Journal Club Compound Database

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Atorvastatin Nursing Considerations & Implications | Bioavailable

Compound database
Statins (HMG-CoA reductase inhibitors)
Atorvastatin

AtorvastatinNursing considerations

Known brand names include Lipitor and Atorvaliq.

A statin that lowers LDL ("bad") cholesterol. Taken once a day alongside diet changes, it lowers the risk of heart attack and stroke.

Nursing implications

Hold parameters

Stop if CK is markedly elevated or myopathy is diagnosed or suspected
Pause during acute conditions that raise the risk of renal failure from rhabdomyolysis, such as sepsis, shock, severe hypovolemia, major surgery, or trauma
Stop promptly for serious liver injury with symptoms, hyperbilirubinemia, or jaundice
Stop if immune-mediated necrotizing myopathy is suspected
Stop when pregnancy is recognized, unless the prescriber decides otherwise

Sources: [1][2][3][4]

Administration

Oral, once daily, at any time of day, with or without food
Missed dose: skip it and take the next scheduled dose

Recheck LDL-C as early as 4 weeks after starting, then adjust

Sources: [1]

Assess and report

Side effects by what to assess

General

Nasopharyngitis, joint pain, diarrhea, limb pain, urinary tract infection (5% or more)

Liver

Transient rise in liver enzymes
Hepatic failure (rare) (serious)

Glucose

Higher A1c and fasting glucose

Musculoskeletal

Myopathy and rhabdomyolysis, with acute kidney injury from myoglobinuria (serious)
Immune-mediated necrotizing myopathy (rare) (serious)

Neuro and mental status

Hemorrhagic stroke at 80 mg in patients with a recent hemorrhagic stroke (serious)

Sources: [1][2][3][4][5][6]

Labs and vitals

ALT (liver enzyme)

Why: Hepatic injury
When: Consider before starting, then when clinically indicated
Act on: Stop promptly for serious liver injury with symptoms, hyperbilirubinemia, or jaundice
Normal: 4 to 36 U/L.

Sources: [1][2]

CK (creatine kinase)

Why: Myopathy and rhabdomyolysis
When: When muscle symptoms appear
Act on: Stop if CK is markedly elevated or myopathy is suspected
Normal: Total CK 10 to 120 mcg/L.

Sources: [1][2]

Hemoglobin A1c

Why: Statin-associated rise in glucose
When: Per routine diabetes screening
Normal: Below 5.7% is normal and 6.5% or higher indicates diabetes. Many people with diabetes aim for below 7%.

Sources: [1][2]

LDL cholesterol

Why: Response
When: As early as 4 weeks after starting, then as clinically appropriate
Act on: Adjust dose based on LDL-C response
Normal: Below 100 mg/dL in adults 20 and older.

Sources: [1][2]

Safety

High-alert status

Statins are not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

None on the current label.

Sources: [1]

Antidote or reversal

No specific antidote. Hemodialysis is not expected to help because the drug is highly protein bound.

Sources: [1]

Patient teaching

Report unexplained muscle pain, tenderness, or weakness right away, especially with fever or malaise
Report fatigue, poor appetite, right upper belly pain, dark urine, or yellow skin or eyes
Avoid large amounts of grapefruit juice and review all medicines with the prescriber
Blood sugar and A1c may rise; keep up exercise, weight control, and healthy eating
Tell the prescriber about pregnancy, and do not breastfeed during treatment

Sources: [1]

Sound-alike and look-alike names

atorvastatin and atomoxetine
Lipitor and Loniten
Lipitor and ZyrTEC

Sources: [1]

Dosing

Doses come from the FDA label. Study tool, not for clinical decisions.

Adult dose

Hyperlipidemia and cardiovascular risk reduction: Start 10 or 20 mg once daily; range 10 to 80 mg once daily. Patients needing more than a 45% LDL-C reduction may start at 40 mg.
With interacting drugs: No more than 20 mg daily with clarithromycin, itraconazole, saquinavir or darunavir plus ritonavir, fosamprenavir, elbasvir plus grazoprevir, or letermovir. No more than 40 mg daily with nelfinavir.

Sources: [1][2]

Renal adjustment

None. Renal impairment does not change atorvastatin levels, but it is a myopathy risk factor, so watch for muscle symptoms.

Sources: [1]

Hepatic adjustment

Contraindicated in acute liver failure or decompensated cirrhosis. Exposure is about 4-fold higher in Child-Pugh A and much higher in Child-Pugh B, so use caution in chronic alcoholic liver disease.

Sources: [1][2]

How it works

Mechanism

Competitively inhibits HMG-CoA reductase, the rate-limiting enzyme in liver cholesterol synthesis. The liver responds by making more LDL receptors and pulling more LDL out of the blood, and LDL production also falls.

Sources: [1]