Drug Guide
Atorvastatin Calcium
Classification
Therapeutic: Lipid-lowering agent, HMG-CoA reductase inhibitor
Pharmacological: Statin
FDA Approved Indications
- Hypercholesterolemia
- Prevention of cardiovascular disease
Mechanism of Action
Inhibits HMG-CoA reductase, an enzyme involved in hepatic cholesterol synthesis, leading to decreased LDL cholesterol and total cholesterol levels.
Dosage and Administration
Adult: Start with 10-20 mg once daily, titrate up to 80 mg as needed.
Pediatric: Not typically recommended for children under 10 years; dosing for adolescents and older children to be determined by healthcare provider.
Geriatric: Adjust dose considering potential increased risk of adverse effects; start at lower end of dosage range.
Renal Impairment: Use with caution; no specific dosage adjustment necessary but monitor renal function.
Hepatic Impairment: Contraindicated in active liver disease; use with caution and monitor liver function.
Pharmacokinetics
Absorption: Well absorbed from gastrointestinal tract.
Distribution: Extensively protein-bound (~98%).
Metabolism: Primarily metabolized by CYP3A4 enzyme.
Excretion: Excreted mainly in feces; urine accounts for a small proportion.
Half Life: About 14 hours.
Contraindications
- Active liver disease
- Unexplained persistent elevations of serum transaminases
- Pregnancy and breastfeeding
Precautions
- History of liver enzyme abnormalities
- Muscle pain or weakness during therapy, indicating potential myopathy
Adverse Reactions - Common
- Muscle pain, weakness (Often)
- Diarrhea, nausea (Common)
- Elevations in liver enzymes (Uncommon)
Adverse Reactions - Serious
- Rhabdomyolysis (Rare)
- Hepatotoxicity (Rare)
Drug-Drug Interactions
- Cyclosporine, Gemfibrozil, other strong CYP3A4 inhibitors, certain antibiotics and antifungals
Drug-Food Interactions
- Large quantities of grapefruit juice may increase plasma levels.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor lipid profile, liver enzymes, and muscle enzymes periodically.
Diagnoses:
- Risk for decreased tissue perfusion related to altered lipid levels
- Risk for muscle damage
Implementation: Administer once daily; monitor for symptoms of myopathy and liver dysfunction.
Evaluation: Assess lipid levels periodically to determine efficacy and adjust dose accordingly.
Patient/Family Teaching
- Take medication as prescribed, at any time of day, with or without food.
- Report unexplained muscle pain, tenderness, weakness, or liver-related symptoms.
- Maintain a healthy diet and exercise regimen.
- Limit alcohol consumption.
Special Considerations
Black Box Warnings:
- Increased risk of diabetes mellitus
Genetic Factors: Genetic variations can influence drug metabolism and response.
Lab Test Interference: May slightly elevate liver transaminases and creatine kinase.
Overdose Management
Signs/Symptoms: Severe muscle pain, weakness, or signs of liver injury.
Treatment: Supportive care; no specific antidote. Hospitalize for monitoring and supportive therapy as needed.
Storage and Handling
Storage: Store at room temperature away from moisture and heat.
Stability: Stable under recommended storage conditions.