Atorvatin
Atorvatin is atorvastatin 5 mg tablets — useful sub-therapeutic starting dose for patients requiring gentle titration (frail elderly, CYP3A4 interaction-prone, history of myalgia on higher statin doses). Standard atorvastatin monotherapy starts at 10-20 mg; 5 mg is a stepping-stone for tolerability-limited initiation. LDL reduction roughly 30-35% vs placebo at 5 mg. Full indication profile of atorvastatin — CV primary and secondary prevention.
✓ Medisch beoordeeld door Morgan Ellis — Apotheekonderzoeker · 8 jaar ervaring · Laatst beoordeeld: mei 2026
⚡ Quick Answer — What is Atorvatin?
Atorvatin is een 5 mg atorvastatin tablet from a WHO-GMP certified manufacturer — a high-intensity HMG-CoA reductase inhibitor (statin), lipophilic. Statins reduce cardiovascular events by 20-30% per mmol/L LDL-cholesterol reduction across primary prevention, secondary prevention, diabetes, and post-stroke populations. Atorvastatin was introduced by Parke-Davis/Pfizer in 1996 as Lipitor — the best-selling drug of all time at its peak ($12.5 billion/year in 2006). Lipophilic statin, hepatically cleared via CYP3A4. Dose range 10-80 mg once daily; 40-80 mg are high-intensity by AHA/ACC 2018 lipid guidelines. Potency: atorvastatin 40 mg typically reduces LDL-C by 50%; 80 mg by 55%. Typical dose: once daily, evening (for short-half-life statins) or any time for atorvastatin (half-life long enough that timing does not matter). Main side effects: muscle symptoms (0.1-1% with confirmed CK elevation; up to 10% nocebo muscle aches), mild transaminase elevation (3%), new-onset diabetes in at-risk patients (~0.2 per 100 patient-years). Absolutely contraindicated in pregnancy, active liver disease, rhabdomyolysis history.
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What Is Atorvatin?
Atorvatin is an oral 5 mg atorvastatin tablet from a WHO-GMP certified manufacturer, supplied in 30-180 tablets. Atorvastatin was introduced by Parke-Davis/Pfizer in 1996 as Lipitor — the best-selling drug of all time at its peak ($12.5 billion/year in 2006). Lipophilic statin, hepatically cleared via CYP3A4. Dose range 10-80 mg once daily; 40-80 mg are high-intensity by AHA/ACC 2018 lipid guidelines.
How Atorvastatin Works
Atorvastatin inhibits HMG-CoA-reductase, the rate-limiting enzyme of hepatic cholesterol biosynthesis. Downstream:
- Reduced intracellular cholesterol in hepatocytes — triggers sterol-regulatory element binding protein (SREBP) activation and upregulation of LDL-receptor expression on the hepatocyte surface
- Increased clearance of circulating LDL-C — the primary LDL-lowering mechanism
- Modest triglyceride reduction (10-20%) and modest HDL rise (5-10%)
- Pleiotropic effects beyond LDL-lowering — reduced vascular inflammation (hs-CRP drop), improved endothelial function, plaque stabilisation, reduced platelet reactivity. The magnitude of the clinical benefit across trials exceeds what is explained by LDL-C change alone.
Atorvatin Dosage
Primary prevention (no prior CV event): start 10-20 mg once daily; titrate to target based on 10-year ASCVD risk. For diabetics or ASCVD risk >7.5%, moderate-intensity (20-40 mg) is typical.
Secondary prevention (prior MI, stroke, PAD, or diabetic CVD): high-intensity therapy — 40-80 mg once daily. Target LDL-C <1.8 mmol/L (<70 mg/dL) per 2019 ESC and <1.4 mmol/L (<55 mg/dL) for very-high-risk ASCVD per 2021 ESC update.
Familial hypercholesterolaemia: maximum-tolerated statin (usually 80 mg) often combined with ezetimibe 10 mg and/or PCSK9 inhibitor (alirocumab/evolocumab/inclisiran) to achieve guideline targets.
Toediening: once daily with or without food. Evening dosing is no longer required for atorvastatin (long half-life); any consistent time of day is fine.
Monitoring:
- Uitgangswaarden: full lipid panel, LFTs (ALT), creatine kinase (CK), HbA1c or fasting glucose, creatinine, thyroid-stimulating hormone (TSH) if not recently checked.
- 4-12 weken: repeat lipids to assess response. Expect atorvastatin 40 mg typically reduces LDL-C by 50%; 80 mg by 55%. Dose-escalate if target not met.
- Jaarlijks: lipids, LFTs (unless symptomatic). CK only on muscle complaints, not routinely.
- Stop en onderzoek: CK >10× ULN, ALT >3× ULN and rising, persistent unexplained muscle pain with CK >5× ULN, rhabdomyolysis (dark urine, profound weakness).
Evidence for Atorvastatin
CARDS (2004) — atorvastatin 10 mg in 2,838 type 2 diabetics without overt CVD reduced major CV events by 37% (primary prevention in diabetes). ASCOT-LLA (2003) — atorvastatin 10 mg in 10,305 hypertensives reduced CV events by 36%. TNT (2005) — 80 mg vs 10 mg in stable CAD; high-dose reduced events by 22%. PROVE-IT (2004) — atorvastatin 80 mg vs pravastatin 40 mg post-ACS; atorvastatin superior. SPARCL (2006) — atorvastatin 80 mg after stroke/TIA reduced recurrent stroke by 16%.
Goedgekeurde en evidence-based toepassingen
- Primary and secondary prevention of cardiovascular disease in patients with dyslipidaemia
- Type 2 diabetes (CARDS) even with “normal” LDL
- Post-stroke secondary prevention (SPARCL)
- Familial hypercholesterolaemia (80 mg; often requires combination with ezetimibe or PCSK9 inhibitor)
Practical Considerations
Grapefruit juice interacts — inhibits intestinal CYP3A4, raising atorvastatin levels 2-3 fold. Small amounts (one glass, once) usually OK; regular daily grapefruit should be avoided. Sterke CYP3A4-remmers (clarithromycin, ritonavir, ketoconazole) substantially raise atorvastatin levels and myopathy risk.
Bijwerkingen
Vaak (>1%):
- Myalgia (muscle pain) — bothersome in 5-10% of users; confirmed statin-associated muscle symptoms with CK rise in 0.1-1%. High nocebo component: SAMSON trial (2020) showed no difference between statin and placebo in double-blind n-of-1 crossovers in many “statin-intolerant” patients.
- Lichte verhoging van transaminasen — 3% have ALT rise below 3× ULN; usually transient and does not require dose change.
- New-onset diabetes — absolute excess ~0.2 per 100 patient-years, mostly in prediabetic patients. CV benefit far exceeds diabetes risk.
- Headache, dyspepsia, nausea
- Erectiestoornissen (uncommon; mechanism unclear)
- Sleep disturbance, cognitive fog (reported but not consistent in RCTs)
Zeldzaam maar klinisch belangrijk:
- Rhabdomyolyse (<1 per 10,000 patient-years) — severe muscle breakdown, renal failure risk. Stop immediately on dark urine + profound weakness + CK >10× ULN.
- Immuungemedieerde necrotiserende myopathie — rare persistent myopathy that continues after stopping statin; anti-HMGCR antibody mediated. Needs immunosuppressive treatment.
- Severe transaminitis / drug-induced liver injury — rare; stop if ALT >3× ULN with symptoms or rising trajectory.
- Perifere neuropathie (zeldzaam)
Contra-indicaties
- Zwangerschap en borstvoeding — statins are contraindicated; cholesterol is required for fetal neurodevelopment.
- Actieve leverziekte or unexplained persistent ALT >3× ULN.
- Prior rhabdomyolysis or severe statin-intolerance confirmed in double-blind rechallenge.
- Concurrent strong CYP3A4 inhibitors (for atorvastatin): clarithromycin, itraconazole, ritonavir — hold statin or switch to rosuvastatin/pravastatin.
- Hypersensitivity to the statin.
Geneesmiddelinteracties
- Sterke CYP3A4-remmers — KRITIEK. Clarithromycin, erythromycin, itraconazole, ketoconazole, ritonavir, cobicistat, ciclosporin — raise atorvastatin levels 2-10 fold. Hold statin during short antibiotic courses; switch to rosuvastatin or pravastatin for long-term CYP3A4 inhibitor co-therapy.
- Grapefruitsap — avoid regular daily consumption with atorvastatin (2-3 fold interaction).
- Fibrates (gemfibrozil, fenofibrate) — additive myopathy risk. Gemfibrozil is the worst; fenofibrate is the preferred fibrate for combination. Reserve combinations for specialist dyslipidaemia care.
- Niacin high-dose — additive myopathy risk. Low-dose niacin (1-2 g) usually tolerated.
- Warfarine — small INR rise with statin initiation; check INR 1 week after starting. Not a contraindication.
- Digoxine — small digoxin level rise with atorvastatin (P-glycoprotein); usually not clinically significant.
- Alcohol — heavy intake raises liver injury risk. Moderate intake is acceptable.
Opslag
Store Atorvatin below 25°C in the original blister pack. Keep out of reach of children.
Veelgestelde vragen
Do I have to take Atorvatin at night?
No — atorvastatin has a 20-30-hour half-life, long enough that the ~24-hour cycle of nocturnal cholesterol synthesis is covered regardless of dose timing. Morning dosing with other medications is fine. The “take statins at night” rule comes from short-half-life statins (simvastatin, lovastatin).
What if I get muscle aches on Atorvatin?
Common and rarely dangerous. Check creatine kinase (CK). If CK is normal, the pains are usually not statin-related — the SAMSON trial (2020) showed most “statin-intolerant” patients had equal aches on placebo in double-blind crossover. Options: continue statin with vitamin D supplementation (if deficient), try coenzyme Q10 (weak evidence but low-risk), switch statin (rosuvastatin has lower muscle-symptom rate than simvastatin and atorvastatin in some trials), lower the dose, or adopt alternate-day dosing. Only stop if CK >10× ULN, symptoms are disabling, or there is objective weakness.
Will Atorvatin give me diabetes?
Statins cause a small excess of new-onset diabetes — approximately 1 extra diabetes case per 1,000 people per year, mostly in those already at high diabetes risk (overweight, prediabetes, family history). The same treatment prevents roughly 5-10 cardiovascular events per 1,000 people per year in the same populations — so the net benefit is strongly positive. Do not stop a statin because of diabetes risk alone.
Can I take Atorvatin with grapefruit juice?
Occasional small amounts of grapefruit juice (one glass) are usually fine. Daily consumption substantially raises atorvastatin levels (2-3 fold via intestinal CYP3A4 inhibition) and increases myopathy risk. If you drink grapefruit juice regularly, switch to rosuvastatin or pravastatin, which have minimal grapefruit interaction.
How long will I need to take Atorvatin?
Indefinitely, in almost all cases. Stopping a statin causes LDL-C to rebound within weeks and cardiovascular protection is lost within months. Statins are lifelong preventive therapy for atherosclerotic disease, not a short course.
Can I take Atorvatin in pregnancy?
No — statins are contraindicated in pregnancy and breastfeeding. Cholesterol is required for fetal neurodevelopment; statins cross the placenta. Stop the statin before planned pregnancy; if pregnancy is unplanned, stop immediately and discuss risks with a specialist. Familial hypercholesterolaemia patients can usually safely defer statin therapy during pregnancy and breastfeeding.
Where can I buy Atorvatin online?
You can buy Atorvatin (atorvastatin 5 mg, 30-180 tablets) from MedsBase with discreet packaging and worldwide shipping.
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Waarom bestellen bij MedsBase
Atorvatin is supplied through a WHO-GMP certified manufacturer with full COA documentation. We ship worldwide in plain, discreet packaging, and every order is covered by our Reshipment Assurance Policy. Uw betalingsbeschrijving bij betaling per kaart toont de gereguleerde betalingsverwerker (een gereguleerde kaartbetalingverwerker), nooit “MedsBase” of een medicijnnaam.
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| Sterkte | 5 mg |
|---|---|
| Hoeveelheid | 30 Tabletten, 60 Tabletten, 90 Tabletten, 180 Tabletten |
Vragen & antwoorden
Atorvatin
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