Atorvastatin

Atorvastatin is a statin (hmg-coa reductase inhibitor) — lipid-lowering agent medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

Atorvastatin is prescribed for:

• High cholesterol (hypercholesterolaemia) — raised total or LDL cholesterol, including inherited (familial) forms.
• Mixed dyslipidaemia — high cholesterol together with high triglycerides.
• Prevention of heart attack and stroke — in people with existing coronary heart disease, previous stroke, diabetes or multiple risk factors, even when cholesterol is only mildly raised.
• After a heart attack or stent (angioplasty) — usually lifelong, to protect the arteries.

The target dose depends on your overall cardiovascular risk, which your doctor calculates.

Most people tolerate Atorvastatin well. Possible side effects include:

• Muscle aches, tenderness or weakness — the most talked-about effect; usually mild, but report any unexplained, persistent muscle pain to your doctor, especially with fever or dark (tea-coloured) urine, as very rare cases of serious muscle breakdown (rhabdomyolysis) can occur.
• Digestive upset — nausea, gas, constipation or diarrhoea.
• Headache, nasopharyngitis or joint pain.
• Liver enzyme rise — usually symptomless; your doctor may check liver tests.
• Small rise in blood sugar — a slightly higher chance of diabetes in predisposed people; heart protection still outweighs this.

Keep these points in mind with Atorvastatin:

• Report muscle pain early — unexplained aches, weakness or cramps, especially with fever or dark urine, need prompt review.
• Tell your doctor about liver disease, kidney disease, thyroid problems or heavy alcohol use before starting; liver tests may be done at baseline and when indicated.
• Avoid grapefruit juice in large amounts — it raises atorvastatin levels and the risk of muscle side effects.
• Statins work alongside, not instead of, diet, exercise and weight control — continue them.
• Tell any new doctor or pharmacist you take a statin before they prescribe antibiotics or antifungals.
• Use effective contraception if you could become pregnant.

Some combinations raise the risk of muscle damage or alter drug levels with Atorvastatin:

• Macrolide antibiotics (clarithromycin, erythromycin) and azole antifungals (itraconazole, ketoconazole) — statin levels rise; the statin may need pausing.
• Fibrates (gemfibrozil in particular) and high-dose niacin — added muscle toxicity risk.
• Ciclosporin, some HIV/HCV protease inhibitors — significant level increases; combinations may be restricted.
• Amiodarone, diltiazem, verapamil — may raise statin exposure; dose caps apply.
• Warfarin — INR may shift slightly when starting or stopping.
• Grapefruit juice in large quantities — avoid.

Atorvastatin should not be taken if you have:

• Active liver disease or persistent, unexplained rises in liver enzymes.
• Pregnancy or breastfeeding — statins are contraindicated; cholesterol is essential for the developing baby.
• Known allergy to atorvastatin or any component of the tablet.
• A previous episode of statin-induced severe myopathy or rhabdomyolysis — only a specialist should decide about re-trying any statin.

Pregnancy: Atorvastatin must not be used during pregnancy. Cholesterol is needed for the baby's normal development, and statins are stopped before a planned pregnancy or as soon as pregnancy is discovered. If you can become pregnant, use reliable contraception while taking it, and tell your doctor immediately if you conceive — pausing a statin for the months of pregnancy is safe for the mother in most situations.

Breastfeeding: It is not known how much atorvastatin enters breast milk, and because of the potential risk to the infant, the medicine is not used while breastfeeding. Your doctor will advise when to restart after feeding is complete.

Store Atorvastatin below 30°C in a dry place away from direct sunlight, heat and moisture. Keep the tablets in their original blister pack until use and out of the reach and sight of children. Do not take the medicine after the expiry date printed on the strip or carton; return expired or unused tablets to a pharmacy for safe disposal.