What are the side effects of atorvastatin for older adults?

In this article:

• Common side effects
• Serious side effects
• When do side effects start?
• How long do they last?
• Long-term side effects
• Interactions
• Safety
• How to avoid side effects
• Side effect treatment

In this article

• Common side effects
• Serious side effects
• When do side effects start?
• How long do they last?
• Long-term side effects
• Interactions
• Safety
• How to avoid side effects
• Side effect treatment

Atorvastatin, a medication in the statin drug class, is prescribed to treat high cholesterol. Available in both tablet and liquid form, atorvastatin blocks the enzyme needed to make low-density lipoprotein (LDL) cholesterol (aka “bad” cholesterol) in the liver. Since high cholesterol can cause heart attacks and strokes, and this risk increases as people age, older adults may be more likely to need lipid-lowering agents like atorvastatin.

With that said, let’s talk to doctors about the side effects of atorvastatin in older adults, as well as other interactions and precautions to be aware of.

Common side effects of atorvastatin in the elderly

First, what side effects do older adults typically experience while taking atorvastatin?

“In clinical trials, side effects from statins are relatively infrequent; however, in clinical practice, side effects are more common, especially muscle-related side effects,” says Dr. Edo Paz, MD, the SVP of Medical Affairs at Hello Heart who’s board-certified in cardiology, internal medicine, echocardiography, and nuclear cardiology.

Here’s a list of the most common side effects reported in clinical trials, along with the percentage of participants who experienced it:

• Nasopharyngitis (the common cold) — 8.3%
• Arthralgia (joint stiffness) and joint pain — 6.9%
• Diarrhea — 6.8%
• Pain in extremities — 6%
• Urinary tract infection —5.7%
• Dyspepsia (indigestion) — 4.7%
• Nausea — 4%
• Musculoskeletal pain — 3.8%
• Muscle spasms — 3.6%
• Myalgia (Muscle aches) — 3.5%
• Insomnia — 3%
• Pharyngolaryngeal (voice and throat) pain — 2.3%

Other adverse effects reported include:

• Malaise
• Pyrexia (fever)
• Abdominal discomfort
• Eructation (burping)
• Flatulence 
• Hepatitis
• Cholestasis (a liver problem in which the flow of bile from the liver is reduced or stopped)
• Myopathy, or muscle weakness, muscle fatigue, muscle pain, and other muscle problems
• Neck pain
• Joint swelling
• An increase in transaminases (liver enzymes)
• Abnormal liver function tests, which may indicate liver damage
• Blood alkaline phosphatase increase
• Creatine phosphokinase increase
• Hyperglycemia (elevated blood sugar)
• Epistaxis (nosebleeds)
• Urticaria (hives)
• Blurry vision
• Tinnitus (ringing in the ears)
• White blood cells in the urine 
• Nightmares 
• Tiredness

Serious side effects of atorvastatin 

According to the medication’s label, stop taking atorvastatin and call your doctor ASAP if any of the following symptoms appear:

• Muscle problems
• Allergic reactions, like skin rashes
• Nausea or vomiting
• Brown or dark-colored urine
• Extra tiredness
• Your skin and/or the whites of your eyes become yellow
• Stomach pain
• Other concerning symptoms, especially if they get worse or don’t go away

How soon do atorvastatin side effects start?

Older adults may quickly experience side effects of atorvastatin, especially in their muscles. “Muscle side effects can occur with as few as one or two doses,” says Dr. Yu-Ming Ni, MD, a board-certified cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California.

How long do atorvastatin side effects last?

The good(ish) news is that the side effects are pretty temporary, though they might last longer in older patients. “Muscle aches are typically temporary, and I generally find that it takes about two to four weeks for the body to adjust to it,” Dr. Ni says. “In most of my younger patients, two weeks is enough time. But perhaps an older patient may take longer.”

What are the long-term side effects of atorvastatin?

When it comes to atorvastatin, patients don’t have to worry too much about long-term side effects. Dr. Ni says the major one is a slightly higher rate of onset of diabetes in people who have never had it, but again, the keyword is “slightly.”

“The risk is quite small, around 1-2% in a five-year period,” he says. “We do not quite understand why this happens, but often the risks associated with needing a statin are greater.”

Put another way, according to a 2018 article in the European Heart Journal, statin treatment is “remarkably safe,” with the only risk being that around one in 1000 patients will become exposed to new-onset diabetes mellitus.

Dr. Ni also wants to clear a wide misconception that statins cause dementia. “While it is true that patients taking statins are more likely to have dementia, it is not because the statin is causing it,” Dr. Ni says. “Rather, it is the kinds of people that might need to take a statin that are at risk for developing dementia.” 

Possible reasoning behind that, he says, could be a cholesterol plaque build-up in the arteries (such as those in the brain), a previous stroke, or taking the statin for diabetes, all of which heighten the risk of dementia.

Atorvastatin interactions

Atorvastatin interactions, per the Lipitor label, include the following: 

• Strong inhibitors of CYP3A4: Combining atorvastatin and strong inhibitors of CYP3A4, an enzyme, can increase plasma concentrations of atorvastatin.
• Grapefruit juice: This beverage contains components that can inhibit CYP3A4, so drinking it while on this medication can also increase plasma concentrations of atorvastatin. Naturally, that risk increases when a person drinks it excessively (aka more than 1.2 liters a day).
• Cyclosporine: As mentioned, atorvastatin can cause myopathy (aka muscle aches or weakness). Combining higher doses of that with cyclosporine can increase the risk of myopathy and/or rhabdomyolysis (muscle inflammation and breakdown). 
• Rifampin or other Inducers of Cytochrome P450 3A4: Combining these two medications can reduce plasma concentrations of atorvastatin. Typically, it is recommended to take the medications together (versus delaying the atorvastatin).
• Digoxin: While patients taking any medication need professional monitoring, it’s especially important for people taking atorvastatin and digoxin. Digoxin concentrations in plasma can increase. Digoxin levels can be monitored by routine lab work. 
• Oral contraceptives: This medication, combined with atorvastatin, can increase values for norethindrone and ethinyl estradiol. This is considered a Category B interaction, and no action is needed.
• Warfarin: Atorvastatin didn’t significantly affect prothrombin time when given to Warfarin patients.
• Alcohol: Atorvastatin should be used cautiously in patients who drink alcohol, specifically more than two glasses a day. Patients who have chronic alcoholic liver disease may be more likely to see increases in plasma concentrations of atorvastatin.
• Coffee: Coffee (and other forms of caffeine) may make atorvastatin less effective.

Safety measures while using atorvastatin

Don’t take atorvastatin if it wouldn’t be safe to do so

This medication is contraindicated in patients who are pregnant or may become pregnant. Additionally, people who are taking this medication should not breastfeed. 

As far as whether it’s okay for children to take, the safety and efficacy of doses over 20 mg have not been studied yet. There is limited research on atorvastatin in children, but common guidelines suggest starting children 10 years and older on atorvastatin 10 mg daily and increasing to 20 mg daily if cholesterol levels remain elevated. 

Do not take atorvastatin if you have liver problems or may have an allergic reaction to any of the ingredients. If you have diabetes, kidney problems, drink more than two glasses of alcohol a day, or have muscle aches or weakness, let a doctor know before you take atorvastatin.

Check for recalls 

Currently, there are no recalls for atorvastatin, but it’s important to continue checking the U.S. Food and Drug Administration’s (FDA) drug recall page.

Take note of black box warnings

It’s important to note that atorvastatin (and other statins) do have a black box warning: The FDA associated statin use with cognitive impairment. 

Share your health history with a medical professional before taking

Atorvastatin can exacerbate other health conditions or symptoms. This is one of several reasons why it’s important to discuss your health history with your healthcare provider before going on any new medication or supplement. 

For example, Dr. Ni believes atorvastatin can be problematic if you have a serious liver condition or moderate kidney disease. “Talk to your doctor about if this medicine is right for you in those situations,” he says.

Know what to do in the case of an overdose

Atorvastatin is not habit-forming, and discontinuing it does not cause withdrawal symptoms.

People can still overdose on the medication, however. “The maximum dose of atorvastatin for an ‘average’ person is 80 mg, but that may be lower depending on other present medical conditions,” Dr. Ni says. “In the event of an overdose, immediately seek medical attention or call 911.”

How to avoid atorvastatin side effects

Read on for instructions on atorvastatin use and tips on avoiding or lessening the side effects.

1. Patients can take atorvastatin any time of day—morning or evening—because it lasts for 24 hours. (The same can’t be said for all other statins.)
2. Don’t take atorvastatin if you are pregnant, think you may be pregnant, are planning to become pregnant, are breastfeeding, have liver problems, or are allergic to the medication or any of its ingredients.
3. Atorvastatin can be taken with or without food. Just avoid grapefruit juice.
4. Dr. Paz emphasizes the importance of a personalized approach—especially with older adults—which is also advised in the American Heart Association guidelines. He recommends considering the benefit in terms of reduced risk of cardiovascular events, side effects, drug-drug interactions, patient frailty, and patient preference.
5. Older adults may need to start with a lower dose. “In my practice, I do use statins in patients 75+, although I will typically start with a lower dose/intensity of statin therapy to minimize the risk of side effects,” Dr. Paz says.
6. Atorvastatin can be taken daily for the rest of your life.

How to treat side effects of atorvastatin

Experiencing muscle aches as a side effect? Some people have found relief by also taking coenzyme Q 10—but it’s not necessarily doctor-recommended. “I have found that it is only occasionally effective, and I do not routinely recommend coenzyme Q 10 with a statin,” Dr. Ni says. 

It’s crucial to pay attention to other side effects that may pop up, too, like a change in the color of your urine. Dark-colored urine can come from rhabdomyolysis, Dr. Ni says, which is a muscle injury where your muscles break down, and it’s a very serious condition requiring immediate medical attention. Thankfully, it’s pretty rare.

Bottom line: Is atorvastatin safe for older adults?

Generally speaking, doctors say atorvastatin is safe for older adults to take.

“Several studies have evaluated the use of statins in adults aged 75+ and have generally found them to be safe despite a higher risk of muscle-related side effects,” Dr. Paz says.

At the same time, be cautious if you’re pregnant or breastfeeding or have certain medical conditions, such as liver problems. Above all, talk to a healthcare provider throughout the process.