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Atorvastatin: Drug information

Atorvastatin: Drug information
(For additional information see "Atorvastatin: Patient drug information" and see "Atorvastatin: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Special Alerts
Statin Pregnancy Contraindication Update July 2021

After a comprehensive review of all available data, the FDA is requesting all statin manufacturers to remove the contraindication in the prescribing information against using statins in pregnant patients. Although statin therapy should be discontinued in most pregnant patients, health care providers should consider the ongoing therapeutic needs of the individual patient, especially patients at very high risk of cardiovascular events during pregnancy, such as patients with homozygous familial hypercholesterolemia or those with established cardiovascular disease. Additionally, breastfeeding is still not recommended in patients taking a statin; health care providers should determine whether it is better to temporarily stop statin therapy while breastfeeding or to continue statin therapy and not have the patient breastfeed. If ongoing statin treatment is necessary, infant formula and other alternatives are available. The FDA expects that removing the contraindication will enable health care providers and patients to make individual decisions about benefit and risk, especially for those at very high risk of heart attack or stroke.

Further information is available at https://www.fda.gov/drugs/drug-safety-and-availability/fda-requests-removal-strongest-warning-against-using-cholesterol-lowering-statins-during-pregnancy.

Brand Names: US
  • Atorvaliq;
  • Lipitor
Brand Names: Canada
  • ACH-Atorvastatin Calcium;
  • AG-Atorvastatin;
  • APO-Atorvastatin;
  • Atorvastatin-10;
  • Atorvastatin-20;
  • Atorvastatin-40;
  • Atorvastatin-80;
  • Auro-Atorvastatin;
  • BIO-Atorvastatin;
  • DOM-Atorvastatin [DSC];
  • JAMP-Atorvastatin;
  • JAMP-Atorvastatin Calcium;
  • Lipitor;
  • M-Atorvastatin;
  • Mar-Atorvastatin;
  • MINT-Atorvastatin;
  • MYLAN-Atorvastatin;
  • NRA-Atorvastatin;
  • PMS-Atorvastatin;
  • PMSC-Atorvastatin;
  • PRIVA-Atorvastatin [DSC];
  • PRZ-Atorvastatin;
  • REDDY-Atorvastatin;
  • RIVA-Atorvastatin;
  • SANDOZ Atorvastatin;
  • TARO-Atorvastatin;
  • TEVA-Atorvastatin
Pharmacologic Category
  • Antilipemic Agent, HMG-CoA Reductase Inhibitor
Dosing: Adult

Dosage guidance:

Dosing: Atorvastatin 40 to 80 mg/day is considered a high-intensity statin (generally reduces low-density lipoprotein cholesterol [LDL-C] by ≥50%). Atorvastatin 10 to 20 mg/day is considered a moderate-intensity statin (generally reduces LDL-C by ~30% to 49%). Assess response ~1 to 3 months after initiation of therapy or dose adjustment and every 3 to 12 months thereafter (Ref).

Clinical considerations: Use in conjunction with lifestyle modification (eg, diet, exercise). When initiating therapy and selecting dose intensity, consider age, baseline LDL-C, 10-year atherosclerotic cardiovascular disease risk, risk-enhancing factors, potential adverse effects, and drug interactions (Ref).

Heterozygous familial hypercholesterolemia

Heterozygous familial hypercholesterolemia:

Note: Multiple lipid-lowering therapies may be needed if statin monotherapy is not effective. Referral to a lipid specialist should be considered if treatment goals are not met (Ref).

High-intensity therapy: Oral: Initial: 40 or 80 mg once daily; if 40 mg once daily is initiated and tolerated, increase to 80 mg once daily.

Homozygous familial hypercholesterolemia

Homozygous familial hypercholesterolemia:

Note: Multiple lipid-lowering therapies are usually needed to achieve treatment goals; treatment should be guided by an experienced lipid specialist (Ref).

High-intensity therapy: Oral: 80 mg once daily (Ref).

Prevention of atherosclerotic cardiovascular disease

Prevention of atherosclerotic cardiovascular disease:

Note: If LDL-C goal (eg, percent reduction or absolute goal) is not met with the initial dose, may consider up-titration based on estimated 10-year ASCVD risk (see ACC/AHA ASCVD Risk Estimator Plus online), LDL-C response, and tolerability. If LDL-C goal is not met with maximally tolerated dose, additional lipid-lowering therapy may be warranted (Ref).

Primary prevention:

Patients without diabetes, age 40 to 75 years, and LDL-C 70 to 189 mg/dL:

ASCVD 10-year risk 5% to <7.5%:

Note: Depending on baseline LDL-C and presence of risk-enhancing factors, consider statin therapy after shared decision-making with patient. Some experts suggest shared decision-making if ASCVD 10-year risk is 5% to 10%; however, in patients with a baseline LDL-C >160 mg/dL, statin therapy is usually recommended (Ref).

Moderate-intensity therapy: Oral: 10 to 20 mg once daily to reduce LDL-C by 30% to 49% (Ref).

ASCVD 10-year risk ≥7.5% to <20%:

Note: Depending on baseline LDL-C and presence of risk-enhancing factors, consider statin therapy after shared decision-making with patient. Some experts suggest initiating moderate-intensity statin therapy in most patients if ASCVD 10-year risk is >10% to <20% and an LDL-C >100 mg/dL (Ref).

Moderate-intensity therapy: Oral: 10 to 20 mg once daily to reduce LDL-C by 30% to 49%; higher risk patients with multiple risk-enhancing factors may benefit from higher doses to reduce LDL-C by ≥50% (Ref).

ASCVD 10-year risk ≥20%: High-intensity therapy: Oral: 40 to 80 mg once daily to reduce LDL-C by ≥50%; if unable to tolerate due to adverse effects, may reduce dose to maximum tolerated (Ref).

Patients with diabetes:

Age 40 to 75 years without additional ASCVD risk factors: Moderate-intensity therapy: Oral: 10 to 20 mg once daily to reduce LDL-C by 30% to 49% (Ref).

ASCVD risk ≥7.5% or multiple ASCVD risk factors: High-intensity therapy: Oral: 40 to 80 mg once daily to reduce LDL-C by ≥50%; if unable to tolerate due to adverse effects, may reduce dose to maximum tolerated (Ref).

Patients with LDL-C ≥190 mg/dL and age 20 to 75 years:

Note: High-intensity therapy indicated regardless of ASCVD risk calculation or coexisting diabetes mellitus.

High-intensity therapy: Oral: 40 to 80 mg once daily to reduce LDL-C by ≥50%; if unable to tolerate due to adverse effects, may reduce dose to maximum tolerated (Ref).

Secondary prevention in patients with established atherosclerotic cardiovascular disease (eg, coronary heart disease, cerebrovascular disease [ischemic stroke or transient ischemic attack], peripheral arterial disease):

Note: Patients with high-risk ASCVD may require additional therapies to achieve LDL-C goal (eg, <70 mg/dL or <50 mg/dL if very high risk).

High-intensity therapy: Oral: 80 mg once daily to reduce LDL-C by ≥50%; if unable to tolerate due to adverse effects, may reduce dose to maximum tolerated (Ref).

Transplantation

Transplantation:

Note: Certain immunosuppressive drugs can induce or exacerbate hypercholesterolemia. Significant drug interactions between statins and immunosuppressant drugs are frequent; some interactions can increase statin serum concentrations and risk of toxicity (eg, myopathy) (Ref). Consult drug interactions database for more detailed information.

Transplantation, post heart (off-label use): Oral: Initial: 10 mg once daily starting 1 to 2 weeks after transplant, regardless of baseline cholesterol levels; increase dose based on response, tolerability, and use of concomitant medications up to 20 mg once daily (Ref).

Transplantation, post kidney (off-label use):

Note: The decision to initiate therapy for primary or secondary prevention is similar to the non-transplant population (see the "Prevention of atherosclerotic cardiovascular disease" indication). However, in patients who are 30 to 39 years of age, some experts suggest statin therapy post-kidney transplantation for primary prevention of ASCVD. For primary prevention of ASCVD in patients 18 to 29 years of age, use shared decision making while considering risks and benefits (Ref).

Oral: Initial: 10 mg once daily; increase dose based on response, tolerability, and use of concomitant medications up to 20 mg once daily (Ref).

Missed doses: Oral suspension: If a dose is missed by >12 hours, omit that dose and administer the next dose at the regularly scheduled time; do not administer extra doses to make up for a missed dose.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function: Mild to severe impairment: No dosage adjustment necessary (Ref).

Hemodialysis, intermittent (thrice weekly): Poorly dialyzed: No supplemental dose or dosage adjustment necessary (Ref).

Peritoneal dialysis: No dosage adjustment necessary (Ref).

CRRT: No dosage adjustment necessary (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).

Dosing: Hepatic Impairment: Adult

The hepatic dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Matt Harris, PharmD, MHS, BCPS, FAST, Jeong Park, PharmD, MS, BCTXP, FCCP, FAST, Arun Jesudian, MD, Sasan Sakiani, MD.

Note: Although use is contraindicated in patients with active liver failure or decompensated cirrhosis according to the manufacturer's labeling, baseline elevation in AST/ALT should not preclude use of statins for compelling indications in patients with chronic stable liver disease including compensated cirrhosis (Ref).

Hepatic impairment prior to treatment initiation:

Child-Turcotte-Pugh class A: No dosage adjustment necessary (Ref).

Child-Turcotte-Pugh class B: Note: Consider use only when benefit likely outweighs risk (eg, secondary prevention in patients with established atherosclerotic cardiovascular disease, including ischemic stroke, transient ischemic attack, peripheral artery disease) (Ref).

Oral: Initial: 20 mg once daily; maximum recommended dose: 20 mg/day (Ref).

Child-Turcotte-Pugh class C: Use of a hydrophilic statin (eg, rosuvastatin) is recommended. If use of atorvastatin is deemed necessary: Initial: 10 mg once daily; a maximum dose of 10 mg once daily is recommended (Ref).

Acute hepatotoxicity or worsening of hepatic function (eg, progression from Child-Turcotte-Pugh class A to B) during treatment:

Progression from baseline to Child-Turcotte-Pugh class A: Although use is contraindicated in patients with active liver failure or decompensated cirrhosis according to the manufacturer's labeling, if atorvastatin-induced hepatoxicity has been ruled out, may continue atorvastatin therapy with no dosage adjustment necessary (Ref).

Progression to Child-Turcotte-Pugh class B and C: Although use is contraindicated in patients with active liver failure or decompensated cirrhosis according to the manufacturer's labeling, if atorvastatin-induced toxicity (eg, liver injury, rhabdomyolysis) has been ruled out, may continue atorvastatin therapy with no dosage adjustment necessary; however, in patients with decompensated cirrhosis, consider not exceeding 10 mg once daily (Ref). Continued use of statin therapy may be hepatoprotective in patients with decompensated cirrhosis (Ref).

Dosing: Adjustment for Toxicity: Adult

Severe muscle symptoms or fatigue: Promptly discontinue use; evaluate creatine kinase level (Ref).

Mild to moderate muscle symptoms: Discontinue use until symptoms can be evaluated; evaluate patient for conditions that may increase the risk for muscle symptoms (eg, hypothyroidism, reduced renal or hepatic function, rheumatologic disorders such as polymyalgia rheumatica, steroid myopathy, vitamin D deficiency, or primary muscle diseases). Upon resolution, resume the original or lower dose of atorvastatin. If muscle symptoms recur, discontinue atorvastatin use. After muscle symptom resolution, may use a low dose of a different statin; gradually increase if tolerated. In the absence of continued statin use, if muscle symptoms or elevated CPK continues after 2 months, consider other causes of muscle symptoms. If determined to be due to another condition aside from statin use, may resume statin therapy at the original dose (Ref).

Dosing: Older Adult

Prevention of atherosclerotic cardiovascular disease:

Note: If LDL cholesterol (LDL-C) goal (eg, percent reduction or absolute goal) is not met with the initial dose, may consider up-titration based on estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk (see ACC/AHA ASCVD Risk Estimator Plus online), LDL-C response, and tolerability. If LDL-C goal is not met with maximally tolerated dose, additional lipid-lowering therapy may be warranted (Ref).

Primary prevention:

Age >75 years: Note: Assess ASCVD risk, life expectancy, and likelihood for adverse effects. Consider moderate-intensity therapy after shared decision-making with patient:

Oral: 10 to 20 mg once daily (Ref).

Secondary prevention in patients with established atherosclerotic cardiovascular disease (eg, coronary heart disease, cerebrovascular disease [ischemic stroke or transient ischemic attack], peripheral arterial disease):

Note: Patients with high-risk ASCVD may require additional therapies to achieve LDL-C goal (eg, <70 mg/dL or <50 mg/dL if very high risk) (Ref).

Age >75 years: Moderate- to high-intensity therapy: Oral: 10 to 80 mg once daily (Ref); if a moderate-intensity dose (10 to 20 mg once daily) is started and tolerated, increase to a high-intensity dose (40 to 80 mg once daily) within 3 months (Ref).

Refer to adult dosing for other indications.

Dosing: Pediatric

(For additional information see "Atorvastatin: Pediatric drug information")

Dosage guidance:

Dosing: Dosage should be individualized according to the baseline LDL-C level, the recommended goal of therapy, and patient response; adjustments should be made at intervals of 4 weeks.

Heterozygous familial and nonfamilial hypercholesterolemia

Heterozygous familial and nonfamilial hypercholesterolemia:

Note: Begin treatment if after adequate trial (6 to 12 months) of intensive lifestyle modification emphasizing body weight normalization and diet, the following are present (Ref):

LDL-C ≥190 mg/dL or

LDL-C remains ≥160 mg/dL and 2 or more cardiovascular risk factors: family history of premature atherosclerotic cardiovascular disease (<55 years of age); overweight; obesity; or other elements of insulin resistance syndrome or

LDL-C ≥130 mg/dL and diabetes mellitus (Ref).

Children 6 to <10 years of age (Tanner stage I): Limited data available: Oral: Initial: 5 mg once daily; if target LDL-C not achieved after 4 weeks, may increase incrementally by doubling dose (10 mg/day, 20 mg/day) at monthly intervals until target LDL-C; usual maximum daily dose: 40 mg/day; however, in some cases doses up to 80 mg/day have been used; dosing based on a long-term trial (3 years) of 272 patients (age range: 6 to 15 years); doses of 80 mg/day were used in 12 patients <10 years of age; over the 3 year study duration, similar efficacy was observed without growth or maturation impairment (Ref).

Children and Adolescents 10 to 17 years: Oral: Initial: 10 mg once daily; if target LDL-C not achieved after 4 weeks, may increase incrementally by doubling dose (20 mg/day, 40 mg/day) at monthly intervals until target LDL-C up to a maximum daily dose: 80 mg/day (Ref).

Hyperlipidemia

Hyperlipidemia: Limited data available: Children and Adolescents 10 to 17 years (males and postmenarchal females): Oral: Initial: 10 mg once daily; if LDL-C target not achieved after 1 to 3 months, may increase to meet target LDL-C; in pediatric patients with heterozygous familial hypercholesterolemia, a maximum titrated dose based upon LDL response: 80 mg/day was used (Ref).

Transplantation post-heart; prevention of cardiac allograft vasculopathy

Transplantation post-heart; prevention of cardiac allograft vasculopathy (CAV): Limited data available:

Note: Initiate following heart transplantation regardless of baseline cholesterol levels in children and adolescents with high risk for rejection and CAV (eg, retransplantation, elevated panel reactive antibodies) (Ref). Significant drug interactions between statins and immunosuppressant drugs are frequent; many interactions can increase statin serum concentrations and risk of toxicity (eg, myopathy) (Ref); consult drug interactions database for more detailed information.

Children and Adolescents: Oral: 0.2 mg/kg/day rounded to nearest 2.5 mg increment; maximum daily dose: 20 mg/day (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing adjustment for toxicity: Muscle symptoms (potential myopathy): Children ≥10 years and Adolescents: Discontinue use until symptoms can be evaluated; check CPK level; based on experience in adult patients, also evaluate patient for conditions that may increase the risk for muscle symptoms (eg, hypothyroidism, reduced renal or hepatic function, rheumatologic disorders such as polymyalgia rheumatica, steroid myopathy, vitamin D deficiency, or primary muscle diseases). Upon resolution (symptoms and any associated CPK abnormalities), resume the original or consider a lower dose of atorvastatin and retitrate. If muscle symptoms recur, discontinue atorvastatin use. After muscle symptom resolution, may reinitiate a different statin at an initial low dose; gradually increase if tolerated. Based on experience in adult patients, if muscle symptoms or elevated CPK persists for 2 months in the absence of continued statin use, consider other causes of muscle symptoms. If determined to be due to another condition aside from statin use, may resume statin therapy at the original dose (Ref).

Dosing: Kidney Impairment: Pediatric

Altered kidney function:

Mild to severe impairment: Children ≥10 years and Adolescents: No dosage adjustment necessary.

Hemodialysis, intermittent: There are no recommendations in the manufacturer's labeling (has not been studied); however, atorvastatin is highly protein bound, making it unlikely to be cleared by dialysis. Based on adult experience, it is poorly dialyzed and no dosage adjustment or supplemental dose is recommended (Ref).

Peritoneal dialysis: There are no recommendations for dosing in patients undergoing peritoneal dialysis. Based on adult experience, it is poorly dialyzed and no dosage adjustment is necessary (Ref).

Dosing: Hepatic Impairment: Pediatric

Children ≥10 years and Adolescents: Contraindicated in active liver disease or in patients with unexplained persistent elevations of serum transaminases.

Adverse Reactions (Significant): Considerations
Hepatic effects

Statins are associated with increased serum transaminases and hepatotoxicity (Ref). Asymptomatic transient or persistent increases both <3 or >3 times the ULN in serum transaminases may occur with all statins; the increase in ALT is typically greater than the increase in AST (Ref). Additionally, there are postmarketing reports of fatal and nonfatal hepatic failure, consisting of a cholestatic/mixed pattern (more common with atorvastatin) or hepatocellular pattern (Ref). Drug-induced autoimmune hepatitis has also been documented (Ref).

Upon dose reduction or discontinuation, transaminase levels return to or near pretreatment levels; although, mild elevations resolve with continued use in some cases (Ref). Chronic liver injury (defined as liver biochemical or histological abnormalities that persisted for 6 months or more after onset) has been reported (Ref).

Mechanism: Unclear; inhibition of the CYP450 system, leading to increased plasma concentrations of statins has been postulated, as well as an immune-mediated response (Ref). Changes in the lipid components of the hepatocyte membrane may lead to increased permeability and leakage of liver enzymes (Ref).

Onset: Varied; most cases occur within the first 3 months of initiation or dose escalation (Ref). Duration of atorvastatin prior to development of hepatotoxicity has been reported from ∼1 month to 10 years (Ref).

Risk factors:

• Administration of high oral daily dose of lipophilic drugs that undergo extensive hepatic metabolism, such as atorvastatin, may increase the risk of developing drug-induced liver injury (Ref).

• Concurrent medications with statin drug-drug interactions or hepatotoxic properties (Ref)

• Hepatotoxicity is more commonly associated with atorvastatin than pravastatin, rosuvastatin, and simvastatin (Ref). Fluvastatin is associated with the greatest risk of developing hepatotoxicity (Ref).

• Cross-reactivity between different statins and the susceptibility to hepatotoxicity is unknown, as data have shown conflicting results (Ref).

• Chronic hepatitis B and alcohol consumption are independent risk factors for hepatic aminotransferase elevation associated with statins in patients 80 years of age or older (Ref).

Muscle-related effects

Statins are associated with several muscle-related effects, including:

Myalgia (muscle symptoms without significant creatine kinase [CK] elevations; also known as statin-associated muscle symptoms) (Ref)

Myopathy (defined as unexplained muscle pain or weakness accompanied by a CK ≥10 times the ULN) (Ref)

Rhabdomyolysis (CK >40 times the ULN) (Ref) often with acute renal failure secondary to myoglobinuria (Ref)

Immune-mediated necrotizing myopathy (IMNM) (elevated CK plus the presence of antibodies against HMG-CoA) (Ref)

Mechanism: Uncertain; alterations in the mevalonate pathway and changes in the electrical and structural characteristics of the sarcolemma related to calcium ion flux possibly contribute (Ref). Decreased ubiquinone, which is essential for energy production in skeletal muscle, may also contribute (Ref). Myopathy/rhabdomyolysis risk is related to circulating active drug concentrations (Ref). IMNM is considered an immune-mediated process; autoantibodies against HMG-CoA reductase (anti-HMG-CoA) have been identified (Ref).

Onset: Delayed; often presents within a few months after starting therapy (highest risk within first year of use), when the dose of the statin is increased, or when introducing an interacting drug (Ref). Muscle symptoms often appear more promptly when patients are reexposed to the same statin (Ref). Duration of statin use prior to development of IMNM is ~2 to 3 years (Ref).

Risk factors:

• First year of therapy (Ref)

• Addition of an interacting drug (eg, concurrent use of strong CYP3A4 inhibitors or medications associated with myopathy [eg, colchicine]) (Ref)

• Older patients (Ref)

• Hypothyroidism (Ref)

• Preexisting muscle disease (Ref)

• Kidney impairment (Ref)

• Females (Ref)

• Low body mass index (Ref)

• Heavy exercise (Ref)

• Surgery (Ref)

• Higher HMG-CoA reductase inhibitory activity (Ref), rosuvastatin > atorvastatin > simvastatin > pravastatin ≈ lovastatin (Ref)

• Although incidence increases with dose for most statins, there was no difference found in incidence with atorvastatin dose (Ref)

• Asian population: Increased plasma concentrations (up to ≈ twofold with atorvastatin) may result in increased risk of myopathy (Ref)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions reported in children, adolescents, and adults.

>10%:

Gastrointestinal: Diarrhea (7% to 14%)

Neuromuscular & skeletal: Arthralgia (9% to 12%)

Respiratory: Nasopharyngitis (13%)

1% to 10%:

Cardiovascular: Hemorrhagic stroke (2%)

Endocrine & metabolic: Diabetes mellitus (6%)

Gastrointestinal: Dyspepsia (6%), nausea (7%)

Genitourinary: Urinary tract infection (7% to 8%)

Hepatic: Increased serum transaminases (≤2%) (table 1)

Atorvastatin: Adverse Reaction: Increased Serum Transaminases

Drug (Atorvastatin)

Placebo

Dose

Number of Patients (Atorvastatin)

Number of Patients (Placebo)

2%

N/A

80 mg

N/A

N/A

0.9%

0.1%

80 mg

2,365

2,366

0.6%

N/A

40 mg

N/A

N/A

0.2%

N/A

10 mg

N/A

N/A

0.2%

N/A

20 mg

N/A

N/A

Nervous system: Insomnia (5%)

Neuromuscular & skeletal: Limb pain (3% to 9%) (table 2), muscle spasm (2% to 5%) (table 3), musculoskeletal pain (2% to 5%) (table 4), myalgia (3% to 8%) (table 5)

Atorvastatin: Adverse Reaction: Limb Pain

Drug (Atorvastatin)

Placebo

Dose

Number of Patients (Atorvastatin)

Number of Patients (Placebo)

9%

6%

40 mg

604

7,311

9%

6%

10 mg

3,908

7,311

4%

6%

20 mg

188

7,311

3%

6%

80 mg

4,055

7,311

Atorvastatin: Adverse Reaction: Muscle Spasm

Drug (Atorvastatin)

Placebo

Dose

Number of Patients (Atorvastatin)

Number of Patients (Placebo)

5%

3%

10 mg

3,908

7,311

5%

3%

20 mg

188

7,311

5%

3%

40 mg

604

7,311

2%

3%

80 mg

4,055

7,311

Atorvastatin: Adverse Reaction: Musculoskeletal Pain

Drug (Atorvastatin)

Placebo

Dose

Number of Patients (Atorvastatin)

Number of Patients (Placebo)

5%

4%

40 mg

604

7,311

5%

4%

10 mg

3,908

7,311

3%

4%

20 mg

188

7,311

2%

4%

80 mg

4,055

7,311

Atorvastatin: Adverse Reaction: Myalgia

Drug (Atorvastatin)

Placebo

Dose

Number of Patients (Atorvastatin)

Number of Patients (Placebo)

8%

3%

40 mg

604

7,311

6%

3%

20 mg

188

7,311

4%

3%

10 mg

3,908

7,311

3%

3%

80 mg

4,055

7,311

Respiratory: Pharyngolaryngeal pain (3% to 4%)

Frequency not defined:

Gastrointestinal: Abdominal distress, eructation, flatulence

Nervous system: Malaise

Neuromuscular & skeletal: Joint swelling, muscle fatigue, neck pain

Ophthalmic: Blurred vision

Otic: Tinnitus

Respiratory: Epistaxis

Miscellaneous: Fever

Postmarketing:

Dermatologic: Bullous rash, erythema multiforme, exacerbation of psoriasis (Cozzani 2009), lichenoid eruption (Forouzan 2020), Stevens-Johnson syndrome, toxic epidermal necrolysis (Pfeiffer 1998), urticaria (Adcock 2001)

Gastrointestinal: Cholestasis (Merli 2010), pancreatitis (Lai 2016)

Genitourinary: Cystitis (interstitial) (Huang 2015)

Hematologic & oncologic: Immune thrombocytopenia (Narayanan 2010)

Hepatic: Autoimmune hepatitis (Russo 2014), hepatic failure, hepatitis (Saha 2021), increased gamma-glutamyl transferase (Xu 2020), increased serum alkaline phosphatase (Xu 2020)

Hypersensitivity: Anaphylaxis, angioedema (Hampson 2005), drug reaction with eosinophilia and systemic symptoms (Zereshkian 2021)

Immunologic: Dermatomyositis (Spiro 2018)

Infection: Reactivation of HBV (Wu 2013)

Nervous system: Cognitive dysfunction (reversible; including amnesia, confusion, memory impairment) (Tuccori 2014), depression, dizziness, fatigue, myasthenia (Dobbels 2015), nightmares (Gregoor 2006), peripheral neuropathy

Neuromuscular & skeletal: Immune-mediated necrotizing myopathy (Hasan 2020), increased creatine phosphokinase in blood specimen (Parker 2013), myopathy (Nemati 2021), myositis (including necrotizing autoimmune myositis) (Akivis 2022), rhabdomyolysis (Dalugama 2018), rupture of tendon (Marie 2008)

Ophthalmic: Diplopia (Abdelmasih 2021)

Renal: Acute interstitial nephritis (Annigeri 2015)

Respiratory: Interstitial pulmonary disease

Contraindications

Hypersensitivity (eg, anaphylaxis, angioneurotic edema, erythema multiforme, Steven Johnson syndrome, toxic epidermal necrolysis) to atorvastatin or any component of the formulation; acute liver failure or decompensated cirrhosis.

Canadian labeling: Additional contraindications (not in US labeling): Concurrent therapy with boceprevir, cyclosporine, elbasvir/grazoprevir, glecaprevir/pibrentasvir, ledipasvir/sofosbuvir, simeprevir, telaprevir, or velpatasvir/sofosbuvir.

Warnings/Precautions

Concerns related to adverse effects:

• Diabetes mellitus: Increases in HbA1c and fasting blood glucose have been reported.

Disease-related concerns:

• Hepatic impairment and/or ethanol use: Use with caution in patients who consume large amounts of ethanol or have a history of liver disease; use is contraindicated in patients with active liver disease or unexplained persistent elevations of serum transaminases.

• Myasthenia gravis: May rarely worsen or precipitate myasthenia gravis (MG); monitor for worsening MG if treatment is initiated (AAN [Narayanaswami 2021]).

• Stroke: Patients with recent stroke or TIA receiving long-term therapy with high-dose (ie, 80 mg/day) atorvastatin may be at increased risk for hemorrhagic stroke (SPARCL Investigators [Amarenco 2006]). A subsequent post-hoc analysis demonstrated that patients with lacunar or hemorrhagic stroke may be at higher risk of hemorrhagic stroke; however, this finding was determined to be hypothesis generating. The overall benefit of treatment with atorvastatin (ie, reduced risk of stroke and cardiovascular events) in this population seems to outweigh the increased risk of hemorrhagic stroke if one truly exists (Goldstein 2008).

Special populations:

• Surgical patients: Based on current research and clinical guidelines, HMG-CoA reductase inhibitors should be continued in the perioperative period for noncardiac and cardiac surgery (ACC/AHA [Fleisher 2014]; ACC/AHA [Hillis 2011]). Perioperative discontinuation of statin therapy is associated with an increased risk of cardiac morbidity and mortality.

Dosage form specific issues:

• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Suspension, Oral, as calcium:

Atorvaliq: 20 mg/5 mL (150 mL) [contains ethylparaben, methylparaben, propylparaben]

Tablet, Oral:

Lipitor: 10 mg, 20 mg, 40 mg, 80 mg

Generic: 10 mg, 20 mg, 40 mg, 80 mg

Generic Equivalent Available: US

May be product dependent

Pricing: US

Suspension (Atorvaliq Oral)

20 mg/5 mL (per mL): $1.44

Tablets (Atorvastatin Calcium Oral)

10 mg (per each): $0.02 - $7.50

20 mg (per each): $0.03 - $10.70

40 mg (per each): $0.04 - $10.70

80 mg (per each): $0.06 - $10.70

Tablets (Lipitor Oral)

10 mg (per each): $14.81

20 mg (per each): $21.12

40 mg (per each): $21.12

80 mg (per each): $21.12

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Lipitor: 10 mg, 20 mg, 40 mg, 80 mg [contains polysorbate 80]

Generic: 10 mg, 20 mg, 40 mg, 80 mg

Administration: Adult

Oral:

Suspension: Administer on an empty stomach, at least 1 hour before or 2 hours after a meal; may take without regard to time of day. Measure dose using a calibrated oral syringe or other oral dosing device containing scored metric units of measurement (eg, mL).

Tablet: Administer with or without food; may take without regard to time of day. The manufacturer's labeling states tablets should not be broken; however, available data do not indicate any safety or efficacy concerns with this practice.

Administration: Pediatric

Oral: May be taken without regard to meals or time of day. The manufacturer's labeling states tablets should not be broken; however, available data do not indicate any safety or efficacy concerns with this practice.

Use: Labeled Indications

Heterozygous familial hypercholesterolemia: To reduce elevated total cholesterol (total-C), LDL cholesterol (LDL-C), apolipoprotein B (apo B), and triglyceride levels, and to increase HDL cholesterol in patients with primary hypercholesterolemia.

Heterozygous familial hypercholesterolemia (pediatrics): To reduce total-C, LDL-C, and apo B levels in pediatric patients 10 to 17 years of age with heterozygous familial hypercholesterolemia with LDL-C ≥190 mg/dL, LDL-C ≥160 mg/dL with positive family history of premature cardiovascular disease (CVD), or LDL-C ≥160 mg/dL with 2 or more other CVD risk factors.

Homozygous familial hypercholesterolemia: To reduce total-C and LDL-C in patients with homozygous familial hypercholesterolemia as an adjunct to other lipid-lowering treatments (eg, LDL apheresis) or if such treatments are unavailable.

Prevention of atherosclerotic cardiovascular disease:

Primary prevention of atherosclerotic cardiovascular disease (ASCVD): To reduce the risk of myocardial infarction (MI), stroke, revascularization procedures, and angina in adult patients without a history of coronary heart disease (CHD) but who have multiple CHD risk factors.

Secondary prevention in patients with established ASCVD: To reduce the risk of MI, stroke, revascularization procedures, and angina in patients with a history of CHD.

Use: Off-Label: Adult

Transplantation, post heart; Transplantation, post kidney

Medication Safety Issues
Sound-alike/look-alike issues:

Atorvastatin may be confused with atomoxetine, lovastatin, nystatin, pitavastatin, pravastatin, rosuvastatin, simvastatin

HMG-CoA reductase inhibitors (when referred to as "statins") may be confused with nystatin.

Lipitor may be confused with labetalol, Levatol, lisinopril, Loniten, Lopid, Mevacor, Zocor, ZyrTEC

Metabolism/Transport Effects

Substrate of BCRP/ABCG2, CYP3A4 (major), OATP1B1/1B3 (SLCO1B1/1B3), P-glycoprotein/ABCB1 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Abiraterone Acetate: May enhance the myopathic (rhabdomyolysis) effect of HMG-CoA Reductase Inhibitors (Statins). Risk C: Monitor therapy

Acipimox: May enhance the myopathic (rhabdomyolysis) effect of HMG-CoA Reductase Inhibitors (Statins). Risk C: Monitor therapy

Amiodarone: May increase the serum concentration of Atorvastatin. Risk C: Monitor therapy

Antihepaciviral Combination Products: May increase the serum concentration of Atorvastatin. Risk X: Avoid combination

Asciminib: May increase the serum concentration of Atorvastatin. Risk X: Avoid combination

Asunaprevir: May increase the serum concentration of Atorvastatin. Risk X: Avoid combination

Atazanavir: May increase the serum concentration of Atorvastatin. Management: Use of atorvastatin and atazanavir/cobicistat is not recommended. Use the lowest atorvastatin dose necessary and titrate carefully in patients taking atazanavir or atazanavir/ritonavir due to the increased risk of myopathy, including rhabdomyolysis. Risk D: Consider therapy modification

Bezafibrate: May enhance the myopathic (rhabdomyolysis) effect of HMG-CoA Reductase Inhibitors (Statins). Bezafibrate may increase the serum concentration of HMG-CoA Reductase Inhibitors (Statins). More specifically, bezafibrate may increase the serum concentration of fluvastatin Management: Avoid use of bezafibrate and HMG-CoA reductase inhibitors (statins) unless strictly indicated due to the increased of muscle toxicity (including rhabdomyolysis). In patients who may be predisposed to myopathy, concomitant use is contraindicated. Risk D: Consider therapy modification

Cimetidine: May enhance the adverse/toxic effect of Atorvastatin. Specifically, there is a theoretical potential for enhanced effects on reducing endogenous steroid activity. Risk C: Monitor therapy

Ciprofibrate: May enhance the adverse/toxic effect of HMG-CoA Reductase Inhibitors (Statins). Management: Avoid the use of HMG-CoA reductase inhibitors and ciprofibrate if possible. If concomitant therapy is considered, benefits should be carefully weighed against the risks, and patients should be monitored closely for signs/symptoms of muscle toxicity. Risk D: Consider therapy modification

Clarithromycin: May increase the serum concentration of Atorvastatin. Management: Limit atorvastatin to a maximum dose of 20 mg/day when used with clarithromycin. If this combination is used, monitor patients more closely for evidence of atorvastatin toxicity. Risk D: Consider therapy modification

Clofazimine: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

Cobicistat: May increase the serum concentration of Atorvastatin. Management: Avoid the combined use of atorvastatin with atazanavir/cobicistat. Atorvastatin dose should not exceed 20 mg daily when combined with other cobicistat-containing regimens. Risk D: Consider therapy modification

Colchicine: May enhance the myopathic (rhabdomyolysis) effect of HMG-CoA Reductase Inhibitors (Statins). Colchicine may increase the serum concentration of HMG-CoA Reductase Inhibitors (Statins). HMG-CoA Reductase Inhibitors (Statins) may increase the serum concentration of Colchicine. Risk C: Monitor therapy

CycloSPORINE (Systemic): May increase the serum concentration of Atorvastatin. Risk X: Avoid combination

CYP3A4 Inducers (Moderate): May decrease the serum concentration of Atorvastatin. Risk C: Monitor therapy

CYP3A4 Inducers (Strong): May decrease the serum concentration of Atorvastatin. Risk C: Monitor therapy

CYP3A4 Inhibitors (Moderate): May increase the serum concentration of Atorvastatin. Risk C: Monitor therapy

CYP3A4 Inhibitors (Strong): May increase the serum concentration of Atorvastatin. Risk C: Monitor therapy

Cyproterone: May increase the serum concentration of HMG-CoA Reductase Inhibitors (Statins). Risk C: Monitor therapy

Daclatasvir: May increase the serum concentration of Atorvastatin. Risk C: Monitor therapy

Danazol: May increase the serum concentration of Atorvastatin. Risk C: Monitor therapy

DAPTOmycin: HMG-CoA Reductase Inhibitors (Statins) may enhance the adverse/toxic effect of DAPTOmycin. Specifically, the risk of skeletal muscle toxicity may be increased. Management: Consider temporarily stopping statin (HMG-CoA reductase inhibitor) therapy prior to daptomycin. If daptomycin is used with a statin, creatine phosphokinase (CPK) monitoring could be considered. Risk D: Consider therapy modification

Darolutamide: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Darunavir: May increase the serum concentration of Atorvastatin. Management: Use the lowest atorvastatin dose necessary and limit the atorvastatin dose to 20 mg daily in patients taking darunavir. Monitor patients for signs and symptoms of myopathy at initiation of therapy and with any dose increase. Risk D: Consider therapy modification

Delavirdine: May increase the serum concentration of Atorvastatin. Risk C: Monitor therapy

Digoxin: Atorvastatin may increase the serum concentration of Digoxin. Risk C: Monitor therapy

Elacestrant: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Elbasvir and Grazoprevir: May increase the serum concentration of Atorvastatin. Management: Limit the adult dose of atorvastatin to a maximum of 20 mg/day when used together with elbasvir and grazoprevir. Use the lowest atorvastatin dose necessary and monitor closely for evidence of statin-related toxicities such as myalgia or myopathy. Risk D: Consider therapy modification

Eltrombopag: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Eltrombopag: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Encorafenib: May increase the serum concentration of Atorvastatin. Encorafenib may decrease the serum concentration of Atorvastatin. Risk C: Monitor therapy

Etravirine: May decrease the serum concentration of HMG-CoA Reductase Inhibitors (Statins). This applies to atorvastatin, lovastatin and simvastatin. Risk C: Monitor therapy

Fenofibrate and Derivatives: May enhance the adverse/toxic effect of HMG-CoA Reductase Inhibitors (Statins). Risk C: Monitor therapy

Fexinidazole: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination

Fosamprenavir: Atorvastatin may increase serum concentrations of the active metabolite(s) of Fosamprenavir. Fosamprenavir may increase the serum concentration of Atorvastatin. Management: Use the lowest atorvastatin dose necessary and limit the atorvastatin dose to 20 mg daily in patients taking fosamprenavir. Monitor patients for signs and symptoms of myopathy at initiation of therapy and with any dose increase. Risk D: Consider therapy modification

Fostemsavir: May increase the serum concentration of HMG-CoA Reductase Inhibitors (Statins). Management: Use the lowest possible starting statin dose and monitor patients closely for statin-related adverse effects (eg, muscle aches and pains) during coadministration with fostemsavir. Risk D: Consider therapy modification

Fusidic Acid (Systemic): May enhance the adverse/toxic effect of HMG-CoA Reductase Inhibitors (Statins). Specifically, the risk for muscle toxicities, including rhabdomyolysis may be significantly increased. Management: Avoid concurrent use whenever possible. Use is listed as contraindicated in product characteristic summaries in several countries, although UK labeling suggests that use could be considered under exceptional circumstances and with close supervision. Risk X: Avoid combination

Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination

Futibatinib: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Gemfibrozil: May enhance the myopathic (rhabdomyolysis) effect of HMG-CoA Reductase Inhibitors (Statins). Risk X: Avoid combination

Gilteritinib: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Glecaprevir and Pibrentasvir: May increase the serum concentration of Atorvastatin. Risk X: Avoid combination

Grapefruit Juice: May increase the serum concentration of Atorvastatin. Management: Avoid large quantities of grapefruit juice (more than 1.2 liters daily) during treatment with atorvastatin. Monitor for atorvastatin adverse effects (eg, myopathy, rhabdomyolysis) in patients who consume smaller quantities or whose intake has changed. Risk D: Consider therapy modification

Indinavir: May increase the serum concentration of Atorvastatin. Management: Use the lowest atorvastatin dose necessary and titrate carefully in patients taking indinavir. Monitor patients carefully for signs and symptoms of myopathy and rhabdomyolysis during coadministration. Risk D: Consider therapy modification

Interleukin-6 (IL-6) Inhibiting Therapies: May decrease the serum concentration of HMG-CoA Reductase Inhibitors (Statins). Risk C: Monitor therapy

Istradefylline: May increase the serum concentration of Atorvastatin. Risk C: Monitor therapy

Itraconazole: May increase the serum concentration of Atorvastatin. Management: Limit atorvastatin to a maximum adult dose of 20 mg/day in patients receiving itraconazole. Assess clinical response to ensure that the lowest necessary dose of atorvastatin is used. Consider use of fluva-, rosuva-, pitava-, or pravastatin when possible. Risk D: Consider therapy modification

Ketoconazole (Systemic): Atorvastatin may enhance the adverse/toxic effect of Ketoconazole (Systemic). Specifically, there is a theoretical potential for additive effects on reducing endogenous steroid concentrations. Ketoconazole (Systemic) may increase the serum concentration of Atorvastatin. Risk C: Monitor therapy

Lanthanum: May decrease the serum concentration of HMG-CoA Reductase Inhibitors (Statins). Management: Administer HMG-CoA reductase inhibitors (eg, statins) at least two hours before or after lanthanum. Risk D: Consider therapy modification

Ledipasvir: May enhance the adverse/toxic effect of Atorvastatin. Risk C: Monitor therapy

Leflunomide: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Leniolisib: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Risk X: Avoid combination

Letermovir: May increase the serum concentration of Atorvastatin. Management: Limit the atorvastatin dose to 20 mg daily when combined with letermovir. When letermovir is coadministered with cyclosporine, the use of atorvastatin (at any dose) is not recommended. Risk D: Consider therapy modification

Lomitapide: May increase the serum concentration of Atorvastatin. Atorvastatin may increase the serum concentration of Lomitapide. Management: When the lomitapide dose is 10 mg daily or greater, reduce the lomitapide dose by 50% when combined with atorvastatin. No dose adjustment is required when the lomitapide dose is 5 mg daily. Risk D: Consider therapy modification

Lonafarnib: May increase the serum concentration of Atorvastatin. Risk X: Avoid combination

Lopinavir: May increase the serum concentration of Atorvastatin. Management: Consider the risks and benefits of this combination. If coadministered, use the lowest dose of atorvastatin necessary and monitor patients for signs and symptoms of myopathy, especially at initiation of therapy and with any dose increase. Risk D: Consider therapy modification

Midazolam: Atorvastatin may increase the serum concentration of Midazolam. Risk C: Monitor therapy

Nelfinavir: May increase the serum concentration of Atorvastatin. Management: Use the lowest atorvastatin dose necessary in patients taking nelfinavir, and do not exceed atorvastatin 40 mg daily. Monitor patients for signs and symptoms of myopathy at initiation of therapy and with any dose increase. Risk D: Consider therapy modification

Niacin: May enhance the adverse/toxic effect of HMG-CoA Reductase Inhibitors (Statins). Risk C: Monitor therapy

Nirmatrelvir and Ritonavir: May increase the serum concentration of Atorvastatin. Management: Consider temporarily discontinuing atorvastatin during treatment with nirmatrelvir/ritonavir. It is not necessary to hold atorvastatin either prior to or after completion of nirmatrelvir/ritonavir treatment. Risk D: Consider therapy modification

Osimertinib: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Oteseconazole: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Pacritinib: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Risk X: Avoid combination

Posaconazole: May increase the serum concentration of Atorvastatin. Risk X: Avoid combination

Pretomanid: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

QuiNINE: May increase the serum concentration of HMG-CoA Reductase Inhibitors (Statins). Risk C: Monitor therapy

Raltegravir: May enhance the myopathic (rhabdomyolysis) effect of HMG-CoA Reductase Inhibitors (Statins). Risk C: Monitor therapy

Red Yeast Rice: May enhance the adverse/toxic effect of HMG-CoA Reductase Inhibitors (Statins). Risk X: Avoid combination

Regorafenib: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Repaglinide: HMG-CoA Reductase Inhibitors (Statins) may increase the serum concentration of Repaglinide. Risk C: Monitor therapy

RifAMPin: May increase the serum concentration of Atorvastatin. RifAMPin may decrease the serum concentration of Atorvastatin. Management: Administer atorvastatin and rifampin simultaneously if using both. Monitor atorvastatin response closely. Risk D: Consider therapy modification

Ritonavir: May increase the serum concentration of Atorvastatin. Management: Use lowest atorvastatin dose needed. If ritonavir is combined with another protease inhibitor, see the drug interaction monograph for that protease inhibitor. Risk D: Consider therapy modification

Rolapitant: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Management: Monitor patients receiving rolapitant for increased exposure to and/or effects of BCRP/ABCG2 substrates. Use the lowest effective rosuvastatin dose when used in combination with rolapitant. Risk C: Monitor therapy

Roxadustat: May increase the serum concentration of HMG-CoA Reductase Inhibitors (Statins). Risk C: Monitor therapy

Rupatadine: May enhance the adverse/toxic effect of HMG-CoA Reductase Inhibitors (Statins). Specifically, the risk for increased CPK and/or other muscle toxicities may be increased. Risk C: Monitor therapy

Sacubitril: May increase the serum concentration of Atorvastatin. Risk C: Monitor therapy

Saquinavir: May increase the serum concentration of Atorvastatin. Management: Limit the atorvastatin dose to 20 mg in patients taking saquinavir and ritonavir. Monitor patients for signs and symptoms of myopathy at initiation of therapy and with any dose increase. Risk D: Consider therapy modification

Simeprevir: May increase the serum concentration of Atorvastatin. Management: The maximum atorvastatin dose should not exceed 40 mg/day with concurrent use of simeprevir, and use of the lowest necessary atorvastatin dose is recommended. Monitor for atorvastatin toxicity with concomitant use. Risk D: Consider therapy modification

Sofosbuvir: May increase the serum concentration of Atorvastatin. Risk C: Monitor therapy

Sparsentan: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Risk X: Avoid combination

St John's Wort: May decrease serum concentrations of the active metabolite(s) of HMG-CoA Reductase Inhibitors (Statins). Management: Consider avoiding the concomitant administration of St John's Wort with atorvastatin, lovastatin and simvastatin in order to avoid the potential for decreased effects statins. If coadministered, monitor for decreased statin efficacy. Risk D: Consider therapy modification

Tafamidis: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Talazoparib: Atorvastatin may increase the serum concentration of Talazoparib. Risk C: Monitor therapy

Taurursodiol: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Risk X: Avoid combination

Tedizolid: May increase the serum concentration of BCRP/ABCG2 Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Teriflunomide: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Ticagrelor: May increase the serum concentration of Atorvastatin. Risk C: Monitor therapy

Tipranavir: May increase the serum concentration of Atorvastatin. Risk X: Avoid combination

Trabectedin: HMG-CoA Reductase Inhibitors (Statins) may enhance the myopathic (rhabdomyolysis) effect of Trabectedin. Risk C: Monitor therapy

Trofinetide: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Management: Avoid concurrent use with OATP1B1/1B3 substrates for which small changes in exposure may be associated with serious toxicities. Monitor for evidence of an altered response to any OATP1B1/1B3 substrate if used together with trofinetide. Risk D: Consider therapy modification

Velpatasvir: May increase the serum concentration of Atorvastatin. Risk C: Monitor therapy

Verapamil: Atorvastatin may increase the serum concentration of Verapamil. Verapamil may increase the serum concentration of Atorvastatin. Management: Consider using lower doses of atorvastatin when used together with verapamil, and monitor closely for signs of HMG-CoA reductase inhibitor toxicity (eg, myositis, rhabdomyolysis, hepatotoxicity). Risk D: Consider therapy modification

Voclosporin: May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates (Clinically Relevant with Inhibitors). Risk C: Monitor therapy

Voxilaprevir: May increase the serum concentration of Atorvastatin. Management: Use the lowest atorvastatin dose possible if combined with voxilaprevir and monitor patients for increased statin effects/toxicities (eg, myopathy, rhabdomyolysis). Risk D: Consider therapy modification

Food Interactions

Atorvastatin serum concentrations may be increased by grapefruit juice. Management: Avoid concurrent intake of large quantities of grapefruit juice (>1.2 liters/day).

Reproductive Considerations

Adequate contraception is recommended if an HMG-CoA reductase inhibitor (statin) is required in patients who may become pregnant (AHA/ACC [Grundy 2019a]; CCS [Pearson 2021]). Patients planning to become pregnant should discuss their lifetime risk of cardiovascular disease, as well as risks and benefits of statin therapy with their health care team (CCS [Pearson 2021]). When appropriate, statins can be discontinued 1 to 2 months prior to conception (AHA/ACC [Grundy 2019a]).

When a statin is needed in a patient of reproductive potential, a more hydrophilic option (eg, pravastatin, rosuvastatin) may be preferred to limit placental transfer (CCS [Pearson 2021]).

Pregnancy Considerations

In healthy pregnancies, changes in lipid synthesis occur that are required for normal placental and fetal growth. Low-density lipoprotein cholesterol and triglycerides increase as pregnancy progresses and decline postpartum. HMG-CoA reductase inhibitors (statins) decrease the synthesis of cholesterol and substances derived from cholesterol. Therefore, based on the mechanism of action, in utero exposure may cause fetal harm (Lecarpentier 2012); however, data from available studies have not shown an increased risk of major congenital anomalies following first trimester exposure (Bateman 2015; Chang 2021; Vahedian-Azimi 2021a). Additional data are needed to evaluate other pregnancy outcomes, such as miscarriage (Vahedian-Azimi 2021b).

Because there is potential for fetal harm, statins should be discontinued once pregnancy is recognized (AHA/ACC [Grundy 2019a]; Brunham 2018). If lipid-lowering therapy during pregnancy is required, it should be individualized based on the therapeutic needs of the patient, considering the lifetime risk of untreated disease, use of nonstatin therapies, as well as the known risks and benefits of statins. Based on limited data, when a statin is needed in a pregnant patient, a more hydrophilic option (eg, pravastatin, rosuvastatin) may be preferred. Lipophilic statins (eg, atorvastatin, fluvastatin, lovastatin, simvastatin, pitavastatin) may be more likely to cross the placenta and increase the risk of congenital malformations (AHA/ACC [Grundy 2019a]; CCS [Pearson 2021]; Lecarpentier 2012).

Additional data are needed to clarify the role of statins for the prevention of atherosclerotic cardiovascular disease in at-risk pregnant patients (AHA/ACC [Grundy 2019a]; CCS [Pearson 2021]; Parikh 2021).

Breastfeeding Considerations

It is not known if atorvastatin is present in breast milk.

HMG-CoA reductase inhibitors (statins) decrease the synthesis of cholesterol and substances derived from cholesterol. Normal concentrations of cholesterol in breast milk are required for infant development (Holmsen 2017; Lecarpentier 2012). Due to the potential for adverse events in the breastfed infant, breastfeeding is not recommended by the manufacturer. Available guidelines recommend resuming statin therapy once breastfeeding is completed (AHA/ACC [Grundy 2019a]; CCS [Pearson 2021]).

Dietary Considerations

Before initiation of therapy, patients should be placed on a standard cholesterol-lowering diet for 3 to 6 months and the diet should be continued during drug therapy. Atorvastatin serum concentration may be increased when taken with grapefruit juice; avoid concurrent intake of large quantities (>1.2 liters/day).

Red yeast rice contains variable amounts of several compounds that are structurally similar to HMG-CoA reductase inhibitors, primarily monacolin K (or mevinolin) which is structurally identical to lovastatin; concurrent use of red yeast rice with HMG-CoA reductase inhibitors may increase the incidence of adverse and toxic effects (Lapi 2008; Smith 2003).

Monitoring Parameters

ACC/AHA Blood Cholesterol Guideline recommendations (ACC/AHA [Grundy 2019a]):

Lipid panel (total cholesterol, HDL, LDL, triglycerides): Lipid profile (fasting or nonfasting) before initiating treatment. Fasting lipid profile should be rechecked 4 to 12 weeks after starting therapy and every 3 to 12 months thereafter. If 2 consecutive LDL levels are <40 mg/dL, consider decreasing the dose.

Hepatic transaminase levels: Baseline measurement of hepatic transaminase levels (AST and ALT); measure AST, ALT, total bilirubin, and alkaline phosphatase if symptoms suggest hepatotoxicity (eg, unusual fatigue or weakness, loss of appetite, abdominal pain, dark-colored urine or yellowing of skin or sclera) during therapy.

Monitor closely for myopathy/rhabdomyolysis. Instruct patients to report unexplained muscle pain, tenderness, weakness, or brown urine, particularly if accompanied by malaise or fever.

CPK: CPK should not be routinely measured. Baseline CPK measurement is reasonable for some individuals (eg, family history of statin intolerance or muscle disease, clinical presentation, concomitant drug therapy that may increase risk of myopathy). May measure CPK in any patient with symptoms suggestive of myopathy (pain, tenderness, stiffness, cramping, weakness, or generalized fatigue).

Evaluate for new-onset diabetes mellitus during therapy; if diabetes develops, continue statin therapy and encourage adherence to a heart-healthy diet, physical activity, a healthy body weight, and tobacco cessation.

If patient develops a confusional state or memory impairment, may evaluate patient for nonstatin causes (eg, exposure to other drugs), systemic and neuropsychiatric causes, and the possibility of adverse effects associated with statin therapy.

Manufacturer's labeling: Consider neuromuscular and serologic testing if immune-mediated necrotizing myopathy is suspected.

Mechanism of Action

Inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, the rate-limiting enzyme in cholesterol synthesis (reduces the production of mevalonic acid from HMG-CoA); this then results in a compensatory increase in the expression of LDL receptors on hepatocyte membranes and a stimulation of LDL catabolism. In addition to the ability of HMG-CoA reductase inhibitors to decrease levels of high-sensitivity C-reactive protein (hsCRP), they also possess pleiotropic properties including improved endothelial function, reduced inflammation at the site of the coronary plaque, inhibition of platelet aggregation, and anticoagulant effects (de Denus 2002; Ray 2005).

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Initial changes: 3 to 5 days; Maximal reduction in plasma cholesterol and triglycerides: 2 to 4 weeks; LDL reduction: 10 mg/day: 39% (for each doubling of this dose, LDL is lowered approximately 6%)

Absorption: Oral: Rapidly absorbed; extensive first-pass metabolism in GI mucosa and liver

Distribution: Vd: ~381 L

Protein binding: ≥98%

Metabolism: Hepatic via CYP3A4; forms active ortho- and parahydroxylated derivatives and an inactive beta-oxidation product; plasma concentrations are elevated in patients with chronic alcoholic liver disease and Child-Pugh class A and B liver disease

Bioavailability: ~14% (parent drug); ~30% (parent drug and equipotent metabolites)

Half-life elimination: Parent drug: ~14 hours; Equipotent metabolites: 20 to 30 hours

Time to peak, serum: 1 to 2 hours

Excretion: Bile (following hepatic and/or extra-hepatic metabolism; does not appear to undergo enterohepatic recirculation); urine (<2% as unchanged drug)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Hepatic function impairment: Cmax and AUC are each 4-fold greater in patients with Child-Pugh class A disease; Cmax and AUC are ~16-fold and 11-fold increased, respectively, in patients with Child-Pugh class B disease.

Older adult: Plasma concentrations are higher (~40% for Cmax and 30% for AUC).

Sex: Plasma concentrations in women differ from those in men (~20% higher for Cmax and 10% lower for AUC)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Astatin | Ator | Atoris | Atorlip | Atortab | Atorva | Atstat | Aztor | Lipicure | Lipigard | Lipitor | Lipodar | Lipomax | Statix | Storvas | Torvacard | Torvacol | Tovast | Tulip | Vastor;
  • (AR) Argentina: Atarva | Ateroclar | Atorvamar | Atorvastan | Atorvastatina | Atorvastatina Cevallos | Atorvastatina Fabra | Faboxim | Finlipol | Kospidel | Liparex | Lipibec | Lipifen | Lipitor | Lipodren | Lipofin | Lipokemia | Liponorm | Lipovastatinklonal | Micinamar | Nexostatin | Normalip | Normolipol | Plan | Ronator | Sincol | Tecoplax | Vanator | Vast;
  • (AT) Austria: Atorvalan | Atorvastatin | Atorvastatin 1a pharma | Atorvastatin accord | Atorvastatin Actavis | Atorvastatin aristo | Atorvastatin bluefish | Atorvastatin bluefish AB | Atorvastatin Easypharm | Atorvastatin G.L. | Atorvastatin Genericon | Atorvastatin HCS | Atorvastatin krka | Atorvastatin pfizer | Atorvastatin Pluspharma | Atorvastatin ranbaxy | Atorvastatin Ratiopharm | Atorvastatin stada | Atorvastatin viatris | Avatarstad | Betastatin | Sortis;
  • (AU) Australia: Apo atorvastatin | Atorvachol | Atorvastatin | Atorvastatin Actavis | Atorvastatin an | Atorvastatin gh | Atorvastatin rbx | Atorvastatin scp | Lipitor | Lorstat | Noumed atorvastatin | Pharmacor atorvastatin | Stada atorvastatin | Terry white chemists atorvastatin | Torvastat | Trovas;
  • (BD) Bangladesh: Anzitor | Aster | Astin | Atasin | Atova | Atovex | Atovin | Atrovast | Atv | Avas | Avator | Avocard | Colostat | Divastin | Frenvas | Lipex | Lipicon | Lipicut | Lipiles | Lipistat | Lipitin | Lipiva | Liplo | Lipostat | Liptor | Livas | Locol | Onvas | Optivas | Orva | Orvatin | Os | Sb ator | Stacor | Taven | Tcl-R | Tigilo | Tiginor | Vass | Vastin | Xelitor | Xelpid | Xerova | Zapitor;
  • (BE) Belgium: Atorasat | Atorstatineg | Atorvastacalc | Atorvastatin ab | Atorvastatin apotex | Atorvastatin bepb | Atorvastatin krka | Atorvastatine eg | Atorvastatine Mylan | Atorvastatine Pfizer | Atorvastatine sandoz | Atorvastatine Teva | Lipitor | Tavara | Totalip;
  • (BF) Burkina Faso: Atorlip | Cholestrom | Lesstrol | Lipikind | Lipovas | Storvas | Tahor | Trova | Vastator | Vastor | X'tor;
  • (BG) Bulgaria: Amicor | Aragil | Atorgamma | Atorgen | Atoris | Atorva | Atorvastatin AL | Atorvastatin aurobindo | Atorvastatin billev | Atorvastatin ecopharm | Atorvastatin Genericon | Atorvin | Atorvistat | Atorvistat k | Avanor | Calipra | Larus | Sortis | Torvacard | Torvalipin | Tulip;
  • (BR) Brazil: Atorless | Atorvastatina | Atorvastatina calcica | Atorvastatina calcica geolab | Atorvasterol | Corastorva | Kolevas | Lipigran | Lipistat | Lipitor | Lipthal | Lumirarte | Vast | Volunta | Zarator;
  • (CH) Switzerland: Atorva pfizer | Atorvastatin Actavis | Atorvastatin axapharm | Atorvastatin Helvepharm | Atorvastatin Mepha | Atorvastatin Mepha Teva | Atorvastatin pfizer | Atorvastatin Sandoz | Atorvastatin spirig | Atorvastatin spirig hc | Atorvastatin streuli | Atorvastatin zentiva | Atorvastax | Sortis;
  • (CI) Côte d'Ivoire: Atorex | Atorfit | Atorlip | Atorvastatine | Atotin | Atroclass | Atron | Avas | Avastatin | Avstat | Carlipo | Lesstrol | Lipias | Lipiduce | Lipovas | Lolip | Optilip | Statinor | Tahor | Tora | Torva | Trova | Vaskol | Vastator | X'tor;
  • (CL) Chile: Atenfar | Atorlip | Dislipor | Hipolixan | Lipitor | Lipoten | Lipotropic | Lipox | Lowden | Zarator;
  • (CN) China: A le | Lipitor | Mei da xin | You li ping;
  • (CO) Colombia: Atorcol | Atorfit | Atorlip | Atorsyn | Atorvastatina | Atorvat | Atovarol | Axo | Cardiostatina | Controlip | Corastatin | Ectasil | Edy | Estatlen | Farmalip | Garmisch nivecol | Glustar | Hipolipin | Isulor | Lipicare | Lipitor | Lipostan | Lowlipen | Nivecol | Nivelar | Ormar | Pakadel | Riscol | Sin ater | Tabtina | Tarvastin | Torvastin | Vast;
  • (CZ) Czech Republic: Amedo | Apo atorvastatin | Atorgamma | Atoris | Atorstad | Atorvastatin +Pharma | Atorvastatin 1a pharma | Atorvastatin Actavis | Atorvastatin aurovitas | Atorvastatin Egis | Atorvastatin Hbf | Atorvastatin medreg | Atorvastatin mylan | Atorvastatin Ratiopharm | Atorvastatin xantis | Atraven | Bisatum | Corat | Larus | Lipfix | Pharmtina | Sortis | Spatizalex | Torvacard | Torvacard neo | Torvazin | Triglyx | Tulip;
  • (DE) Germany: Atorbem | Atorgamma | Atoris | Atorva Q | Atorvastatin | Atorvastatin 1 a pharma | Atorvastatin Aaa | Atorvastatin abz | Atorvastatin accord | Atorvastatin Actavis | Atorvastatin AL | Atorvastatin aristo | Atorvastatin aurobindo | Atorvastatin axiromed | Atorvastatin Basics | Atorvastatin Biomo | Atorvastatin CT | Atorvastatin Dexcel | Atorvastatin Hennig | Atorvastatin Heumann | Atorvastatin Hexal | Atorvastatin mylan | Atorvastatin puren | Atorvastatin Ratiopharm | Atorvastatin stada | Atorvastatin vivanta | Atorvastatin zentiva | Lipitor | Sortis;
  • (DO) Dominican Republic: Arvas | Atorvastatina | Atorvastin | Atrolip | Bioppal | Fravastatin | Hipovastin | Hopenor | Lesator | Lipatrol | Lipitor | Lipotrop | Orator | Redugrel | Rotaqor | Statin;
  • (EC) Ecuador: Ampliar | Atocor | Atorcross | Atorisk | Atorlip | Atorvastatina | Atorvastatina mk | Atrolip | Atvas | Lipitor | Liponorm | Lipotropic | Lipox | Lowden | Storvas | Triglicol | Vast;
  • (EE) Estonia: Atilen | Atorgamma | Atoris | Atorvastatin | Atorvastatin accord | Atorvastatin billev | Atorvastatin Medochemie | Atorvastatin Polpharma | Atorvastatin Portfarma | Atorvastatin Ratiopharm | Atorvastatin tad | Atorvastatin teva | Atorvastatin zentiva | Lopamol | Sortis | Torvacard | Tulip;
  • (EG) Egypt: Ator | Atorstat | Atovast | Borgastatin | Fatestatin | Lipicole | Lipiless | Lipinorm | Lipitor | Lipomax | Lipona | Lipovast | Orgovastin | Rostatine | Sigmalip | Torastatin | Torvast | Vonteroid;
  • (ES) Spain: Atoris | Atorvastatina Abex | Atorvastatina actavis group | Atorvastatina Almus | Atorvastatina alter | Atorvastatina alter farmacia | Atorvastatina amneal | Atorvastatina Apotex | Atorvastatina aristo | Atorvastatina aurobindo | Atorvastatina Bexal | Atorvastatina bluefish | Atorvastatina Cinfa | Atorvastatina Combix | Atorvastatina Davur | Atorvastatina Edigen | Atorvastatina Kern Pharma | Atorvastatina Korhispana | Atorvastatina krka | Atorvastatina Mabo | Atorvastatina mundogen | Atorvastatina mylan | Atorvastatina Mylan Pharmaceuticals | Atorvastatina Normon | Atorvastatina normon | Atorvastatina Pensa | Atorvastatina pharma combix | Atorvastatina Pharmacia | Atorvastatina Qualigen | Atorvastatina Ranbaxy | Atorvastatina ranbaxygen | Atorvastatina ratiopharm | Atorvastatina sandoz | Atorvastatina Stada | Atorvastatina stadagen | Atorvastatina Tarbis | Atorvastatina tecnigen | Atorvastatina Tevagen | Atorvastatina Urquima | Atorvastatina vir | Atorvastatina vivanta | Atorvastatina zentiva | Cardyl | Prevencor | Thervan | Zarator;
  • (ET) Ethiopia: Atorin | Atorva | Atorvastatin | Atorvastatina Mabo | Atstat | Caditor | Cholvast | Lipiduce | Lipigard | Lipinorm | Lipor | Liptor | Mactor | Thervan | Vastor;
  • (FI) Finland: Atorbir | Atorvaratio | Atorvastatin accord | Atorvastatin actavis | Atorvastatin bluefish | Atorvastatin krka | Atorvastatin Leiras | Atorvastatin orion | Atorvastatin pfizer | Atorvastatin Ratiopharm | Atorvastatin Sandoz | Lipistad | Lipitor | Lipitor orifarm | Orbeos;
  • (FR) France: Atorvastatine | Atorvastatine accord | Atorvastatine Actavis | Atorvastatine Almus | Atorvastatine Arrow | Atorvastatine Biogaran | Atorvastatine Bluefish | Atorvastatine Cristers | Atorvastatine eg | Atorvastatine Evolupharm | Atorvastatine isomed | Atorvastatine Krka | Atorvastatine Mylan | Atorvastatine Pfizer | Atorvastatine Phr | Atorvastatine RPG | Atorvastatine sandoz | Atorvastatine Teva | Tahor;
  • (GB) United Kingdom: Atorvastatin | Atorvastatin Almus | Lipitor;
  • (GR) Greece: Altoram | Antorcin | Arvastatil | Ator chol | Atorcard | Atorgon | Atoridor | Atorlip | Atormax | Atorplus | Atorsild | Atorstat | Atorval | Atorvalet | Atorvanox | Atorvastatin/generics | Atorvastatin/krka | Atorvastatin/mylan | Atorvastatin/sandoz | Atorvastatin/tad | Atorvin | Atorzem | Atrost | Atrosterol | Atrovita | Biger | Card ok | Cardiostyl | Danelip | Delipost | Doss Medichrom | Fluxol M T F | Holisten | Latrovin | Lipigan | Lipimed | Lipitor | Lipium Raldex | Lipizem | Lipodial | Lipogen | Lipostatin | Lipovast | Lorvaten | Mexitory | Minolip | Nelibat | Provicard | Rafitin | Rotacor | Rotova | Tevastatin | Torvacard | Torvacard neo | Torvachol | Torvaplus | Torvastin | Vastazor | Xanator | Xolister all | Zarastin | Zarator;
  • (GT) Guatemala: Colvasten | Dislip;
  • (HK) Hong Kong: Apo atorvastatin | Atacor | Atoris | Atorlip | Atorvastatin | Atorvastatin teva | Biotor 10 | Divator | Emstat | Lesstrol | Lipiduce | Lipiget | Lipistad | Lipitor | Lipivas | Lipiwon | Orvakline | Vaspitor | Vick Lipidstatin | Xtor;
  • (HR) Croatia: Artas | Atoris | Atorvastatin Genera | Atorvastatin PharmaS | Atorvox | Calipra | Liptin | MEDiStatin | Sortis | Synordia | Torvas | Tulip;
  • (HU) Hungary: Atorgamma | Atoris | Atorva teva | Atorvastatin 1a pharma | Atorvastatin krka | Atorvastatin Polpharma | Atorvastatin Q Pharma | Atorvastatin ranbaxy | Atorvastatin Ratiopharm | Atorvastatin teva | Atorvep | Copator | Decholest | Gletor | Hypolip | Liprimar | Obradon | Pharmastatin | Sortis | Torvalipin | Torvatec | Voredanin;
  • (ID) Indonesia: Actalipid | Atofar | Atorsan | Atorvastatin | Atorwin | Atostin | Cholestor | Covetor | Fastor | Lipidef | Lipitor | Litorcom | Livator | Nulipid | Orvast | Removchol | Stator | Stavinor | Tavora | Truvaz;
  • (IE) Ireland: Atorvastatin | Atorvastatin Clonmel | Atorvastatin krka | Atorvastatin mylan | Atorvastatin rowa | Lipitor | Torvacol | Torvan;
  • (IL) Israel: Lipitor | Litorva | Torid;
  • (IN) India: A-vin | Ab vas | Acrostatin | Alistor | Alten | Altrip | Alvastatin | Alvotin | Aostin | Arpitor | Asat | Astin | Atalo | Atast | Atcasia | Atchol | Atevas | Atheart | Atix | Ato | Atocare | Atocer | Atocor | Atodin | Atofast | Atorbest | Atorcia | Atorcyn | Atorday | Atordil | Atordin | Atorec | Atorem | Atorfirst | Atorfit | Atorget | Atorica | Atoril | Atorin | Atorise | Atoritic | Atorkem | Atorlip | Atormac | Atormat | Atormed | Atornam | Atornet | Atoroll | Atorsave | Atorslim | Atortin | Atortus | Atorva | Atorvastatin | Atosar | Atosta | Atostat | Atr | Atrocard | Atrolar | Atrolet | Atrostat | Atstat | Attic | Attor | Atv | Atvas | Atvast | Atvastin | Atvel | Avas | Avastin | Avistatin | Avor | Azerva | Aztor | Barostatin | Biotor | Biovas | Caat | Caditor | Cardiozen | Cardistat | Cholechek | Cholestat | Cipvas | Cotrilo | Ctor | Dipolip | Dispitor | Durastat | Dyslip | Dysliptin | Esternex | Etovas | Eze | Genxvast | Hartor | Hypolin | Ibitor | Instatin | Itor | Latin | Ldlow | Ldtor | Lesskaa | Lesstrol | Lilo | Lipichek | Lipicor | Lipicure | Lipid | Lipigold | Lipikind | Lipiles | Lipinorm | Lipipres | Lipira | Lipiric | Lipisafe | Lipitab | Lipivas | Lipofix | Liponorm | Liporest | Lipvas | Lower A | Mactor | Modlip | Molvast | Monotorva | Morstat | Normator | Oltrova | Omnitor | Orvas | Orvastin | Ozovas | Pileca | Pleotor | Pritorva | Pulmistat | Qest | Redustat | Rotacor | Saanvas | Sitestat | Soraton | Statchol | Statfit | Statiga | Statix | Statlip | Stator | Stator-ez | Statwa | Storvas | Strovent | Tg tor | Tonact | Tor hdl | Torsa | Torvason | Trava | Turbostat | Tvs | Unitor | Vagator | Vagolip | Vasc | Vasolip | Vast | Vasta | Vedator | Vestan | Violip | Wolip | Xtor | Zivast;
  • (IQ) Iraq: Atorvasam | Atorvastatin | Atrovastatin awa | Kivas | Liponeer;
  • (IT) Italy: Arkas | Atoris | Atorvastatina | Atorvastatina abc | Atorvastatina accord | Atorvastatina actavis | Atorvastatina Almus | Atorvastatina angenerico | Atorvastatina doc generici | Atorvastatina EG | Atorvastatina firma | Atorvastatina Germed | Atorvastatina git | Atorvastatina krka | Atorvastatina mylan | Atorvastatina nisura | Atorvastatina Pensa | Atorvastatina Ranbaxy | Atorvastatina sandoz | Atorvastatina tecnigen | Atorvastatina zentiva | Coleama | Lipitor | Melemib | Omegastatin | Sopavi | Taxat | Torastin | Torvacol | Torvast | Totalip | Tovanira | Vastat | Xarator;
  • (JM) Jamaica: Lipirest;
  • (JO) Jordan: Aditor | Atorvast | Lipitor | Lipodar | Lipomax | Toralac | Tovast | Vastor;
  • (JP) Japan: Atorvastatin | Atorvastatin me | Lipitor;
  • (KE) Kenya: Arvaz | Astoril | Atocor | Atorcip | Atorec | Atorem | Atorfit | Atorid | Atorin | Atorlip | Atormed | Atorva | Atova | Atrona | Atstat | Avas | Avastatin | Aztor | Caditor | Cholestrom | Colastin L | Colestop | Dipitor | Lesstrol | Lipicon | Lipidrop | Lipiget | Lipikind | Lipilab | Lipimol | Lipitas | Lipitin a | Lipitor | Lipizar | Lipofix | Lipor | Lipsava | Locol | Lolip | Lowchol | Optilip | Storvas | Tg tor | Toralac | Torvast | Umestatin | Vastor;
  • (KR) Korea, Republic of: A Pito | A Stin | A tova | Actovar | Ador | Adwin | Aitatin | Alipid | Allfit | Alphastartin | Alphastatin | Altorva | Apecor | Apito | Aripid | Arito | Arostin | Arotatin | Arotin | Aroto | Arovan | Artech | Artin | Arva | Arvatin | Astan | Astatin | Atatin | Atocel s | Atolow | Atolva | Ator | Atoran | Atoren | Atorin | Atorix | Atorotin | Atorsan | Atorstan | Atorva | Atorvadid | Atorvan | Atorvastatin | Atorvastatin huons | Atorvatin | Atorvin | Atosan | Atosen | Atospo | Atostan | Atostar | Atostin | Atotatin | Atoterol | Atotin m | Atovan | Atovas | Atozal | Atrode | Atrovan | Aukovasta | Ava q | Avasta | Avatin | Barostatin | Bi pito | Bipito | Boriato | Cirmitor | Daewoongbio atorvastatin | Daviato | Eltorva | Farotin | Glosta | Hator | Huniz atorvastatin calcium | Hustar | Hutecs Atorvastatin | I rito | Il yang atorvastatin | Ilyangbio atorvastatin calcium trihydrate | Inist atorvastatin | K torva | Latova | Ldilow | Lipar | Lipiator | Lipiclean | Lipicure | Lipido | Lipien | Lipikhan | Lipilor | Lipilou | Lipino | Lipinon | Lipisante | Lipistatin | Lipistop | Lipitan | Lipiterol | Lipitol | Lipitop | Lipitor | Lipitrol | Lipiwon | Lipoactin | Lipomet | Litoatin | Livatin | Livato | Neustatin a | New atorta | Newpex | Newsta | Newtor | Newvast | Olpit | Pharmbio korea atorvastatin calcium hydrate | Radova | Resterol | Retostin | Retova | Ripia | Ripinon | Ripistin | Rivantin | Rivatadin | Rp vastatin | Ryvantin | Sandoz atorvastatin | Sofia | Speetin | Torvis | Tovast | Tovastin | Udamva | Unipito | Vastatin | Vator | Yungjin atorvastatin;
  • (KW) Kuwait: Atorlip | Lipigard | Lipiless | Lipitor | Lipomax | Lorvast | Toralac | Tovast;
  • (LB) Lebanon: Apo atorvastatin | Astatin | Ator | Atorec | Atorlip | Atorva | Atorvast | Atorvastatin | Atorvastatine arrow generiques | Emitor | Lipigard | Lipitor | Lipodar | Lipomax | Lorvast | Orbalip | Orvasta | Tarden | Toralac | Torstat | Torvacard | Torvalip | Tovast | Zyrotor;
  • (LT) Lithuania: Abaran | Astator | Atorgamma | Atoris | Atorvastatin Actavis | Atorvastatin billev | Atorvastatin Polpharma | Atorvastatin Portfarma | Atorvastatin Ratiopharm | Atorvastatin teva | Atorvastatin zentiva | Lopamol | Sortis | Torvacard | Torvarin | Tulip;
  • (LU) Luxembourg: Atorasat | Atorstatineg | Atorvastatin apotex | Atorvastatin Ratiopharm | Atorvastatine eurogenerics | Atorvastatine sandoz | Lipitor | Totalip;
  • (LV) Latvia: Amicor | Astator | Atilen | Atilen Actavis | Atorgamma | Atoris | Atorvastatin accord | Atorvastatin Actavis | Atorvastatin billev | Atorvastatin Polpharma | Atorvastatin Portfarma | Atorvastatin ranbaxy | Atorvastatin Ratiopharm | Atorvastatin tad | Atorvastatin teva | Lopamol | Sortis | Torvacard | Torvazin | Tulip;
  • (MA) Morocco: Costal | Ld nor | Liptorva | Tahor | Torva;
  • (MX) Mexico: Apolistina | Atorlip | Atorvastatin | Atorvastatina | Atromcor | Bacat | Blodivit | Collipor | Deslocron | Dylaxyl | Eturion | Inastor | Inmetcol | Lipitor | Odivitor | Teinemia | Thoreva | Vascol | Xiadani;
  • (MY) Malaysia: Apo atorvastatin | Astatin | Atacor | Atoris | Atorvas | Atorvastatin | Crystorvas | Lipiduce | Lipistad | Lipitor | Orvakline | Rotaqor | Storvas | Synerrv atorvastatin | Trovem | Tulip;
  • (NG) Nigeria: Artom | Atocard | Atorec | Atorkem | Atorvastatin | Atostor | Atswift | Chovastin | Cidovastin | Filstatin | Grevast | Intracell's atorvastatin | Lipiduce | Lipitor | Medley atorvastatin | Shinfield atorvastatin | Sivovas | Solvastin | Storvas | Suvast | Torvastin | Tostin;
  • (NL) Netherlands: Atorab | Atorvastatin | Atorvastatin ranbaxy | Atorvastatine | Atorvastatine accord | Atorvastatine ratiopharm | Atorvastatine xiromed | Cardyl | Lipitor | Prevencor | Zarator;
  • (NO) Norway: Atorvastatin | Atorvastatin accord | Atorvastatin aristo | Atorvastatin Hexal | Atorvastatin krka | Atorvastatin mylan | Atorvastatin pensa | Atorvastatin Pfizr | Atorvastatin Ratiopharm | Atorvastatin Sandoz | Atorvastatin teva | Atorvastatin xiromed | Lipitor | Sortis;
  • (NZ) New Zealand: Atorvastatin | Lipitor | Lorstat | Noumed atorvastatin | Zarator;
  • (OM) Oman: Torvast;
  • (PE) Peru: Alkast | Ator | Atorquilab | Atorslim | Atorvast | Atorvastatina | Atovarol | Aztor | Biostatina | Corastatin | Lipimid | Lipitas | Lipitor | Lipotropic | Lipovastin | Storvas | Unovas;
  • (PH) Philippines: Adivast | Atonamis | Ator | Ator 10 | Atorbet | Atorcad | Atorcal | Atormax | Atorphil | Atorsaph | Atorschwartz | Atorvacor | Atorvas | Atorvast natrapharm | Atorvastatin | Atorvastatin ritemed | Atorvastatin Sandoz | Atorwin | Atovas | Atv | Atvas | Avamax | Avas | Avator | Bestatin | Betorvas | Brelvastin | Cholduce | Cholesta | Choltrol | Dystatin | Florvast | Fulvast | Globastat | Itorvaz | Leztrol | Lipend | Lipiblac | Lipigo | Lipikhan | Lipiric | Lipitor | Lipivent | Lipotrim | Lofat | Lolip | Mayor | Metorvast | Mytorvas | Onestatin | Orvakline | Pharex Atorvastatin | Protorvas | Q tor | Ranvast | Redulip | Saatin | Stalip | Synator | Truvast | Vastor | Vazi2r | Xantor | Xentor | Zanvator | Zydusatorva;
  • (PK) Pakistan: Apetor | Astat | Atastan | Atavast | Atopitar | Atorax | Atorin | Atorlip | Atorlite | Atorpharm | Atorsan | Atorscot | Atorsim | Atorva | Atorviz | Atovas | Atrachol | Atrata | Atrocal | Atrow | Atvast | Caliptrol | Cholestor | Colezaf | Colstat | Delip | Descol | Etortin | Fatilor | Genovax | Hitor | Lastolip | Lipidin | Lipidip | Lipifal | Lipiget | Lipilow | Lipirex | Lipistat | Lipitor | Lipivas | Lipivastin | Lipotrim | Lochol | Lovas | Megavastin | Momentium | Myopro | Oravast | Orva | Orvast | Oscar | Pro-statin | Raytor | Reduse | Renorm | Ridlip | Rostinox | Save | Sensicon | Sotis | Stat A | Statin | Stator | Tavas | Tavist | Trovas | Truva | Univastin | Vasclear | Vasta | Vastor | Winstor | Zepitor;
  • (PL) Poland: Apo atorva | Atorgamma | Atoris | Atorvagen | Atorvastatin Arrow | Atorvastatin bluefish | Atorvastatin genoptim | Atorvastatin ranbaxy | Atorvastatin teva | Atorvastatin Vitama | Atorvastatinum Farmacom | Atractin | Atrox | Corator | Ivistatyna | Lambrinex | Olvastim | Pharmastatin | Sortis | Storvas | Torvacard | Tulip | Voredanin | Xavitor;
  • (PR) Puerto Rico: Atorvaliq | Atorvastatin | Lipitor;
  • (PT) Portugal: Atorvas | Atorvastatina | Atorvastatina actavis | Atorvastatina alter | Atorvastatina alter genericos | Atorvastatina atorvan | Atorvastatina aurobindo | Atorvastatina Azevedos | Atorvastatina bluepharma | Atorvastatina ciclum | Atorvastatina Cinfa | Atorvastatina daquimed | Atorvastatina Farmogene | Atorvastatina Farmoz | Atorvastatina Generis | Atorvastatina Germed | Atorvastatina gp | Atorvastatina krka | Atorvastatina labesfal | Atorvastatina mepha | Atorvastatina mylan | Atorvastatina pfizer | Atorvastatina pharmakern | Atorvastatina Ranbaxy | Atorvastatina ratiopharm | Atorvastatina sandoz | Atorvastatina tad | Atorvastatina tavitan | Atorvastatina tetrafarma | Atorvastatina teva | Atorvastatina tolife | Atorvastatina triangor | Atorvastatina wynn | Atorvastatina zentiva | Divastina | Zarator;
  • (PY) Paraguay: Atorlip | Atorvastatina | Atorvastatina caplin point | Atorvastatina cipla | Atorvastatina dallas | Atorvastatina medicine | Atorvastatina pasteur | Atorvastatina prosalud | Atorvastatina sandoz | Atorvastol | Hopenor | Liparex | Lipitor | Lipomax | Lipomin | Lipotropic | Torva | Vast;
  • (QA) Qatar: Aprolip | Astatin | Atorcor | Atorlip | Atstat | Cholvast | Colastin-L | Lipigard | Lipitor | Lipodar | Lipomax | Lorvast | Storvas | Torvacol | Torvastin | Tovast | Vastor;
  • (RO) Romania: Amicor | Ascord | Atilen | Atorgamma | Atoris | Atorvastatin ranbaxy | Atorvastatina accord | Atorvastatina aurobindo | Atorvastatina mylan | Atorvastatina teva | Atorvastatina torrent | Gletor | Sortis | Tulip | Xamara;
  • (RU) Russian Federation: Anvistat | Atomax | Ator | Atoris | Atorvastatin | Atorvastatin alkaloid | Atorvastatin avexima | Atorvastatin k | Atorvastatin leksvm | Atorvastatin ms | Atorvastatin nanolek | Atorvastatin Obl | Atorvastatin tabuk | Atorvastatin teva | Atorvox | Lipoford | Lipona | Liprimar | Liptonorm | Torvas | Torvazin | Tulip | Vasator;
  • (SA) Saudi Arabia: Apo atorvastatin | Astatin | Atorlip | Atorva | Ld nor | Lipicure | Lipitor | Lipodar | Tovast | Tulip;
  • (SE) Sweden: Atorab | Atorbir | Atorstad | Atorvastad | Atorvastatin 1a farma | Atorvastatin accord | Atorvastatin Actavis | Atorvastatin aristo | Atorvastatin bluefish | Atorvastatin ebb | Atorvastatin krka | Atorvastatin mylan | Atorvastatin orifarm | Atorvastatin orion | Atorvastatin pfizer | Atorvastatin ranbaxy | Atorvastatin Sandoz | Atorvastatin teva | Atorvastatin xirom | Lipistad | Lipitor | Tavara;
  • (SG) Singapore: Apo atorvastatin | Atavor | Atocor | Atoris | Atorvon | Eturion | Lipitor | Torvalipin | Tulip;
  • (SI) Slovenia: Atoris | Atorvastatin Actavis | Atorvastatin Lek | Atorvastatin stada | Atorvastatin zentiva | Bisatum | Lipitor | Sortis | Stavra | Torvacard | Torvalipin | Tulip;
  • (SK) Slovakia: Amicor | Astator | Atorgamma | Atoridor | Atoris | Atorvastatin | Atorvastatin +Pharma | Atorvastatin Farmax | Atorvastatin Hbf | Atorvastatin Hikma | Atorvastatin mylan | Atorvastatin Polpharma | Atorvastatin stada | Atorvastatin teva | Atorvastatin xantis | Gletor | Pharmastatin | Sortis | Spatizalex | Torvacard | Torvacard novum | Torvazin | Tulip;
  • (TH) Thailand: Atorsan | Atorvastatin Sandoz | Atorvin | Chlovas | Lipitor | Xarator;
  • (TN) Tunisia: Ator | Atorvex | Atrovast | Cholestyl | Laptor | Statinor | Tahor | Tavastor;
  • (TR) Turkey: Alvastin | As Atoks | Ateroz | Ator | Avitorel | Cholvast | Colastin L | Divator | Kolestor | Lipidra | Lipitaksin | Lipitor | Lipsum | Saphire | Tarden | Torvaxal;
  • (TW) Taiwan: Anxolightor | Anxolipo | Atorcal | Atorin | Atoroty | Atorva | Atotin | Atoty | Atova | Atover | Lightor | Lipikon | Lipiminus | Lipistad | Lipitor | Torvacard | Tulip;
  • (UA) Ukraine: Actastatin | Amvastan | Atorem | Atorem 40 | Atoris | Atormac | Atorvacor | Atorvastatin | Atorvastatin teva | Atorvasterol | Atotex | Atsat | Aztor | Emstat | Etset | Limistin | Lipitin | Lipitin a | Lipodemin | Liprimar | Livostor | Torvacard | Torvadac | Vasocleen;
  • (UG) Uganda: Atorem | Atorfit | Atorin | Atorlip | Atorva | Atvin | Avas | Caditor | Colestop | Divator | Lipicure | Lipiduce | Lipitor | Lipizar | Lipodar | Lipor | Torvast | Vast;
  • (UY) Uruguay: Atorva | Atorvestol | Atosclerol | Hipovacor | Integrator | Lipitor | Liponorm | Normolip | Tovaris;
  • (VE) Venezuela, Bolivarian Republic of: Antip | Atorvastatina | Atorvid | Atovarol | Aztor | Colastin L | Estatlen | Filstatin | Glustar | Lipitor | Tarimyl | Teinemia | Volunta;
  • (VN) Viet Nam: Aforsatin | Amtopid | Apamtor | Aszolzoly | Ator vpc | Atorhasan | Atorpa | Atroact | Avasboston | Avastor | Bitorvas | Dorotor | Glovitor | Hacortin | Inbacid | Insuact | Lipidtab | Lipotatin | Lipvar | Normelip | Statinagi | Tormeg 10 | Troytor | Vasitor | Vaslor | Zoamco | Zyatin;
  • (ZA) South Africa: Alipto | Aspavor | Astor | Atolip | Atorvastatin | Atorvastatin lhc | Atorvastatin unicorn | Atorvastatin winthrop | Dezzolip 10 | Dynator | Lestavor | Lipitor | Lipogen | Vasmak | Vastor;
  • (ZM) Zambia: Aspavor | Atorec | Atorem | Atorfit | Atorin | Atorlip | Atorvastatin | Avastatin | Caditor | Lesstrol | Lipitas | Lipitor | Lolip | Modlip | Storvas | Tg tor | Tonact | Torvast;
  • (ZW) Zimbabwe: Aspavor | Storvas
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