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Atorvastatin

Indicated to reduce elevated total cholesterol, low density lipoprotein cholesterol, apolipoprotein B, and triglyceride levels, and to increase high density lipoprotein cholesterol in patients with primary hypercholesterolemia and mixed dyslipidemia.

Most frequent side effects related to gastrointestinal symptoms.

Incidence of persistent elevation of liver functions occurs in 0.7% of patients.

The elimination half life of atorvastatin is 13 hours.

High dose atorvastatin therapy 80 mg/day in patients with CRD, diabetes and hyperlipidemia results in significant reduction in major cardiovascular events compared to patients with 10 mg daily of atorvastatin.

High dose statin therapy improves cardiovascular outcomes in diabetic patients with mild to moderate chronic renal disease.

High dose atorvastatin reduces the relative risk of major cardiovascular events by 35% in diabetic patients with chronic renal insufficiency but only 10% in those with diabetes and normal kidney function.

Rare cases associated with rhabdomyolysis, and starting doses should be lowered when administered concomitantly with cyclosporine, fibric acid derivatives, erythromycin clarithromycin, ritonavir, lopinavir, immunosuppressive drugs, azole antifungal, or niacin.

Liver functions should be performed prior to and 12 weeks after the initiation of treatment and periodically thereafter.

If liver functions are three times or greater than normal the dose should be reduced or the drug discontinued.

Contraindicated in patients with active liver disease, or unexplained persistent elevations of serum transaminases.

Collaborative Atorvastatin Diabetes Study (CARDS) assesses effectiveness of Lipitor versus placebo in the primary prevention of cardiovascular disease inpatients with type 2 diabetes: resulted in a 37% reduction in the incidence of major cardiovascular events, with 36% reduction in acute coronary events, and a 48% reduction in stroke and 31% reduction in coronary revascularization events, 27% reduction in total mortality and a 32% reduction in the rate of any acute cardiovascular event.

The Treating to New Targets (TNT) study randomized, double blind parallel group study assessed lowering LDL-C <100 mg/dL in diabetic men and women with coronary heart disease and mean LDL-C <130 mg/dL aged 35-75 years to receive Lipitor 80 mg/day vs. Lipitor 10 mg/day: the 80 mg/day dose associated with a mean reduction of LDL-C level of 77 mg/dL and a 22% relative risk reduction in cardiovascular events compared with a mean level of LDL-C of 101 mg/dL with the lower dose.

In the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study in 4,731 patients without coronary artery disease who had a stroke or transient ischemic attack within the preceding six months: a higher incidence of hemorrhagic stroke seen in patients with 80 mg of this agent compared to placebo.

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