This medicine contains the active ingredient atorvastatin, which is a type of medicine called a statin. It works by reducing the production of cholesterol by the liver.

For the sake of simplicity, there are two sorts of cholesterol; a bad sort called low density lipoprotein (LDL) and a good sort called high density lipoprotein (HDL). LDL is deposited in the arteries and increases the risk of heart disease by clogging and narrowing the arteries (atherosclerosis), while HDL actually protects the arteries against this.

Atorvastatin decreases the production of LDL cholesterol by blocking the action of the enzyme in the liver (called HMG-CoA reductase) that is responsible for its production. This decreases the amount of cholesterol in the liver cells, which causes them to take up LDL cholesterol from the blood. The decreased cholesterol production and increased removal of LDL cholesterol from the blood ultimately results in lowered blood cholesterol levels.

As the body produces most cholesterol at night, statins are generally more effective if taken at night.

Atorvastatin also causes a small decrease in the production of other bad fats in the blood called triglycerides, and a small increase in the level of HDL cholesterol. This results in lowered levels of bad fats and raised levels of good fats in the blood.

Statins have an important role in the prevention of coronary heart disease. They reduce the risk of excess cholesterol being deposited in the major blood vessels of the heart. Any blockage in the blood vessels limits the amount of blood and therefore oxygen being carried to the heart muscle. In severe cases this can result in a heart attack (myocardial infarction).

Statins also reduce the risk of stroke by decreasing the risk of excess cholesterol being deposited in the blood vessels leading to the brain. These fat deposits can cause blockage and therefore limit blood and oxygen supply to certain parts of the brain.

Atorvastatin is used to reduce high blood levels of cholesterol and other fats when these cannot be lowered by diet and exercise alone. This helps to reduce the risk of hardening of the arteries (atherosclerosis) and the problems described above that this can cause. It is important to continue to follow a cholesterol-lowering diet and exercise regime while taking atorvastatin.

What is it used for?

High blood cholesterol levels (hypercholesterolaemia)

Inherited high blood cholesterol levels (familial hypercholesterolaemia)

Inherited high levels of fat (lipids) in the blood (mixed hyperlipidaemia)

Warning!

Unless your doctor or pharmacist tells you otherwise, you should avoid drinking grapefruit juice while taking this medicine, as it may affect the level of this medicine in your blood.

It is recommended that you avoid drinking excessive amounts of alcohol while taking this medicine.

This medicine may very rarely have side effects on the muscles. For this reason you should inform your doctor immediately if you experience any muscular symptoms such as pain, tenderness, cramps, or weakness while taking this medicine, particularly if it is accompanied by a fever or feeling generally unwell. Your doctor may need to check for side effects on the muscles by taking a blood test to measure the level of a compound called creatinine kinase in your blood. If this is the case, the test should not be done following strenuous exercise.

You should have blood tests to monitor your liver function (liver function tests) before starting treatment and regularly throughout treatment with this medicine.

You should should continue eating a cholesterol-lowering diet during treatment with this medicine. Discuss this with your doctor.

Use with caution in

Decreased kidney function

Decreased liver function

History of liver disease

History of muscular side effects during previous treatment with a statin or fibrate medicine

Hypothyroidism

Individuals who consume large quantities of alcohol

People aged over 70 years

Personal or family history of hereditary muscle disorders

Not to be used in

Active liver disease

Breastfeeding

Pregnancy

Unexplained raised results in liver function tests

Women of child-bearing potential, unless effective contraception is used to prevent pregnancy

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

This medicine should not be used during pregnancy and pregnancy should be avoided for one month after stopping treatment. Women who could get pregnant should use an effective method of contraception to prevent pregnancy both during treatment with this medicine and for one month after stopping. Seek further medical advice from your doctor.

There is no information available about the safety of this medicine during breastfeeding. For this reason, the manufacturer states that it should not be used during breastfeeding. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Headache

Difficulty in sleeping (insomnia)

Excess gas in the stomach and intestines (flatulence)

Impotence

Chest pain (angina)

Muscle cramps

Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain

Indigestion (dyspepsia)

Hair loss (alopecia)

Alteration in results of liver function tests

Changes in blood sugar levels

Severe swelling of lips, face or tongue (angioedema)

Disorder of the peripheral nerves causing weakness and numbness (peripheral neuropathy)

Disorder of the muscles (myopathy)

Dizziness

Loss of appetite

Decrease in the number of platelets in the blood (thrombocytopenia)

Muscle pain and weakness

Skin reactions such as rash and itch

The side effects listed above may not include all of the side effects reported by the drugs manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

There may be an increased risk of side effects on the muscles

(myopathy) if atorvastatin is taken with any of the following medicines: - ciclosporin
- fibrates, eg bezafibrate, gemfibrozil
- erythromycin
- clarithromycin
- azole antifungals, eg itraconazole
- niacin (nicotinic acid)
- nelfinavir.
Atorvastatin may increase the blood level of digoxin. If you are taking both these medicines your digoxin blood level should be monitored.

Atorvastatin may slightly increase the blood levels of ethinylestradiol and norethisterone that are found in certain brands of the contraceptive pill. For women needing contraception while taking this medicine, a pill that doesnt contain these particular hormones may therefore be preferable.