Atorvastatin (Lipitor) Uses and Side Effects: 10, 20, 40, 80mg Tablets
Atorvastatin (Lipitor) 10mg, 20mg, 40mg, and 80mg uses and side effects. Learn the “LIPITOR” mnemonic to remember the main side effects involving the liver, blood sugar, muscles, and more!
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Atorvastatin (Lipitor) Uses
Generic Name: Atorvastatin
Brand Name: Lipitor
Drug Class: Statins, Lipid-Lowering Agents, HMG-CoA reductase inhibitors
Dosage Forms and Strengths: 10mg, 20mg, 40mg, and 80mg tablets
Atorvastatin (Lipitor) is a medication used to help lower cholesterol and reduce the risk of cardiovascular disease such as strokes and heart attacks.
Atorvastatin belongs to a drug class called “statins”.
Common statin medications include Atorvastatin (Lipitor), Rosuvastatin (Crestor), Simvastatin (Zocor), Pitavastatin (Livalo), Pravastatin (Pravachol), Fluvastatin (Lescol), and Lovastatin (Mevacor, Altoprev).
For more information on how statins work, check out their mechanism of action in the general statin side effects lecture.
While atorvastatin is effective in lowering cholesterol levels, some individuals may experience side effects.
Let’s walk through the main side effects associated with atorvastatin.
Atorvastatin (Lipitor) Side Effects
Here is a simple mnemonic to remember the main side effects of atorvastatin.
The mnemonic fittingly uses the word “LIPITOR”.
Some of the main side effects we will discuss include liver effects, increased blood sugar, muscle pain, impaired memory, fatigue, headaches, rhabdomyolysis, and more!
Let’s walk through each side effect below.
Atorvastatin (Lipitor) Side Effects: Use the mnemonic “LIPITOR” to remember Liver effects, Increased blood sugar, Pain, Impaired memory, Tiredness, Other, and Rhabdomyolysis.
Liver Side Effects - Atorvastatin
The first letter in the “LIPITOR” mnemonic is “L”, which stands for “Liver Effects”.
“LIPITOR” Mnemonic
L = Liver Effects
Atorvastatin may increase liver enzyme levels in the blood.
The main liver enzymes affected are aspartate transaminase (AST) and alanine transaminase (ALT).
AST and ALT are called transaminases, so the elevation of these enzymes is referred to as transaminitis.
Let’s take a closer look below.
Elevated AST and ALT (Transaminitis)
AST and ALT are 2 of the main enzymes found in the liver, and they are involved in hepatic function.
Atorvastatin may increase AST and ALT levels in the blood, a phenomenon known as transaminitis.
Transaminitis is thought to be due to leakage of the enzymes into the bloodstream rather than actual damage to the liver.
In rare cases, however, statins may cause inflammation or injury to the liver as well.
As AST and ALT leak into the bloodstream, higher than normal levels may be detected on a blood test.
This is why your provider may run a blood test to check your AST/ALT levels, along with your overall liver function, before starting you on atorvastatin.
Depending on your situation, your provider may also monitor your AST/ALT levels periodically while taking atorvastatin.
Transaminitis most commonly occurs when first starting atorvastatin, and it typically does not cause symptoms.
In many cases, the increase in liver enzymes is temporary and will return to a normal range on its own without having to stop the statin.
However, if you show signs of liver injury (yellowing of the skin/eyes, abdominal pain, vomiting, changes to stool, etc.), then you should seek medical attention and/or consult with your provider.
Atorvastatin (Lipitor) Side Effects: Atorvastatin can cause elevated liver enzymes (AST and ALT) called transaminitis.
If the elevated liver enzymes do not improve on their own, then they typically resolve by decreasing the atorvastatin dose or temporarily stopping the medication.
Once the liver enzymes are back to normal, many individuals can restart their statin medication without the liver enzymes increasing again.
The potential for developing transaminitis is typically dose-dependent.
This means the higher the dose of atorvastatin, the greater the risk of developing transaminitis.
Other contributing risk factors for elevated liver enzymes include preexisting hepatitis (inflammation of the liver), advanced age, presence of other chronic illnesses, etc.
Atorvastatin (Lipitor) Side Effects: The risk for developing transaminitis (elevated liver enzymes such as AST and ALT) is typically dose dependent.
Increased Blood Sugar - Atorvastatin
The next letter in the “LIPITOR” mnemonic is the first “I”, which stands for “Increased Blood Sugar”.
“LIPITOR” Mnemonic
I = Increased Blood Sugar
Normally
The pancreas produces and secretes a hormone called insulin.
Insulin is important in regulating blood sugar.
After a meal, insulin is secreted by the pancreas and binds to insulin receptors on cells.
This allows for cells to take up glucose from the blood and use it as a source of energy to help the cell function.
Atorvastatin (Lipitor) Side Effects: Normally the pancreas secretes insulin which allows for cells to take up glucose from the blood to be used as energy.
Atorvastatin Use
The use of statins may decrease insulin secretion from the pancreas, as well as make cells less sensitive to insulin.
As a result, cells will have a harder time taking up glucose from the blood.
This can lead to an increase in blood sugar.
Atorvastatin (Lipitor) Side Effects: Atorvastatin can decrease insulin secretion from the pancreas and make cells less sensitive to insulin, which can increase blood sugar levels.
Having Said That…
The benefit of reducing cardiovascular disease (strokes, heart attacks, etc.) from a statin typically outweighs the risk of developing a mild increase in blood sugar, even in those who already have diabetes.
The risks and benefits of atorvastatin vary from person to person, so it is always good to discuss with your provider.
Muscle and Joint Pain - Atorvastatin
The next side effect in the “LIPITOR” mnemonic is the “P”, which stands for “Pain”.
This primarily involves muscle pain, but joint pain has been reported as well.
“LIPITOR” Mnemonic
P = Pain (Muscles and Joints)
Some individuals taking atorvastatin have reported muscle pain, tenderness, cramps, spasms, or weakness.
The muscle pain may be bilateral and symmetrical.
Symptoms are limited to the skeletal muscles and do not involve cardiac or smooth muscles.
Similar to transaminitis, muscle pain has been shown to be dose-dependent as well.
This means the higher the dose of atorvastatin, the greater the potential risk of developing muscle pain.
Symptoms are typically reversible with discontinuation of the statin.
Some studies have shown individuals to report muscle pain when they were actually taking a placebo instead of a statin, so muscle pain from atorvastatin may not be as common as reported.
Atorvastatin (Lipitor) Side Effects: Atorvastatin may cause muscle pain, tenderness, cramps, spasms, or weakness.
Impaired Memory - Atorvastatin
The next side effect in the “LIPITOR” mnemonic is the second “I”, which stands for “Impaired Memory”.
“LIPITOR” Mnemonic
I = Impaired Memory
Some individuals have reported mild memory loss and confusion while taking a statin.
However, there is not much supportive data to suggest statins are the cause nor that statins lead to dementia.
Cognitive side effects are often labeled as “non-serious and reversible”.
Tiredness and Fatigue - Atorvastatin
The next letter in the “LIPITOR” mnemonic is “T”, which stands for “Tiredness”.
“LIPITOR” Mnemonic
T = Tiredness
Some individuals have reported increased tiredness and fatigue while taking atorvastatin.
Others have reported insomnia and difficulties falling/staying asleep.
Other (Headaches, etc.) - Atorvastatin
Next we have the “O” which stands for “Other”.
“LIPITOR” Mnemonic
O = Other (Headaches, Nausea)
This is the “catch-all” category to include other mild side effects such as headaches, nausea, vomiting, diarrhea, dizziness, fevers, and infectious symptoms.
This list does not contain all possible side effects. Consult with your provider for more information, or if you have any symptoms, concerns, changes to health, etc.
Rhabdomyolysis - Atorvastatin
Finally, we have the “R” in “LIPITOR” which stands for “Rhabdomyolysis”.
“LIPITOR” Mnemonic
R = Rhabdomyolysis
Rhabdomyolysis is a rare side effect, characterized by the breakdown of skeletal muscle.
As mentioned above, atorvastatin can cause muscle side effects including muscle pain and tenderness.
Rhabdomyolysis is the severe form of that.
Symptoms of rhabdomyolysis may include muscle pain or weakness, and dark urine.
Creatine kinase (CK) is an enzyme found in muscle cells and is involved in muscle cell function.
When muscle cells breakdown, as seen in rhabdomyolysis, creatine kinase is released into the bloodstream.
CK can be measured using a blood test, and elevated levels could be a marker for muscle damage.
Myoglobin is a protein found in muscle cells.
When muscles breakdown, myoglobin is also released into the bloodstream and excreted in the urine (myoglobinuria).
Myoglobinuria may cause the urine to appear dark.
Myoglobin can be measured as part of a urine test, and increased levels could suggest rhabdomyolysis.
Atorvastatin (Lipitor) Side Effects: A rare side effect of atorvastatin is rhabdomyolysis, characterized by muscle breakdown.
Possible risk factors for rhabdomyolysis include taking high doses of statins, advanced age, diabetes, taking certain medications with a statin, among others.
Complications of rhabdomyolysis include electrolyte abnormalities (such as high potassium levels), kidney injury, and arrhythmias to name a few.
Atorvastatin (Lipitor) Side Effects: Characteristics of rhabdomyolysis, a rare side effect of atorvastatin.
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References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5853001/
https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-018-1685-0
https://www.acc.org/latest-in-cardiology/articles/2018/12/12/07/23/statin-safety-and-adverse-events
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766774/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4360430/
https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statin-side-effects/art-20046013
https://www.mdpi.com/1422-0067/21/13/4725/htm
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https://www.ncbi.nlm.nih.gov/books/NBK430940/