Introduction to Atorvastatin Side Effects
When the cholesterol levels are high and you cannot manage with diet, your doctor will probably prescribe statins. (1) Nearly 94 million Americans over 20 have above 200 mg/dL total cholesterol levels, and almost 55% are on medications. High cholesterol levels affect children too. (2)
Atorvastatin, a prescription medication from the statins group, may effectively reduce increased levels of LDL and total cholesterol and reduce the risk of heart attack or stroke. (3) However, a smaller group of patients cannot benefit from its effectiveness due to experiencing specific side effects. Nose and throat inflammation, diarrhea, or urinary tract infection are possible common side effects that can be easily managed.
Rhabdomyolysis and hemorrhagic stroke, on the other side, are life-threatening and, although rarely, could be fatal. (3) Your doctor has for sure judged that the effect of atorvastatin is greater than the risk of side effects before prescribing, yet, recognizing their symptoms will help you to prevent severe complications.
This article explains possible side effects associated with atorvastatin. Keep reading to learn about signs and when to call a doctor. You may also find valuable recommendations for overall high cholesterol levels reduction.
Cholesterol: Its role in the body and negative effects
Before moving to side effects, let’s find out the cholesterol role in our bodies and how atorvastatin works.
Cholesterol is a lipid substance that our body needs to make hormones (testosterone and estrogen), cell membranes, and bile acids, which are important for the absorption and digestion of fats and vitamin D. The liver produces most cholesterol that our bodies need. Still, we take a small amount of cholesterol with food, such as meat, eggs, yolks, and cheese. (4-5)
When talking about cholesterol, we should understand the difference between high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol. HDL brings cholesterol from the body into the liver for its elimination. LDL is the cholesterol that forms plaques when increased levels exceed the body’s needs. (4-5)
Plaques are stuck to the walls of the arteries, which are the manifestation of atherosclerosis; this leads to narrowing or blocking arteries and limits oxygen supply to the heart, brain, and other vital organs. Atherosclerosis may cause a heart attack or stroke. (4-5)
Atorvastatin: How it works and why is used
Atorvastatin, a statin also named HMG-CoA (hydroxymethylglutaryl-coenzyme A) reductase inhibitor, completely inhibits the enzyme HMG-CoA reductase and does not allow it to convert to mevalonate. Without this enzyme, the liver cannot produce cholesterol, so the cholesterol level decreases.
Aside from heart attack and stroke due to the plaques, high levels of bad cholesterol can cause chest pain (angina), carotid artery disease, or peripheral artery disease. (3, 6) Therefore, atorvastatin is used to:
- Reduce LDL, total cholesterol, and triglycerides, and increase HDL in those with hyperlipidemia;
- Reduce the risk of myocardial infarction, stroke, revascularization procedures, hospitalization, and angina in adults with coronary heart disease (CHD), and as prevention in those without CHD but at risk. (3)
Common Atorvastatin Side Effects
As with any other medication, atorvastatin may cause side effects. The five most common side effects reported in placebo-controlled clinical trials by the patients using atorvastatin were:
- Inflammation of the nose and throat (nasopharyngitis) – 8.3%;
- Joint stiffness (arthralgia) – 6.9%;
- Diarrhea – 6.8%;
- Pain in extremities – 6.0%;
- Urinary tract infection – 5.7%. (3)
Upset stomach, nausea, insomnia, pharyngolaryngeal pain, tiredness, memory loss, and confusion are other side effects associated with atorvastatin. (3)
Atorvastatin or other drug ingredients may cause an allergic reaction. As a result, swelling of the face, lips, tongue, and/or throat may cause difficulty in breathing or swallowing and may require immediate medical treatment. Call your doctor right away if you experience any of these allergic reactions. (3)
Warning and precautions
Aside from mild side effects, some are moderate to serious and might require medical help. For example, effects on the muscles, liver problems, and stroke are side effects listed in the Warning and precautions part of the Patient information. (3)
Skeletal muscle effects
Atorvastatin may rarely cause very serious conditions, myopathy, and rhabdomyolysis. (3)
Myopathy is a disease of the skeletal muscles (muscles that connect the bones). The fibers of the muscles become weak. Pain in the muscle, cramps, and stiffness are possible myopathy symptoms. Patients with myopathy have limitations in their daily activities, such as standing up, having a bath, combing hair, etc. (7-8)
Rhabdomyolysis is muscle damage when the protein myoglobin is released into the blood. This protein is eliminated with urine through the kidneys. If the myoglobin amount is too large, it can damage the kidneys. (9-10)
Rhabdomyolysis leads to permanent disability but can also be a life-threatening medical condition with kidney failure and even death. If you experience some of the following signs, they could be symptoms of rhabdomyolysis:
- Swollen muscles with pain;
- Dark urine (tea- or cola-colored);
- Feeling weak or tired;
- Unable to complete job tasks or workout routine. (9-10)
The risk increases when higher doses of atorvastatin are used concomitantly with cyclosporine, clarithromycin, erythromycin, antifungals, and medication to treat human immunodeficiency virus (HIV), or hepatitis C virus. (3)
Call your doctor immediately to report if you have unexplained and/or persistent muscle pain, tenderness, or weakness. If rhabdomyolysis is suspected, your doctor will discontinue atorvastatin treatment and prescribe other medication. (3)
Atorvastatin may increase hepatic transaminases (liver enzymes) and cause liver inflammation. This rare side effect was reported by 0.7% of the patients in clinical trials. Transaminase levels return to normal by dose reduction, treatment interruption, or discontinuation. If the transaminase levels are increased more than three times on two or more occasions, it is about persistent elevation. (3, 11)
The signs of possible liver problems are yellowing skin or eye whites, dark-colored urine, unusual fatigue or weakness, loss of appetite, and pain in your upper abdomen. (3, 11)
For this reason, before initiating atorvastatin or other statin therapy, your doctor would ask for an enzyme test and to check again during the treatment if necessary. If symptoms of jaundice or hyperbilirubinemia occur, call your doctor; if serious, the doctor will discontinue the therapy. (3)
A higher incidence of hemorrhagic stroke
Atorvastatin is used to reduce the risk of stroke in adults at risk and without CHD and to reduce the risk of fatal and nonfatal stroke in adults with CHD. However, studies have shown a higher incidence of hemorrhagic stroke (bleeding in the brain after rupture of the weakened vessel) in patients at 80 mg atorvastatin without CHD who had a stroke in the last six months vs. placebo. (3)
The incidence of nonfatal stroke was significantly higher in the atorvastatin group compared with the placebo. A fatal stroke might happen, although the incidence was similar in both groups. (3)
American Stroke Association suggests the F.A.S.T. warning signs:
F = Face Drooping – Does one side of the face droop, or is it numb?
A = Arm Weakness – Is one arm weak or numb?
S = Speech Difficulty – Is speech slurred?
T = Time to call 911
Acting following the F.A.S.T. warning signs might save a life. (12)
Blood sugar increase
Atorvastatin, like other statins, may increase blood sugar, a side effect reported in clinical trials. This may lead to developing type II diabetes or worsening existing diabetes. (3) The risk is small; however, you should be aware and talk to your doctor if any of the type 2 diabetes symptoms occur, such as:
- Unintended wreased thirst or hunger.
- Frequent weight loss.
- Blurred vision.
- Slow-healing sores. (13)
Atorvastatin is available in tablets of 10, 20, 40, and 80 mg and offers flexibility for dosing.
The recommended initial dose in adults is 10 to 20 mg once daily, while those who need more considerable LDL reduction (>45%) will begin with 40mg. The dose can be increased to 80mg once daily. (3)
In children 10 to 17 years of age, the starting dose is 10 mg, in a range of 10 to 20 mg. (3)
Take atorvastatin every day at the same time, with or without food. Don’t break the tablets before taking them. If you miss a dose, take it as soon as possible unless the time for the next dose is less than 12 hours. In that case, wait until the regular time comes. (3)
If you take too much, go to the closest emergency room or call Poison Control Center immediately. (3)
Atorvastatin can effectively lower bad cholesterol and/or reduce the risk of heart attack, stroke, certain types of heart surgery, and chest pain. However, it is not recommended for patients with active liver disease, who are allergic to any component of this medication, who are pregnant, or breastfeeding. (3)
Side effects of atorvastatin have been well-known during its therapeutic usage for over 25 years. However, learn all about side effects in patient information and how to identify symptoms of stroke, myopathy, rhabdomyolysis, and liver or kidney problems. Call your doctor to tell the adverse reaction you experience and report to Food and Drug Administration at 1-800-FDA-1088 or www.fda.gov/medwatch or the manufacturer.
Atorvastatin is an adjunct therapy to diet; therefore, you should continue with a healthy diet containing lots of fruits and vegetables, whole grain cereals, beans, lentils, and fish. Limit food rich in cholesterol (liver, organ meats, eggs, shrimp, etc.) and salt, and limit alcohol. (14)
In addition to diet, National Heart, Lung, and Blood Institute recommends regular physical activity and achieving and maintaining of healthy weight. You may find more about lowering cholesterol in the Therapeutic Lifestyle Changes guide (15) and the American Heart Association website.
Cholesterol management is a long-term process, sometimes for a whole life. Therefore, your dedication is necessary to prevent life-threatening situations by using medications as recommended and introducing and maintaining a healthy lifestyle.
- American Heart Association, Cholesterol Medications, 2020 Nov,
- Centers for Disease Control and Prevention, High Cholesterol Facts, 2022 Oct,
- Food and Drug Administration, LIPITOR® (atorvastatin calcium) tablets, for oral use, Prescribing Information Patient information, 2019 Apr,
- Harvard Medical School, Cholesterol,
- MedlinePlus, Cholesterol, 2020 Dec,
- National Library of Medicine, Atorvastatin, 2022 Sep,
- Cleveland Clinic, Myopathy, 2022 Jan,
- American Association of Neuromuscular & Electrodiagnostic Medicine, Myopathy, https://www.aanem.org/Patients/Muscle-and-Nerve-Disorders/Myopathy
- Centers for Disease Control and Prevention, Rhabdomyolysis, 2019 Apr, https://www.cdc.gov/niosh/topics/rhabdo/default.html#:~:text=Rhabdomyolysis%20(often%20called%20rhabdo)%20is,permanent%20 disability%20or%20 even%20death.
- Cleveland Clinic, Rhabdomyolysis, 2019 Apr, https://my.clevelandclinic.org/health/diseases/21184-rhabdomyolysis
- Mayo Clinic, Statin side effect: Weigh the benefits and risks, 2022, Sep,
- American Stroke Association, Stroke Symptoms,
- Mayo Clinic, Type 2 diabetes, 2022 Nov,
- MedlinePlus, How to Lower Cholesterol with Diet, 2021 May,
- National Heart, Lung, and Blood Institute, Therapeutic Lifestyle Changes, 2005 Dec,