Atorvastatin

Atorvastatin

[98 cents per tablet]

ADMINISTRATION ROUTES:

  • PO

ALTERNATIVE NAMES:

  • Lipitor

ICU INDICATIONS:

  1. secondary prevention in patients with coronary artery disease
  2. treatment of hypercholesterolaemia

PRESENTATION AND ADMINISTRATION:

  • PO:
    10mg, 20mg, 40mg and 80mg strengths (white).  Tablets may be crushed and adminstered via NG tube.

DOSAGE:

  • PO:
    Commenced at 10-20mg daily at night; slowly increase to a maximum of 80mg if required.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • PO:
    Familial hypercholesterolaemia:

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

  • The risk of myopathy during treatment with other drugs of this class is increased with concurrent administration of cyclosporine, fibric acid derivatives, niacin (nicotinic acid), erythromycin, and azole antifungals
  • When multiple doses of atorvastatin and digoxin were coadministered, 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, paresthesia, somnolence
  • Skin:
    Pruritus
  • Musculoskeletal:
    Myalgia, myopathy

Critical Care Drug Manual

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