WHAT ATORVASTATIN IS AND WHAT IT IS USED FOR
•Atorvastatin belongs to a group of medicines known as statins. Statins lower blood cholesterol (and triglycerides).
•Atorvastatin is advised when a low-fat diet and lifestyle changes have not been adequate to lower blood cholesterol as recommended.
•If you are at an increased risk of heart disease, atorvastatin may also be used to reduce such risk even if your blood cholesterol is “normal”. You should maintain a standard cholesterol-lowering diet during treatment.
WHAT YOU NEED TO KNOW BEFORE YOU TAKE ATORVASTATIN
Do not take atorvastatin if you:
•Are hypersensitive (allergic) to atorvastatin or to any similar medicines used to lower blood lipids or to any of the other ingredients of the medicine – see Section 6 for details.
•Have or have ever had a disease which affects the liver.
•Have had any unexplained abnormal blood tests for liver function.
•Are women able to have children and not using reliable contraception?
•Are pregnant or trying to become pregnant.
Warnings and precautions:
The following are reasons why atorvastatin may not be suitable for you.
Talk to your doctor or pharmacist before taking atorvastatin if you have:
•Had a previous stroke with bleeding into the brain, or have small pockets of fluid in the brain from previous strokes.
•An under-active thyroid gland (hypothyroidism).
•Had repeated or unexplained muscle aches or pains, a personal history or family history of muscle problems.
•Had previous muscular problems during treatment with other lipid-lowering medicines (e.g. other ‘-statin’ or ‘-fibrate’ medicines).
•Had liver disease.
Also take special care with atorvastatin if you:
•Regularly drink a large amount of alcohol
•Are older than 70 years.
Check with your doctor or pharmacist before taking atorvastatin
•If you have severe respiratory failure.
The above are reasons why atorvastatin may not be suitable for you.
If any of the above reasons apply to you, your doctor will need to carry out a blood test before and possibly during your atorvastatin treatment to predict your risk of muscle related side effects. The risk of muscle related side effects e.g. rhabdomyolysis is known to increase when certain medicines are taken at the same time (see Section 2 “Other medicines and atorvastatin”).
While you are on this medicine your doctor will monitor you closely if you have diabetes or are at risk of developing diabetes. You are likely to be at risk of developing diabetes if you have high levels of sugars and fats in your blood, are overweight and have high blood pressure.
Other Medicines and atorvastatin
There are some medicines that may change the effect of atorvastatin or their effect may be changed by atorvastatin. This type of interaction could make one or both of the medicines less effective. Alternatively it could increase the risk or severity of side-effects, including the important muscle wasting condition known as rhabdomyolysis
•Medicines used to alter the way your immune system works, e.g. ciclosporin
•Certain antibiotics or antifungal medicines, e.g. erythromycin, clarithromycin, telithromycin, ketoconazole, itraconazole, voriconazole, fluconazole, posaconazole; rifampin, fusidic acid
•Other medicines to lower blood cholesterol and triglycerides e.g. gemfibrozil, other fibratres, colestipol
•Medicines used for angina or high blood pressure known as “calcium channel blockers” e.g. amlodipine, diltiazem
•Medicines to regulate your heart rhythm e.g. digoxin, verapamil, amiodarone
•Medicines used in the treatment of HIV e.g. ritonavir, lopinavir, atazanavir, indinavir, darunavir, etc.
•Other medicines known to interact with atorvastatin include ezetimibe (lowers cholesterol), warfarin (reduces blood clotting), oral contraceptives, stiripentol (for epilepsy), cimetidine (for heartburn and peptic ulcers), phenazone (a painkiller) and antacids (indigestion products containing aluminium or magnesium)
•Medicines obtained without a prescription: St John’s Wort.
Tell your doctor or pharmacist if you are taking, have recently taken or may take any other medicines.
Atorvastatin with food and drink
how to take atorvastatin. Please note the following:
Do not take more than one or two small glasses of grapefruit juice per day because large quantities of grapefruit juice can change the effects of atorvastatin.
Avoid drinking too much alcohol while taking this medicine. See Section 2 “Warnings and precautions” for details.
Pregnancy, breast-feeding and fertility
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Do not take atorvastatin if you are pregnant or if you are trying to become pregnant.
Do not take atorvastatin if you are able to become pregnant unless you use reliable contraceptive measures.
Do not take atorvastatin if you are breast-feeding. The safety of atorvastatin during pregnancy and breast-feeding has not yet been proven.
Ask your doctor or pharmacist for advice before taking any medicine.
Driving and using machines
Normally this medicine does not affect your ability to drive or operate machines. However, do not drive if this medicine affects your ability to drive. Do not use any tools or machines if your ability to use them is affected by this medicine.
Atorvastatin contains lactose monohydrate
If you have been told by your doctor that you have intolerance to some sugars, contact your doctor before taking this medicinal product.
HOW TO TAKE ATORVASTATIN
Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.
Before starting treatment, your doctor will advise a low-cholesterol diet: you should continue this diet whilst taking atorvastatin.
The usual starting dose of atorvastatin is 10 mg once a day in adults and children aged 10 years or older. This may be increased if necessary by your doctor until you are taking the amount you need. Your doctor will adapt the dose at intervals of 4 weeks or more. The maximum dose of atorvastatin is 80 mg once daily for adults and 20 mg once daily for children.
Atorvastatin tablets should be swallowed whole with a drink of water, and can be taken at any time of day, with or without food. However, try to take your tablet at the same time every day.
The duration of treatment with atorvastatin is determined by your doctor.
Please ask your doctor if you think that the effect of atorvastatin is too strong or too weak.
If you take more atorvastatin than you should
If you accidentally take too many atorvastatin tablets (more than your usual daily dose), contact your doctor or nearest hospital for advice.
If you forget to take atorvastatin
If you forget to take a dose, just take your next scheduled dose at the correct time.
Do not take a double dose to make up for a forgotten dose.
If you stop taking atorvastatin
If you have any further questions on the use of this medicine or wish to stop your treatment, ask your doctor or pharmacist.
POSSIBLE SIDE EFFECTS
Like all medicines, atorvastatin can cause side effects, although not everybody gets them.
If you experience any of the following serious side effects, stop taking your tablets and tell your doctor immediately or go to the nearest hospital accident and emergency department.
Uncommon: affects 1 to 10 users in 1000:
•Inflammation of the pancreas causing abdominal pain and vomiting
Rare: affects 1 to 10 users in 10,000:
•Swelling of the face, tongue and windpipe that can cause great difficulty in breathing
•Severe, extensive, blistering skin rash
•Severe muscle disease: symptoms include muscle weakness, tenderness or pain and if you also feel unwell or have a high temperature then the symptoms may be caused by abnormal muscle breakdown that can be life-threatening and lead to kidney problems.
Very rare: affect less than 1 user in 10,000:
•A sudden allergic reaction with shortness of breath, rash, wheezing and drop of blood pressure
•Unexpected or unusual bleeding or bruising
•Severe liver problems
The following side-effects have also been reported:
Common side effects (affects 1 to 10 users in 100) include:
•Inflammation of the nasal passages, pain in the throat, nose bleed
•Changes in blood sugar levels (if you have diabetes continue careful monitoring of your blood sugar levels)
•Nausea, constipation, wind, indigestion, diarrhoea
•Joint pain, muscle pain and back pain
Uncommon: affects 1 to 10 users in 1000:
•Loss of appetite, vomiting, belching, abdominal pain
•Dizziness, ringing in the ears (tinnitus)
•Numbness or tingling in the fingers and toes, reductions of sensation to pain or touch
•Change in sense of taste
Rare: affects 1 to 10 users in 10,000:
•Jaundice (yellowing of skin)
•Sore muscle tendons that may rupture
Very rare: affects less than 1 user in 10,000:
•Increase in breast tissue in men
Possible side effects reported with some statins (medicines of the same type):
•Breathing problems including persistent cough and/or shortness of breath or fever
•Diabetes. This is more likely if you have high levels of sugars and fats in your blood, are overweight and have high blood pressure. Your doctor will monitor you while you are taking this medicine.
If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet.
HOW TO STORE ATORVASTATIN
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the outer packaging. The expiry date refers to the last day of that month.
Store in the original package.
Do not use this medicine if you notice visible signs of deterioration.
Do not throw away any medicines via waste water or household waste. Ask your pharmacist how to throw away medicines you no longer use.
These measures will help protect the environment.