Syndrome or toxic epidermal necrolysis.
Very rare (affect less than 1 in 10,000 people)
- Hearing loss.
- Liver failure.
- Enlargement of the breasts in men.
The following side effects have been reported with other statins and may also be possible with atorvastatin:
- Interstitial lung disease (see warning section above).
- Sexual problems.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor what medicines you are taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, ask your doctor or pharmacist before taking any new medicines while taking this one, so they can check that the combination is safe.
There may be an increased risk of side effects on the muscles (myopathy) if any of the following medicines are taken in combination with atorvastatin:
- azole antifungals, eg itraconazole, ketoconazole, voriconazole, fluconazole, posaconazole (posaconazole is not recommended with atorvastatin - if you need to take a course of this antifungal your doctor may recommend that you temporarily stop taking atorvastatin during the course)
- fibrates for lowering cholesterol, eg bezafibrate, gemfibrozil
- fusidic acid (this is not recommended with atorvastatin - if you need to take a course of this antibiotic your doctor may recommend that you temporarily stop taking atorvastatin during the course and not start it again until seven days after you finish the course of fusidic acid)
- niacin (nicotinic acid)
- protease inhibitors for HIV infection, eg atazanavir, nelfinavir, lopinavir, indinavir, ritonavir, tipranavir
- telaprevir (not recommended with atorvastatin)
- telithromycin (this is not recommended with atorvastatin - if you need to take a course of this antibiotic your doctor may recommend that you temporarily stop taking atorvastatin during the course)
If you are prescribed any of the medicines listed above in combination with your atorvastatin, it is important to let your doctor know if you experience any unexplained muscle symptoms, such as pain or tenderness, muscle weakness or muscle cramps.
Atorvastatin may increase the blood level of digoxin. If you are taking both these medicines the amount of digoxin in your blood should be monitored more frequently, for example when you start or stop treatment with atorvastatin, and if your atorvastatin dose is altered.
The anti-blood-clotting effect of anticoagulants such as warfarin may be affected by atorvastatin. For this reason, if you are taking an anticoagulant your doctor may want to check your blood-clotting time when you start or stop treatment with atorvastatin, and if your atorvastatin dose is altered.
Atorvastatin may slightly increase the blood levels of ethinylestradiol and norethisterone that are found in certain brands of the contraceptive pill. This could increase the chance of getting side effects from these pills. Your doctor should take this into account if you are taking this medicine and need an oral contraceptive.
The following medicines may reduce the amount of atorvastatin in your blood and could make it less effective:
- rifampicin (If you are prescribed a course of rifampicin, for the first few days you should take it at a different time of day to your atorvastatin. After a few days you should start taking it at the same time as your atorvastatin. This is to minimise the effect of the rifampicin on your atorvastatin. Ask your pharmacist for further advice.)
- the herbal remedy St John's wort (Hypericum perforatum).
Other medicines containing the same active ingredient
Atorvastatin tablets are also available without a brand name, ie as the generic medicine.