Atorvastatin: uses, side effects and cautions

Atorvastatin belongs to the statin family. The NHS describes it as a medicine used to treat high cholesterol and to prevent heart attacks and strokes. It is also prescribed for people who have diabetes, kidney disease or familial hypercholesterolaemia, an inherited form of very high cholesterol.

Most people who are offered a statin are not unwell when they start it. The aim is long-range protection: keeping blood fats lower so that fatty deposits in artery walls are less likely to build up over the years. That is why you can feel completely normal on atorvastatin and still be doing something useful.

Atorvastatin is the generic name. Pharmacies may supply it under the active-ingredient name from one of several manufacturers, and the brand the NHS names is Lipitor. The tablets look different from one manufacturer to another, so if the appearance of your supply changes, check with the pharmacist that it is still atorvastatin.

Statins reduce the amount of cholesterol the liver makes. When the liver produces less, more cholesterol is pulled out of the bloodstream and the blood level falls. Lower circulating cholesterol, particularly the LDL fraction, means less material available to be laid down in artery walls.

A statin does not replace the other things that shape heart risk. Stopping smoking, keeping blood pressure under control, being active and eating well all sit alongside the tablet rather than being swapped out by it.

The NHS says most adults can take atorvastatin, and children aged 10 and over can be prescribed it. A prescriber will go through your history first because some conditions make it unsuitable or call for extra care.

• Previous allergic reaction to atorvastatin or another statin.

• Liver or kidney problems.

• An underactive thyroid.

• A family history of muscle disorders.

• A past bleed in the brain.

• Regular heavy drinking.

Atorvastatin comes as tablets or as a liquid called an oral suspension. It is taken once a day, and the NHS suggests choosing a time that suits you and keeping to it. It can be taken with or without food.

The dose depends on the reason you are taking it. The NHS notes that a doctor may start with a low dose and then increase it after four weeks if needed. Follow the dose on your prescription and the leaflet rather than adjusting it yourself.

If you miss a dose, the NHS advice is to skip it and take the next one at the usual time. Do not take two doses to make up for the one you missed. Do not stop because you feel well or because a result has improved; cholesterol tends to rise again once treatment ends, so stopping is a decision to make with your prescriber.

Many people notice nothing. The NHS lists the commoner effects as headache, dizziness, feeling sick, digestive upsets, muscle aches, nose and throat symptoms and difficulty sleeping. Mild effects often settle; if one bothers you or does not go away, mention it to your pharmacist or doctor.

The effect that deserves the most attention is muscle trouble. Unexplained muscle pain, tenderness or weakness should be reported, because rarely a statin can damage muscle. The NHS also lists inflammation of the liver and of the pancreas, and serious allergic reactions, among the rare serious effects. Use NHS 111 if you think you may be having a serious side effect, and 999 for signs of anaphylaxis such as swelling of the face or throat or trouble breathing.

Alcohol increases the risk of liver problems with statins, so keep it modest. Grapefruit juice changes how the body handles atorvastatin; the NHS says not to exceed one or two small glasses a day.

Atorvastatin does not usually affect driving, but if you feel dizzy afterwards, wait until it passes before driving or riding a bike.

Several types of medicine can interact with it, among them fibrates, some antifungals, certain antibiotics and antivirals, some blood pressure and heart medicines, ciclosporin and warfarin. The herbal remedy St John's wort is also on the NHS list. Tell the prescriber and pharmacist about everything you take, including over-the-counter and herbal products.

Statins are not recommended in pregnancy. The NHS says that if you are planning to conceive you should stop atorvastatin three months before you start trying, and it advises discussing breastfeeding with a pharmacist or doctor because it may be compatible but needs checking.

The manufacturer leaflet for an atorvastatin tablet on the emc database also says regular blood tests are used to monitor the medicine and tells patients to report unexplained muscle aches. If liver or muscle symptoms appear between checks, report them rather than waiting for the next appointment.

Other statins such as simvastatin, rosuvastatin and pravastatin work in the same way, and ezetimibe lowers cholesterol by a different route. Which is suitable depends on your risk, other medicines and how you tolerate treatment, and that choice belongs to the prescriber.

Suspected side effects can be reported by patients as well as clinicians through the MHRA Yellow Card scheme.