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Atorvastatin (brand name Lipitor) belongs to the statin drug class, also called HMG-CoA reductase inhibitors. It is a prescription medication often prescribed to men and women living with high cholesterol and an increased risk of heart attacks and strokes. Despite its popularity, it comes with potential side effects and warnings, and the key is understanding how to interpret that information for yourself. For many people, atorvastatin’s benefits far outweigh its risks.
Common side effects of atorvastatin
Common side effects of statins like atorvastatin are cold symptoms (nasopharyngitis), joint pain (arthralgia), diarrhea, pain in the arms or legs, and urinary tract infections (FDA, 2017).
Other side effects include:
- Muscle aches, pain, or spasms
- Trouble sleeping (insomnia)
- Forgetfulness or memory loss
Less often, atorvastatin can cause more serious side effects. You should seek immediate medical help if you experience any of the following (UpToDate, n.d.):
- Muscle disease or rhabdomyolysis
- Liver failure
- Unusual bleeding or bruising
- Anaphylaxis (severe allergic reaction with swelling and difficulty breathing)
- Severe skin rash (including erythema multiforme and Stevens-Johnson syndrome)
Myopathy, or muscle disease, is one of the serious adverse effects of atorvastatin that you may encounter. Forms of myopathy include myalgia (muscle aches/pain), myositis (muscle inflammation), and rhabdomyolysis (muscle breakdown) (Tomaszewski, 2011).
Some people (5% or fewer) will notice muscle pain, muscle tenderness, or muscle weakness shortly after starting atorvastatin (Tomaszewski, 2011). For most people, these symptoms go away within a few weeks. However, in rare cases, the pain may continue and worsen.
If you notice that the muscle aches or muscle pain are accompanied by extreme tiredness, fever, or dark-colored urine, this might be a sign of a serious condition called rhabdomyolysis. Rhabdomyolysis is muscle breakdown that can lead to kidney failure and even death (Tomaszewski, 2011).
Lipitor vs. generic Lipitor (atorvastatin): a comparison
The exact processes that cause statin-induced myopathy are not fully understood; the prevention of statin-related myopathy often involves using the lowest statin dose required to achieve your treatment goals. Before prescribing atorvastatin, you may need to have your baseline creatine kinase (CK) levels checked—this will allow your healthcare provider to monitor the drug and measure any potential muscle damage.
However, an elevated CK level can occur with exercise and does not necessarily mean that you have statin-related muscle damage (Valiyil, 2011). Talk to your healthcare professional about any questions or concerns you may have about muscle disease with statins.
In rare cases, atorvastatin can lead to liver problems like liver damage or liver failure. People who have acute liver disease should not take atorvastatin.
More often, atorvastatin can cause abnormalities with liver function blood tests (elevated serum transaminases)—this can be simply a test abnormality and not reflect liver damage (McIver, 2020). However, if you develop symptoms like fatigue and weakness, dark urine, loss of appetite, stomach pain, yellowing of your skin, or the whites of your eyes, you may have liver problems or liver failure.
Seek medical advice immediately if you experience any of these symptoms (McIver, 2020).
Healthcare providers often check baseline liver blood tests before starting atorvastatin and then monitor lab values throughout your treatment as needed.
The U.S. Food and Drug Administration (FDA) states that atorvastatin should not be used in the following groups of people (DailyMed, 2019):
- Women who are pregnant or breastfeeding
- People with active liver disease
- Anyone with a hypersensitivity or severe allergic reaction to atorvastatin
Cholesterol is essential for fetal development, and decreasing cholesterol levels could cause fetal harm. For this reason, atorvastatin is contraindicated for pregnant women and nursing mothers.
Atorvastatin should not be used in people with active liver disease because of the risk of liver toxicity and liver damage. However, providers can use statins with caution in people with chronic and stable (not active) liver disease, like chronic alcoholic liver disease (Jose, 2016).
Know that the blood levels of atorvastatin may be higher than expected in people with these people, which is why it needs to be used with caution. Let your healthcare provider know if you have a history of liver disease. Many providers will check liver enzyme tests before starting atorvastatin.
Potential side effects of Lipitor and other statins
More research is still needed on people with kidney disease and the use of statins, as some studies show a benefit to the kidneys, whereas others show an increased risk of kidney problems (Verdoodt, 2018).
There is not enough data to recommend against using statins in people with kidney disease—lower cholesterol helps the kidneys. Differences in which statin, the dose, other medications, etc. may play a role in which statin (if any) your healthcare provider recommends.
Atorvastatin, when taken with other specific drugs, may increase the risk of adverse effects. Examples include (DailyMed, 2019):
- Antibiotic medicines like clarithromycin
- Antifungal medications like itraconazole or ketoconazole
- Fibrates like gemfibrozil
- Antiretroviral drugs to treat HIV/AIDS like ritonavir, fosamprenavir, tipranavir, or saquinavir
- Birth control pills
- Heart medications like digoxin
Another potential interaction is with grapefruit. Grapefruits can interfere with the enzymes that break down the statins in your digestive system. While most providers advise against drinking grapefruit juice if you’re taking simvastatin (brand name Zocor), it is safe to consume grapefruits or grapefruit juice if you are taking atorvastatin. That is, as long as you are drinking less than one quart per day (FDA, 2017).
Inform your healthcare provider of any other medications you may be taking, including prescription drugs, over-the-counter medicines, or supplements to avoid any potential drug interactions.
Lipitor and grapefruit: how dangerous is it to mix them?
Atorvastatin is widely used to treat cardiovascular disease and hyperlipidemia in adults.
In adults without coronary heart disease, but with multiple risk factors for coronary heart disease (age, smoking, hypertension, low HDL-C, or a family history of early heart disease), atorvastatin can help reduce the risk of (DailyMed, 2019):
- Heart attack (myocardial infarction)
- Revascularization procedures and angina (chest pain)
In adults with type 2 diabetes who do not have coronary heart disease but are living with multiple risk factors, like retinopathy (diabetic eye disease), albuminuria (protein in the urine), smoking, or high blood pressure, atorvastatin can help reduce the risk of (DailyMed, 2019):
- Heart attacks
In adult patients with coronary heart disease, atorvastatin (brand name Lipitor) can help reduce the risk of (DailyMed, 2019):
- Heart attacks
- Revascularization procedures
- Hospitalization for congestive heart failure
- Angina (chest pain)
Lipitor vs. generic Lipitor: should I switch?
One of the most common uses for atorvastatin is to treat hyperlipidemia, a medical condition where you have high levels of fats, such as cholesterol and triglycerides, in the blood. Cholesterol is a waxy substance found in the walls of cells that the body uses to create substances like hormones, bile acids, and vitamin D, while triglycerides provide the body with energy (HHS, 2005).
Along with a healthy diet and lifestyle modifications, atorvastatin helps reduce “bad” cholesterol and fats, such as low-density lipoprotein (LDL) and triglycerides) and increases the amount of high-density lipoprotein (HDL) cholesterol or “good” cholesterol in the blood.
The FDA approved atorvastatin to treat the following conditions that cause abnormally elevated cholesterol and/or fats in the blood (McIver, 2020).
- Hypertriglyceridemia (high triglycerides)
- Primary dysbetalipoproteinemia (a genetic disorder with high cholesterol and triglycerides)
- Homozygous familial hypercholesterolemia (inability to get rid of the body’s cholesterol)
- Pediatric patients with heterozygous familial hypercholesterolemia (after failing dietary modifications)
- DailyMed. (2019). Atorvastatin calcium, film coated tablets. Retrieved Oct. 8, 2020 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1daa6f20-a032-4541-939d-931f36a020dd#ID95
- Jose, J. (2016). Statins and its hepatic effects: Newer data, implications, and changing recommendations. Journal of Pharmacy & Bioallied Sciences, 8(1), 23–28. https://doi.org/10.4103/0975-7406.171699. Retrieved from https://www.jpbsonline.org/article.asp?issn=0975-7406;year=2016;volume=8;issue=1;spage=23;epage=28;aulast=Jose
- McIver, L. A. & Siddique, M. S. (2020). Atorvastatin. StatPearls. Retrieved on Oct. 8, 2020 from https://www.ncbi.nlm.nih.gov/books/NBK430779/
- Tomaszewski, M., Stępień, K. M., Tomaszewska, J., & Czuczwar, S. J. (2011). Statin-induced myopathies. Pharmacological Reports, 63(4): 859-866. doi: 10.1016/s1734-1140(11)70601-6. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1734114011706016
- UpToDate. (n.d.). Atorvastatin: Drug Information. Retrieved on Oct. 8, 2020 from https://www.uptodate.com/contents/atorvastatin-drug-information
- U.S. Department of Health and Human Services (HHS). (2005). Your guide to lowering your cholesterol with TLC. Retrieved on Oct. 8, 2020 from https://www.nhlbi.nih.gov/files/docs/public/heart/chol_tlc.pdf
- U.S Food and Drug Administration (FDA). (May 2017). LIPITOR (atorvastatin calcium) tablets, for oral use. Parke-Davis. Retrieved on Oct. 8, 2020 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020702s067s069lbl.pdf
- Valiyil, R., & Christopher-Stine, L. (2010). Drug-related myopathies of which the clinician should be aware. Current Rheumatology Reports, 12(3): 213-220. doi: 10.1007/s11926-010-0104-3. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092639/
- Verdoodt, A., Honore, P. M., Jacobs, R., De Waele, E., Van Gorp, V., De Regt, J., et al. (2018). Do Statins Induce or Protect from Acute Kidney Injury and Chronic Kidney Disease: An Update Review in 2018. Journal of Translational Internal Medicine, 6(1), 21–25. https://doi.org/10.2478/jtim-2018-0005. Retrieved from https://www.sciendo.com/article/10.2478/jtim-2018-0005
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.