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