Atorvastatin (Lipitor®) – HMG-CoA Reductase Inhibitor

Overview

Atorvastatin is statin-class drug commonly prescribed for the treatment of dyslipidemias and for the prevention of ischemic cardiovascular events.  It works by inhibiting hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase, a key enzyme in the cholesterol biosynthetic pathway.  Inhibition of HMG-CoA reductase decreases hepatic cholesterol synthesis, increases hepatic cholesterol re-uptake, and decreases serum cholesterol levels.

Atorvastatin is a first-line treatment for several dyslipidemic disorders, including hyperlipidemia (elevated triglycerides, cholesterol, or ApoB), mixed dyslipidemia, heterozygous and homozygous familial hypercholesterolemia, and dysbetalipoproteinemia.  It is also used in secondary prevention of cardiovascular events in patients with clinical evidence of coronary heart disease (CHD), and in primary prevention of ischemic cardiovascular events in patients at high risk (e.g., due to smoking or diabetes) for developing CHD.

The most common adverse effects associated with atorvastatin use are myalgia, arthralgia, GI distress, and an increased risk of upper respiratory and urinary tract infections.  Rarely, atorvastatin can precipitate rhabdomyolysis, myopathy, or tendon rupture.

In Plain English

Atorvastatin decreases the amount of cholesterol made by your liver, lowering the cholesterol in your blood and slowing the growth of plaques in your blood vessels.  This lowers the risk of a plaque rupture and resulting heart attack or stroke.

Clinical Considerations

atorvastatin

Figure 1. Atorvastatin clinical considerations at a glance

Evidence Basis

 

Atorvastatin in the News

  • 2015 NYTimes: https://www.nytimes.com/2015/08/30/health/new-alternatives-to-statins-add-to-a-quandary-on-cholesterol.html

 

Citations

  1. Wishart DS, Feunang YD, Guo AC, Lo EJ, Marcu A, Grant JR, Sajed T, Johnson D, Li C, Sayeeda Z, Assempour N, Iynkkaran I, Liu Y, Maciejewski A, Gale N, Wilson A, Chin L, Cummings R, Le D, Pon A, Knox C, Wilson M. DrugBank 5.0: a major update to the DrugBank database for 2018. Nucleic Acids Res. 2017 Nov 8. doi: 10.1093/nar/gkx1037
  2. Epocrates Rx Online [Internet database]. San Mateo (CA): Epocrates, Inc. 2003. Retrieved at mobile.epocrates.com. Web-based; continuous content updates. Accessed 2018 May 21.
  3. “Prescription Prices, Coupons & Pharmacy Information – GoodRx.” Prescription Prices, Coupons & Pharmacy Information – GoodRxhttp://www.goodrx.com
  4. “DailyMed.” U.S. National Library of Medicine, National Institutes of Health, dailymed.nlm.nih.gov/dailymed/.

 

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