What are the side effects of Lipitor (atorvastatin)?

Side Effects of Lipitor (Atorvastatin)

Lipitor (atorvastatin) can cause several side effects ranging from common mild symptoms to rare serious adverse events, with muscle problems and liver issues being the most concerning potential complications.

Common Side Effects

• Nasal congestion, sore throat, and runny nose 1
• Diarrhea and upset stomach 1
• Urinary tract infection 1
• Nausea 1
• Muscle spasms and joint pain 1
• Pain in extremities 1
• Trouble sleeping 1

Serious Side Effects

Muscle Problems

• Muscle pain, tenderness, and weakness (myopathy) that can be serious and, rarely, lead to kidney damage 1, 2
• Risk factors for muscle problems include:
  • Advanced age (especially >80 years), with women at higher risk than men 2
  • Small body frame and frailty 2
  • Multisystem disease (e.g., chronic renal insufficiency, especially due to diabetes) 2
  • Multiple medications 2
  • Perioperative periods 2
  • Higher doses of atorvastatin 2
  • Concomitant medications that interact with atorvastatin 2

Liver Problems

• Elevated liver enzymes (transaminases) occur in up to 3% of patients 3
• Serious idiosyncratic liver reactions are rare but can be severe 3
• High-dose atorvastatin (80 mg) has been associated with a six-fold increase in enzymatic signs of liver damage compared to lower doses (from 0.2% to 1.2%) 2

Other Potential Serious Side Effects

• Increase in blood sugar levels 1
• Hypersensitivity reactions 2

Drug Interactions

• Increased risk of adverse effects when combined with:
  • Fibrates (particularly gemfibrozil) 2, 4
  • Cyclosporine 2, 5
  • Macrolide antibiotics (e.g., erythromycin) 2, 5
  • Azole antifungals 2, 5
  • Niacin in high doses 2
  • Protease inhibitors 2, 5
  • Grapefruit juice (more than 1.2 liters daily) 1, 5

Monitoring Recommendations

• Baseline liver function tests (ALT, AST) before starting therapy 2
• Follow-up liver function tests approximately 12 weeks after starting therapy, then annually or more frequently if indicated 2
• Baseline CK (creatine kinase) levels before starting therapy 2
• Monitor for muscle symptoms at 6-12 weeks after starting therapy and at each follow-up visit 2
• Obtain CK measurements when patients report muscle soreness, tenderness, or pain 2

Special Considerations

• Pregnancy: Discontinue when pregnancy is recognized as statins should be avoided during pregnancy 1
• Breastfeeding: Should be avoided during breastfeeding 1
• Elderly patients: Use more cautiously, particularly in thin or frail older women 2
• Surgery: Consider withholding atorvastatin during hospitalization for major surgery 2

When to Seek Medical Attention

Patients should contact their healthcare provider immediately if they experience:

• Unexplained muscle pain, tenderness, or weakness, especially with fever or unusual tiredness 1
• Symptoms of liver problems: fatigue, weakness, nausea, vomiting, loss of appetite, upper belly pain, dark amber colored urine, or yellowing of skin or eyes 1
• Signs of allergic reactions 1

Practical Advice for Patients

• Atorvastatin can be taken at any time of day, with or without food 1
• Do not stop taking the medication without consulting your healthcare provider 1
• Report all potential adverse effects immediately, especially muscle symptoms 2
• Maintain regular exercise and healthy diet while taking the medication 1

Remember that while side effects can occur, the benefits of atorvastatin in reducing cardiovascular events in high-risk patients generally outweigh the risks of adverse effects for most patients 2.