Atorvastatin Nursing Considerations & Patient Teachings

Atorvastatin is a statin medication. It reduces the cholesterol that may accumulate on the artery walls and obstruct blood flow to the heart, brain, and other areas of the body. Atorvastatin prevents heart diseases, stroke, and heart attacks along with proper diet and lifestyle modifications.

Generic names: Atorvastatin Calcium

Brand names: Lipitor

Pharmacologic class: HMG-CoA reductase inhibitor

Therapeutic class: Lipid-lowering agent 

Mechanism of action: Atorvastatin reduces the risk of heart disease, stroke, and myocardial infarction (MI) by:

• Decreasing “bad” cholesterol (low-density lipoproteins)
• Decreasing fats (triglycerides)
• Increasing “good” cholesterol (high-density lipoproteins)
• Reducing cholesterol production in the liver 
• Inhibiting HMG-CoA reductase (an enzyme needed in cholesterol formation)

Indications for use: Atorvastatin is for patients with the following risks:

• High risk for cardiovascular disease 
• Risk of stroke and heart attack 
• Type 2 diabetes (with or without evidence of heart disease) 
• High cholesterol not managed by diet

Off-label uses include secondary prevention in transient ischemic attack (TIA or “mini-stroke”), or acute coronary syndrome (ACS).

Precautions and contraindications: 

• Do not use if sensitive to other antihyperlipidemic agents
• Do not use with hepatic disease or unexplained elevated serum liver enzymes 
• Not for use during pregnancy or breastfeeding
• Avoid using other HMGCoA reductase inhibitors
• Take caution in patients with hypotension, uncontrolled seizures, muscle disease, alcoholism, and severe metabolic, endocrine, or electrolyte disorders
• Carefully use atorvastatin with cyclosporine, protease inhibitors, colchicine, niacin, clarithromycin, or grapefruit juice
• Take caution in women of childbearing age and children younger than age 18

Drug Interactions

• Atorvastatin with antacids, colestipol, efavirenz, and rifampin can decrease atorvastatin blood level
• Higher risk of muscle disease (myopathy or rhabdomyolysis) when taking azole antifungals, colchicine, cyclosporine, erythromycin, HIV protease inhibitors, niacin, HMG-CoA reductase inhibitors, and strong CYP3A4 inhibitors (such as clarithromycin, itraconazole) 
• Digoxin can increase digoxin blood levels and cause toxicity
• Elevated hormone levels when taken with contraceptives 

Adverse Effects

• Memory and emotional changes, headache, drowsiness, abnormal dreams
• Poor coordination, numbness, nerve damage, weakness
• Orthostatic hypotension, palpitations, arrhythmias
• Vision changes, eye hemorrhage, dry eyes
• Hearing loss, ringing in the ears (tinnitus)
• Nose bleeding, swelling of the sinuses (sinusitis)
• Loss of taste, mouth sores, dry mouth, gingival bleeding, dysphagia
• Changes in appetite, nausea, vomiting, diarrhea, constipation, abdominal discomfort, stomach ulcers
• Blood in the stool (melena), intestinal gas (flatulence)
• Blood in the urine (hematuria), changes in urination, bladder or kidney inflammation, renal stones
• Decreased libido and erectile dysfunction
• Decrease in red blood cells (anemia) and platelets (thrombocytopenia)
• Jaundice, liver failure, hepatitis, pancreatitis
• Alterations in blood glucose levels
• Joint pain, leg cramps, gout
• Dyspnea, pneumonia
• Hair loss, acne, dry skin, pruritus, rash, photosensitivity, excessive sweating (diaphoresis)
• Fever, flu-like symptoms, and infection
• Facial paralysis, facial or generalized edema, weight gain, allergic reaction, Stevens-Johnson syndrome

Administration Considerations

Available preparations: Oral tablets

Dosages for adults: Dosage is dependent on use. For dyslipidemias and primary hypercholesterolemia:10–80 mg/day. 

For prevention of cardiovascular disease: 10 mg/day. 

For the prevention of stroke and MI with type 2 DM: dosage depends on baseline LDL/ cholesterol, the goal of therapy, and patient response. 

Dosages for elderly: Dosage is dependent on use, baseline LDL/ cholesterol, the goal of therapy, and patient response. For dyslipidemias: 10–80 mg/day. 

Dosages for children 10-17 years old: Dosage is dependent on use. For heterozygous hypercholesterolemia: 10-20 mg/day.

Nursing Considerations for Atorvastatin

Related Nursing Diagnoses

• Decreased cardiac output
• Ineffective peripheral tissue perfusion
• Imbalanced nutrition: more than body requirements
• Risk for impaired liver function
• Diarrhea, constipation, acute pain, etc., as potential side effects of atorvastatin

Nursing Assessment:

1. Assess for allergies to HMG-CoA reductase inhibitors
2. Obtain baseline cholesterol, triglycerides, and liver function tests
3. Monitor liver function and creatine kinase level
4. Assess for signs of muscle weakness or pain
5. Monitor for EKG changes
6. Assess for changes in concentration, alertness, and vision

Nursing Interventions:

1. Do not crush, dissolve, or divide atorvastatin
2. Determine the goal of therapy in starting atorvastatin
3. Monitor serum lipid levels regularly
4. Evaluate the patient’s response to atorvastatin
5. For muscle pain, administer pain medications as ordered
6. Implement safety and fall precautions as atorvastatin may affect concentration, alertness, and vision
7. Immediately report EKG changes, yellowish discoloration to the skin, muscle weakness, or unusual bleeding
8. Administer at bedtime

Patient Teaching Associated with Atorvastatin

1. Instruct the patient that atorvastatin can be taken with or without food. It should not be chewed, crushed, dissolved, or divided. 
2. Teach the patient that atorvastatin should be taken before bed. Statins work better when taken at night as this is when cholesterol enzymes are more active.
3. Report irregular heartbeats, unusual bruising or bleeding, fatigue, yellowing of the skin or eyes, or muscle weakness.
4. Advise female patients taking hormonal contraceptives that atorvastatin increases estrogen levels.
5. Male patients should discuss sexual changes (decreased libido, erectile dysfunction, and abnormal ejaculation) with their provider.
6. Alert the provider for signs of adverse effects (such as dark urine, muscle weakness, or pain)
7. Discuss the regular blood testing required during treatment.
8. Do not take with grapefruit juice.
9. Atorvastatin works best when changes are made to diet and lifestyle. Encourage a low-fat, low-cholesterol diet with an increase in fiber, fruits, and vegetables. Increase physical activity. Avoid smoking.

This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult further with a pharmacist for complete information.

References and Sources

1. Kizior, R. J., & Hodgson, K. J. (2019). Saunders Nursing Drug Handbook 2019. Elsevier Health Sciences.
2. Schull, P. (2013). McGraw-hill nurses drug handbook (7th ed.). McGraw Hill Professional.