Atorvastatin (Lipitor) Nursing Implications and Patient Teachings

Introduction

In this article, you’ll learn about atorvastatin nursing implications and patient teachings. Also, its dosage, indication, contraindications, interactions, side effects, nursing assessment, and nursing interventions.

Atorvastatin also known as its brand name Lipitor is the most commonly prescribed statin. It is beneficial in the treatment of dyslipidemia and hypercholesterolemia.

Atorvastatin (Lipitor) is also used to prevent cardiovascular events (such as MI, stroke, revascularization procedures, and angina) in patients with coronary heart disease (CHD) and several risk factors (such as smoking, hypertension, diabetes mellitus type 2, low HDL-C, age, or a family history of early coronary heart disease).

Generic Name: Atorvastatin

Brand Names: Lipitor

Atorvastatin (Lipitor) Class and Category

Pharmacologic class: 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor (statin)  

Therapeutic class: Anti-hyperlipidemic,

Pregnancy category: X

Atorvastatin (Lipitor) Dosage

  • Adults: PO: 10-40 mg, OD. Maximum dose: 80 mg/day

Atorvastatin Pharmacokinetics and Pharmacodynamics

RouteOnsetPeakDuration
PO1 – 2 hr
Atorvastatin (Lipitor) Pharmacokinetics and Pharmacodynamics

Absorption: Atorvastatin is rapidly absorbed in the GI tract when taken orally. However, bioavailability is low (approximately 14%).

Distribution: Protein binding is more than 98%.

Metabolism: Hepatic.

Half-life: 14 hr (for plasma elimination) and 20–30 hr (for inhibitory activity of HMG-CoA reductase due to active metabolites)

Excretion: Primarily excretes through feces and about 2% is excreted in the urine.

Atorvastatin (Lipitor) Mechanism of Action

Reduces cholesterol synthesis by inhibiting the HMG-CoA reductase enzyme.

Therapeutic effect: reduces LDL, VLDL, and plasma triglyceride levels, while increasing HDL levels.

What are the indications of atorvastatin (Lipitor)?

Atorvastatin indications include:

  • To treat hypercholesterolemia, hyperlipidemia, and dyslipidemia.
  • As a cardiac prophylactic to lower the risk of cardiac events in people who have several risk factors.

What are the contraindications of atorvastatin (Lipitor)?

The contraindications of atorvastatin are:

  • Hypersensitivity to atorvastatin.
  • During lactation.
  • Present liver disease
  • Pregnancy

Caution: Anticoagulant therapy; previous hepatic disorder; persistent and unexplained increase in hepatic transaminase levels.

Atorvastatin (Lipitor) Interactions

Atorvastatin (Lipitor) interactions include:

  • Antacids, colestipol, and cholestyramine reduces atorvastatin levels.
  • Strong CYP3A4 inhibitors (such as clarithromycin, erythromycin, protease inhibitors, itraconazole) can increase plasma atorvastatin levels. This increases the risk of rhabdomyolysis.
  • Cyclosporine increases bioavailability of atorvastatin.
  • Rifampin and other cytochrome P450 3A4 inducers decrease plasma atorvastatin levels.
  • Atorvastatin elevates the serum digoxin levels up to 20%. As a result, there is a greater risk of digoxin toxicity.
  • Oral contraceptives (norethindrone and ethinyl estradiol) increases hormone values.
  • Increases serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and Creatine Kinase (CK) levels.

Herbal/food interactions

Following herbs/foods can enhance the effect of atorvastatin (Lipitor).

  • Grapefruit juice (excessive intake [more than 1.2L per day] with CYP3A4 inhibitors significantly increases plasma atorvastatin levels)
  • Pomegranate juice
  • Red yeast rice
  • Sitostanol
  • Vitamin B3

Following herbs/foods can decrease the effect of atorvastatin (Lipitor).

  • St. John’s wort
  • Fibers like pectin and oat bran.

What are the side-effects of Atorvastatin (Lipitor)?

Atorvastatin side effects / adverse reactions include:

  • Nasopharyngitis
  • Diarrhea
  • Pain in extremity
  • Headache
  • Urinary tract infection
  • Rash
  • Pruritus
  • Flatulence
  • Dyspepsia
  • Adverse effects: Rhabdomyolysis; Myopathy; Arthralgia; Photosensitivity; Hepatic dysfunction, Depression.  

Atorvastatin (Lipitor) Nursing Implications [Nursing Considerations]

Atorvastatin (Lipitor) nursing implications are divided into nursing assessment, nursing diagnosis, nursing interventions, and evaluation. 

Atorvastatin nursing assessment

  • Obtain detailed medical and drug related history including hypersensitivity, possible pregnancy.
  •  Obtain baseline LFTs.

Atorvastatin nursing diagnosis

  • Risk for impaired tissue integrity (indication).
  • Anxiety related increased risk of cardiac event due to elevated cholesterol level.
  • Deficient knowledge related to drug’s adverse effects; disease process.

Atorvastatin nursing interventions/ actions

  • Monitor patient’s lipid profile 6 -8 weeks for first 6 months initially and then 3 – 6 months routinely. Abnormally high lipid levels (total cholesterol levels >240 mg/dL, LDL levels >160 mg/dL, and HDL levels <35 mg/dL) increases risk of adverse cardiac events such as MI or cerebrovascular accident (CVA). Target lipid levels are:
    • Total cholesterol level: less than 200 mg/dL (5.17 mmol/L).
    • Triglyceride level: less than 150 mg/dL (1.7 mmol/L).
    • LDL level: less than 130 mg/dL (3.4 mmol/L).
    • HDL: for men – more than 40 mg/dL (1 mmol/L) and for women – 50 mg/dL (1.3 mmol/L).
  • Monitor LFTs. Statins increase the risk of hepatic dysfunction.
  • Observe for symptoms of GI irritability and hepatic dysfunction (e.g.; jaundice).
  • Observe for musculoskeletal symptoms such unexplained muscle pain, tenderness, or weakness. Because acute myopathy in patients on atorvastatin has increased risk of renal failure secondary to rhabdomyolysis.
  • Ensure atorvastatin is not given to the patients on cyclosporine, gemfibrozil, tipranavir plus ritonavir, or telaprevir. Because of the increased risk of rhabdomyolysis with acute renal failure.

Evaluation

Evaluate the effectiveness of the atorvastatin (Lipitor): decrease in total cholesterol levels, triglyceride levels, LDL levels, and increase in HDL levels; adherence to pharmacological and non-pharmacological treatment regime.  

Pregnancy/breastfeeding considerations for Atorvastatin (Lipitor)

  • Atorvastatin (Lipitor) is pregnancy category X which means it’s a teratogenic agent. Teratogenic drugs can harm the development of embryo or fetus.
  • Atorvastatin (Lipitor) is also contraindicated during lactation because it is excreted in breastmilk.

What is the nursing patient teachings for atorvastatin (Lipitor)?

The nursing patient teachings of atorvastatin (Lipitor) should include the following points.

  • Teach the patient/family importance adherence to low-cholesterol diet. Emphasize that atorvastatin is a supplement to, not a replacement for, a low-cholesterol diet.
  • Advise the patient to take the medication at the same time every day to maximize its effect.
  • Tell the patient to take any missing doses as soon as possible if is not too close to the next dose. Caution not to take double dose.
  • Advise the patient to seek medical advice before taking OTC niacin. Because it increases risk of rhabdomyolysis.
  • Educate the patient/family about the musculoskeletal warning signs (such as unexplained muscle pain, tenderness, or weakness) which should be reported immediately to the prescriber. Because it increases risk of renal failure secondary to rhabdomyolysis.
  • Teach the importance of adherence to treatment regimen to prevent adverse cardiac events such as myocardial infarction, angina, revascularization procedures, hospitalizations, and stroke.
  • Instruct female patients of childbearing age to tell their doctor as soon as they believe or know they are pregnant. Because atorvastatin needs to be discontinued as it is contraindicated during pregnancy.

Treatment for Atorvastatin Overdose

Atorvastatin (Lipitor) overdosage does not have a specific treatment. Symptomatic treatment should be given to the patient. 

Conclusion

You’ve learned about atorvastatin (Lipitor) nursing implications (aka nursing considerations) and patient teaching in this article. In addition, you’ve learned about atorvastatin’s mechanism of action, pharmacokinetics, dosage, indications, contraindications, side effects, nursing assessment, and nursing interventions.

FDA Atorvastatin (Lipitor) information  

Frandsen, G., & Smith Pennington, S. (2020). ABRAMS’ CLINICAL DRUG THERAPY Rationales for Nursing Practice (12th ed.). Wolters Kluwer.

Kizior, R., & Hodgson, K. (2021). SAUNDERS NURSING DRUG HANDBOOK 2021. Elsevier Inc.

Jones & Bartlett Learning. (2021). Nurse’s Drug Handbook (20th ed.). Jones & Bartlett Learning, LLC.

Skidmore-Roth, L. (2021). MOSBY’S 2021 NURSING DRUG REFERENCE (34th ed.). Elsevier Inc.

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