Experiences with

Atorvastatin

Atorvastatin belongs to a group of medicines called statins.

It's used to lower cholesterol if you've been diagnosed with high blood cholesterol. It's also taken to prevent heart disease, including heart attacks and strokes. Your doctor may prescribe atorvastatin if you have a family history of heart disease, or a long-term health condition such as type 1 or type 2 diabetes or rheumatoid arthritis.

This medicine is available on prescription only. It comes as tablets, including chewable tablets for people who have difficulty swallowing.

• It's usual to take atorvastatin once a day.
• The most common side effects are headaches, feeling sick (nausea), diarrhoea and cold-like symptoms.
• Do not take atorvastatin if you're pregnant, trying to get pregnant or breastfeeding.
• Keep taking atorvastatin even if you feel well, as you will still be getting the benefits. Most people with high cholesterol don't have any symptoms.
• Atorvastatin is also called by the brand name Lipitor.

Atorvastatin can be taken by adults and children over the age of 10 years.

Atorvastatin isn't suitable for some people. Tell your doctor if you:

• have had an allergic reaction to atorvastatin or any other medicines in the past
• have liver or kidney problems
• are trying to get pregnant, think you might be pregnant, you're already pregnant, or you're breastfeeding
• have severe lung disease
• have previously had a stroke caused by bleeding into the brain
• drink large amounts of alcohol
• have an underactive thyroid
• have had muscular side effects when taking a statin in the past
• have had, or have, a muscle disorder (including fibromyalgia)

Lipitor chewable tablets contain a substance called aspartame - check with your doctor before taking these if you have phenylketonuria (a rare inherited disorder of protein metabolism).

Take atorvastatin once a day. You can choose to take it at any time, as long as you stick to the same time every day.

Sometimes doctors may recommend taking it in the evening. This is because your body makes most cholesterol at night. If you're not sure when to take your medicine, ask a pharmacist or your doctor for advice.

Atorvastatin doesn't upset the stomach, so you can take it with or without food.

Swallow atorvastatin tablets whole with a glass of water. If you've been given chewable tablets, you can chew them or swallow them whole with a glass of water.

Dosage

The usual dose for adults is between 10mg and 80mg a day.

In children, the usual dose is 10mg to 20mg once a day. Your doctor will use your child's age to work out the amount of atorvastatin that's right for them.

Your dose depends on the reason for taking it, your cholesterol levels, and what other medicines you're taking. Ask your doctor or pharmacist for advice if you're unsure how much to take. Don't reduce your dose without talking to your doctor first.

What if I forget to take it?

If you occasionally forget to take a dose, take your next dose the next day at the usual time. Never take 2 doses at the same time. Never take extra doses.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Taking an extra dose of atorvastatin by accident is unlikely to harm you.

Talk to your pharmacist or doctor if you're worried or take more than 1 extra dose.

Like all medicines, atorvastatin can cause side effects in some people - and different statins affect people in different ways.

One rare but serious side effect is unexplained muscle aches and pains, tenderness or weakness. This can happen a few weeks or months after you first start taking this medicine.

Talk to your doctor or a pharmacist if side effects are bothering you. They may recommend trying an alternative statin.

Common side effects

These common side effects of atorvastatin happen in more than 1 in 100 people.

Some side effects may improve after the first few days, as your body gets used to the medicine.

Keep taking the medicine, but talk to your doctor or pharmacist if these side effects bother you or don't go away:

• feeling sick (nausea) or indigestion
• headaches
• aches and pains in your back and joints
• nosebleeds
• sore throat
• cold-like symptoms, such as a runny nose, blocked nose or sneezing
• constipation or wind
• diarrhoea

Report any unexplained muscle aches and pains, tenderness or weakness to a doctor straight away.

Less than 1 in 100 people may have some memory loss. Talk to your doctor or pharmacist if this side effect bothers you. It usually goes away after you stop taking the medicine.

Serious side effects

Serious side effects when taking atorvastatin are rare and happen in less than 1 in 1,000 people.

Stop taking atorvastatin and call a doctor if you get:

• muscle pain, tenderness, weakness or cramps - these can be signs of muscle breakdown and kidney damage
• yellow skin or the whites of your eyes turn yellow, or if you have pale poo and dark pee - this can be a sign of liver problems
• a skin rash with pink-red blotches, especially on the palms of the hands or soles of the feet
• severe stomach pain - this can be a sign of pancreas problems
• a cough, feeling short of breath, and weight loss - this can be a sign of lung disease

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to atorvastatin.

These are not all the side effects of atorvastatin. For a full list see the leaflet inside your medicines packet.

What to do about:

• feeling sick (nausea) or indigestion - stick to simple meals and do not eat rich or spicy food. It might help to take your atorvastatin after a meal or snack. If you continue to get symptoms of indigestion ask your pharmacist to recommend an antacid. Contact your doctor if your symptoms continue for more than a few days or if they get worse.
• headaches - make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking atorvastatin. Talk to your doctor if they last longer than a week or are severe.
• aches and pains in your back and joints - if you get unusual muscle pain, weakness or tiredness which isn't from exercise or hard work, talk to your doctor. You may need a blood test to check what might be causing it. You can also ask your pharmacist to recommend a painkiller.
• nosebleeds - try applying a thin layer of Vaseline to the inside edges of your nose.
• sore throat - try gargling with warm salty water (children shouldn't try this), or use paracetamol or ibuprofen to ease any pain or discomfort. If the symptoms last longer than a week ask your pharmacist or doctor for advice.
• cold-like symptoms - try taking paracetamol or ibuprofen regularly for a few days. If the symptoms return when you stop taking the painkillers ask your doctor for advice.
• constipation or wind - eat more high-fibre foods such as fresh fruit, vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example, by going for a daily walk or run. If this doesn't help, talk to your pharmacist or doctor. Watch this short video about how to treat constipation.
• diarrhoea - drink plenty of water to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee.

Atorvastatin isn't recommended during pregnancy or breastfeeding, as there's no firm evidence it's safe.

Talk to your doctor if you want to get pregnant. It's best to stop taking atorvastatin at least 3 months before you start trying for a baby.

If you become pregnant while taking atorvastatin, stop taking the medicine and tell your doctor.

Atorvastatin and breastfeeding

It's not known if atorvastatin gets into breast milk, but it may cause problems for your baby.

Speak to your doctor about what's best for you and your baby while you're breastfeeding. It may be possible to delay starting or restarting atorvastatin until you've stopped breastfeeding completely.

Some medicines affect the way atorvastatin works and can increase the risk of serious side effects.

Medicines that may not mix well with atorvastatin include:

• some antibiotics and antifungals
• some HIV medicines
• some hepatitis C medicines
• warfarin (stops blood clotting)
• ciclosporin (treats psoriasis and rheumatoid arthritis)
• colchicine (a medicine for gout)
• contraceptive pills
• verapamil, diltiazem, amlodipine (for high blood pressure and heart problems)
• amiodarone (makes your heart stable)

If you're taking atorvastatin and need to take one of these medicines, your doctor may:

• prescribe a lower dose of atorvastatin
• prescribe a different statin medicine
• recommend that you stop taking atorvastatin for a while

These are not all the medicines that can interfere with atorvastatin. For a full list see the leaflet inside your medicine packet or check with your pharmacist.

Mixing atorvastatin with herbal remedies and supplements

St John's wort, a herbal medicine taken for depression, reduces the amount of atorvastatin in your blood, so it doesn't work as well.

Talk to your doctor if you're thinking about starting St John's wort, as it will change how well atorvastatin works.

How does atorvastatin work?

Atorvastatin acts on the liver to stop it making cholesterol. This lowers your blood cholesterol level.

For the first 12 months on this medicine, you'll be offered a couple of routine tests to make sure your liver is working normally.

How long do statins take to work?

Your cholesterol levels should drop noticeably within 4 weeks - if you take your medicine regularly, as prescribed.

How long will I take atorvastatin for?

Usually, treatment with a statin such as atorvastatin is for life. The benefits will only continue for as long as you take it. If you stop taking atorvastatin without starting a different treatment, your cholesterol level may rise again.

Are statins safe?

You may have read negative stories about statins, but they're thought to be very safe, effective medicines.

Statins are thought to have very few side effects. Sometimes the side effects that people report aren't related to their medicine. However, if you're concerned about the safety of statins, talk to your doctor.

Is it safe to take atorvastatin for a long time?

Atorvastatin is safe to take for a long time, even many years. In fact, it works best when you take it for a long time.

Statins have been used for nearly 30 years to lower cholesterol.

Is atorvastatin addictive?

No, there's no evidence that atorvastatin is addictive. You won't get any withdrawal symptoms when you stop taking it.

What will happen if I come off it?

You may want to stop atorvastatin if you think you're having side effects. Talk to your doctor first to see if it really is a side effect of atorvastatin or an unrelated problem. Your doctor may decide to lower your dose or change your medicine.

You won't get any withdrawal symptoms. However, stopping atorvastatin may cause your cholesterol to rise. This increases your risk of heart attacks and strokes.

If you want to stop taking your medicine, it's important to find another way to lower your cholesterol.

Does it help to take supplements together with statins?

There's some interest in taking CoQ10 together with statins. However there's no firm evidence that taking CoQ10 at the same time as atorvastatin will benefit your health. More research is needed.

If you decide to take a CoQ10 supplement, tell your doctor or pharmacist. Supplements can interfere with other medicines you may also be taking.

Will taking atorvastatin increase my risk of diabetes?

If you're at high risk of developing type 2 diabetes, taking statins may slightly increase this risk. This is because statins can raise your blood sugar a little.

Speak to your doctor, who will be able to explain how the benefits of taking statins are likely to outweigh this small increased risk.

If you already have type 2 diabetes, your doctor may advise monitoring your blood sugar levels more closely for the first few months. Tell your doctor or diabetes nurse if you find it harder to control your blood sugar.

How does it compare with other medicines for high cholesterol?

Statins all work in the same way, but they differ in how well they lower cholesterol.

There are several other statin medicines for lowering your cholesterol, including:

• fluvastatin
• pravastatin
• rosuvastatin
• simvastatin

If you have a side effect with one statin, it may not happen with another. Some medicines do not mix well with one statin, but you can take them with a different one.

Your doctor will find the right statin and dose for you, depending on your medical history, cholesterol level and the other medicines you take.

Can I drive or ride a bike?

Yes, you can drive or cycle while taking atorvastatin.

Will it reduce my fertility?

There's no firm evidence to suggest that taking atorvastatin will reduce fertility in either men or women.

However, speak to a pharmacist or your doctor before taking it if you're trying to get pregnant.

Will it stop my contraception working?

For women, atorvastatin may slightly increase the hormones released into your system from some contraceptive pills. You will still be protected from pregnancy, but this could increase your chances of side effects from contraceptive pills.

If you have any side effects, talk to your doctor or pharmacist.

Can I drink alcohol with it?

Yes, you can drink alcohol while taking atorvastatin.

However, drinking a lot of alcohol may mean you're more likely to get muscle and liver side effects. Try not to drink more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.

Is there any food or drink I need to avoid?

It's best not to have too much grapefruit juice when taking atorvastatin.

Drinking lots of grapefruit juice (more than about a litre a day) can interfere with the way this medicine works. It increases the concentration of atorvastatin in your system.

Can lifestyle changes help?

Reducing your cholesterol may mean you don't need to be prescribed a statin medicine. There are lifestyle changes you can make that will help lower your cholesterol:

• make sure you're a healthy weight
• eat well - cut saturated fat and increase fibre, fruits, vegetables, wholegrains and fish
• quit smoking
• cut down on alcohol
• try to exercise every day

Related links

Angina — Link to Related Condition

Cardiovascular disease — Link to Related Condition

Heart attack — Link to Related Condition

Stroke — Link to Related Condition

Atorvastatin: forums — Link to Useful Resource

British Heart Foundation: charity — Link to Useful Resource

Heart UK: charity — Link to Useful Resource

Stroke Association: charity — Link to Useful Resource

Statins: videos of real stories — Link to Useful Resource

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