Atorvastatin

ADMINISTRATION ROUTES:

PO, NG

ALTERNATIVE NAMES:

Lipitor

ICU INDICATIONS:

1. Secondary prevention in patients with coronary artery disease

2. Treatment of hypercholesterolaemia

PRESENTATION AND ADMINISTRATION:

PO / NG:

10 mg, 20 mg, 40 mg and 80 mg strengths (white)

Tablets may be crushed for administration via NG tube

DOSAGE:

PO:

Start at 10-20 mg daily at night; slowly increase to a maximum of 80 mg if required

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

PO:

Familial hypercholesterolaemia:

0.2 mg/kg daily, increased every 4 weeks to a maximum of 1.6 mg/kg daily

CLINICAL PHARMACOLOGY:

Atorvastatin is a selective, competitive inhibitor of HMG-CoA reductase. Atorvastatin is rapidly absorbed after oral administration; maximum plasma concentrations occur within 1-2 hours. It can be taken with or without food

CONTRAINDICATIONS:

1. Active liver disease or unexplained persistent elevations of serum transaminases

2. Hypersensitivity to any component of this medication

WARNINGS:

Liver Dysfunction

HMG-CoA reductase inhibitors, like some other lipid-lowering therapies, have been associated with biochemical abnormalities of liver function

Skeletal Muscle

Rare cases of rhabdomyolysis with acute renal failure secondary to myoglobinuria have been reported with atorvastatin and with other drugs in this class

PRECAUTIONS:

General:

Patients should be advised to report promptly unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever

Laboratory Tests:

CK should be measured if there is concern about development of myopathy due to statins

Drug/Laboratory Test Interactions:

None known

IMPORTANT DRUG INTERACTIONS IN ICU:

The risk of myopathy during treatment with other drugs of this class is increased with concurrent administration of cyclosporin, fibric acid derivatives, niacin (nicotinic acid), erythromycin, and azole antifungals.

When multiple doses of atorvastatin and digoxin were co-administered, steady-state plasma digoxin concentrations increased by approximately 20%. Patients taking digoxin should be monitored appropriately.

ADVERSE REACTIONS:

Body as a Whole:

Malaise

Digestive System:

Constipation, derangement of LFTs, flatulence, dyspepsia, and abdominal pain

Nervous System:

Insomnia, dizziness, paraesthesia, somnolence

Skin:

Pruritus

Musculoskeletal:

Myalgia, myopathy