Atorvastatin; (R,R)-2-(4-Fluorophenyl)-beta,delta-dihydroxy-5-(1-methylethyl)-3-phenyl-4-((phenylamino)carbonyl)-1H-pyrrole- 1-heptanoic acid; (R-(R*,R*))-2-(4-Fluorophenyl)-beta,delta-dihydroxy-5-(1-methylethyl)-3-phenyl-4-((phenylamino)carbonyl) -1H-pyrrole -1-heptanoic acid; Atorvastatin calcium; Word 981; 2(4 fluorophenyl) β, δ dihydroxy 5 isopropyl 3 phenyl 4 phenylcarbamoyl 1h pyrrole 1 heptanoic acid; Lipitor; Lipitor; Sorting; Torment; ym 548; Zalato; -4-((phenylamino)carbonyl)-1H-pyrrole-1-heptanoic acid; 2(4fluorophenyl)β,δdihydroxy5isopropyl3phenyl4phenylcarbamoyl1hpyrrole1heptanoic acid; ci981; ym548
HMG-CoA reductase inhibitors (statins) what is atorvastatin
Statins inhibit cholesterol biosynthesis, upregulate LDL receptors, enhance LDL clearance, reduce hepatic release of lipoproteins, and may lower triglycerides by enhancing VLDL clearance and reducing lipoprotein production.
Statins can be used for all types of hyperlipidemia with elevated LDL. They are particularly useful in patients with vascular disease and those with very high LDL (eg, FH, combined hyperlipidemia), and they are the drug of choice for lowering LDL as primary or secondary prevention, but not in patients with homozygous LDL receptor deficiency The curative effect is poor. Several statins are approved for children and adolescents with FH, high LDL, or a family history of premature coronary artery disease.
Table 41.11 provides the relative potency of various statins when used at different doses, and Table 41.12 lists the expected effects of various statins on LDL. They lower LDL by 20% to 60%, raise HDL by 2% to 16%, and lower triglycerides by 7% to 37%, depending on the drug; dosage; and, in the case of triglycerides, baseline levels . Effects also vary from patient to patient, with varying degrees of LDL reduction even at the same dose. Doubling the dose typically resulted in an additional 6% reduction in LDL for each statin. 165 LDL reductions are seen within 1 to 2 weeks of treatment initiation and stabilize within approximately 4 to 6 weeks. Pitavastatin, atorvastatin, and rosuvastatin have longer half-lives of approximately 12 hours, 14 hours, and 21 hours, respectively. Other statins have a half-life of about 2 to 3 hours. First-generation statins with shorter half-lives should be taken at night. Atorvastatin and fluvastatin have very low renal clearance and may be more suitable for patients with renal insufficiency. There are several statins available as generics in the United States. Table 41.13 shows specific characteristics of available statins.
The most common side effects of statins are abdominal pain, constipation, gas, nausea, headache, fatigue, diarrhea, and muscle discomfort. With the exception of musculoskeletal symptoms, most side effects are rare.