Lipitor side effects and how to avoid them

What is Lipitor used for?

Lipitor is a brand-name prescription drug used to lower cholesterol and triglyceride levels in the blood. Atorvastatin, the active ingredient in Lipitor, belongs to a family of drugs called statins or HMG-CoA reductase inhibitors. It works by reducing the liver’s production of LDL cholesterol and increasing the liver’s removal of LDL cholesterol from the blood. Also known as the “bad” cholesterol, LDL cholesterol or low-density lipoprotein can build up and clog the blood vessels. 

Statins also work to increase the levels of “good” cholesterol (HDL cholesterol) and reduce levels of certain fats called triglycerides that can damage the blood vessels. In addition, statins like Lipitor may help prevent heart attacks, strokes, and other cardiovascular problems

Learn about Lipitor’s side effects, contraindications, warnings, and potential drug interactions.

RELATED: Learn more about Lipitor

Common side effects of Lipitor

Lipitor has been widely used for over 20 years, so its side effects are well-known. The most commonly reported side effects are:

• Common cold symptoms, such as sore throat
• Joint pain
• Diarrhea
• Pain in the arms or legs
• Urinary tract infections
• Stomach upset
• Nausea
• Muscle pain
• Muscle spasms
• Insomnia

Common cold symptoms

In placebo-controlled clinical trials, common cold symptoms were the most commonly reported side effect of Lipitor. The common cold, also known as nasopharyngitis, involves swelling of the back of the throat and nasal passages. Symptoms may include a sore throat, runny nose, sneezing, and coughing. 

Joint and muscle pain

Joint pain, or arthralgia, is another common side effect of Lipitor. Some people may also experience muscle pain or general pain in the arms and legs along with pain in the joints. One study from the Journal of the American Medical Association found that people taking statins have a 19% higher chance of experiencing musculoskeletal pain than people who are not taking statins. Joint and muscle pain may affect a person’s ability to exercise, which may contribute to possible weight gain. 

Diarrhea

In addition to common cold symptoms and pain in the joints or muscles, Lipitor can also cause gastrointestinal side effects. Around 7%​​ of people in clinical trials experienced diarrhea while taking Lipitor. Diarrhea may also be accompanied by other gastrointestinal side effects like nausea, stomach upset, or nausea. 

Other side effects reported with Lipitor include:

• Urinary tract infections
• Flatulence
• Blurred vision
• Ringing in the ears
• Elevated liver enzymes
• Increased blood sugar levels, which could worsen or lead to diabetes
• Mental impairment or memory loss

Muscle pain or weakness is one of the most common reasons people stop taking Lipitor. If muscle problems arise, a healthcare professional might reduce the dose, switch to a different statin, or stop treatment for a while.

Serious side effects of Lipitor

Lipitor can cause severe and even life-threatening side effects including:

• Muscle pain, tenderness, or weakness (myopathy)
• Severe muscle damage and breakdown of the muscle (rhabdomyolysis) that can lead to kidney failure
• Liver problems
• Tendon rupture
• Nerve damage
• Lung injury and scarring
• Immune-mediated necrotizing myopathy (a rare autoimmune disorder of the skeletal muscles) 
• Severe allergic reactions

Myopathy and rhabdomyolysis

People who take statins may be at an increased risk of severe side effects that affect the muscles. The use of Lipitor has been associated with myopathy, which includes symptoms like muscle pain, tenderness, or weakness. In severe cases, myopathy can worsen and develop into rhabdomyolysis, or the breakdown of the muscle tissue. 

Creatinine kinase (CK) is an enzyme that is released into the blood when there is muscle damage. Because CK is filtered by the kidneys, high CK levels can take a toll on the kidneys and cause severe kidney damage or kidney failure. A healthcare provider will often run blood tests to check CK levels if they suspect myopathy or rhabdomyolysis. 

Immune-mediated necrotizing myopathy 

Immune-mediated necrotizing myopathy, also known as necrotizing autoimmune myopathy, is a rare autoimmune condition that can result from the use of Lipitor. This condition develops when the immune system starts attacking the muscle cells, leading to the death of the muscle tissue. Symptoms may include extreme fatigue, difficulty walking up stairs or getting up from a sitting position, and weakness of the muscles (particularly those closest to the body, such as the back, shoulders, and neck).

Liver problems

Lipitor, especially in high doses, can lead to liver problems, such as liver injury and liver disease. Symptoms of liver injury include jaundice, fatigue, dark urine, and decreased appetite. Initially, someone taking Lipitor may experience increased levels of the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) liver enzymes. Elevated liver enzyme tests could signify liver problems; therefore, healthcare providers often check liver enzyme levels before starting therapy with a statin. 

Allergic reactions

A serious allergic reaction to Lipitor is rare. However, cases have been reported. An allergic reaction to Lipitor may include signs or symptoms like severe rash, itching, trouble breathing, and swelling of the face, lips, or throat. 

How long do Lipitor side effects last?

Lipitor is typically cleared from the body in about 77 hours, or three days, with a half-life of about 20 to 30 hours. Side effects could last as long as the medication is being taken. Healthcare providers may still recommend taking the medication if side effects are minor and develop at the start of treatment. Side effects are usually mild and temporary, and the severity of side effects may dissipate over time as the body adapts to the medication. If side effects persist or worsen, contact a healthcare provider. 

Serious side effects such as muscle damage and severe allergic reactions may require immediate medical attention and discontinuation of the drug. Muscle pain and weakness could last for several months after Lipitor has been discontinued. If left untreated, serious side effects can lead to lifelong complications. Some side effects, such as lung injury and muscle damage, may be irreversible and require lifelong treatment.

Lipitor contraindications & warnings

Although effective at reducing cholesterol levels and lowering the risk of heart attack or stroke, Lipitor may not be suitable for everyone. Continue reading to learn about misuse, withdrawal, overdose, and how Lipitor may worsen pre-existing medical conditions.

Abuse and dependence

Lipitor is not a drug subject to abuse or psychological dependence. When statins are discontinued after long-term use, however, LDL cholesterol levels can quickly rebound to higher than normal. Because increased LDL cholesterol can lead to cardiovascular events, stopping a drug like Lipitor may lead to an increased risk of heart attacks and strokes. 

It is possible for most people to safely stop taking a statin, but there are no concrete guidelines for discontinuing statin therapy in older people. If a statin is not working, get professional medical advice before stopping the medication.

Overdose

High doses of Lipitor can increase the risk of statin toxicity, which can lead to serious side effects. You may experience symptoms such as muscle pain, muscle weakness, and muscle inflammation, plus high levels of creatine kinase in the blood. When muscles are damaged, the cells leak creatine kinase and a protein called myoglobin into the bloodstream. If muscle damage is severe enough, the kidneys can be injured by the substances released from the dead muscle cells.

An overdose can be a concern while taking statins. Some people who take several other medications or have other health conditions may forget to take their dose correctly—forgetting a dose one day and taking too high of a dose another day. To prevent an overdose, medication reminders such as daily alarms can be helpful.

If an overdose is suspected, get emergency medical attention. When taking statins, talk to a doctor or other healthcare professional if you feel unusual muscle pain or muscle weakness while taking Lipitor. Muscle pain and muscle weakness are possible signs of statin toxicity.

Restrictions

Certain people should never take Lipitor, such as:

• People with active liver disease
• Women who are pregnant
• Women who are breastfeeding
• People who are allergic to atorvastatin or any other ingredients in Lipitor

Lipitor may be less effective or more hazardous with certain medical conditions or lifestyle choices, including:

• Kidney problems: People with kidney impairment may be more likely to experience muscle problems, including severe muscle damage while taking Lipitor. The drug can still be prescribed in people with kidney problems with no dose adjustments needed.

• • Thyroid problems: People with an underactive thyroid (hypothyroidism) are at an increased risk of developing muscle pain, muscle weakness, and severe muscle damage while taking Lipitor or other statins, such as Zocor (simvastatin). Uncontrolled hypothyroidism may need to be treated before starting statin therapy.
  • Liver impairment: Because of an increased risk of liver damage, Lipitor is not prescribed to people with active liver disease. Lipitor may also be prescribed with caution in people with a history of liver problems. The Food and Drug Administration (FDA) recommends blood tests to assess liver function before Lipitor is first prescribed.

• Alcohol consumption: Men and women who heavily consume alcohol daily are at a higher risk of liver disease than other men and women. People with chronic alcoholic liver disease are more likely to experience liver problems with Lipitor. Tell your doctor if you drink more than two alcoholic drinks daily before starting treatment with Lipitor.

• Diabetes: Lipitor and other statins can worsen hyperglycemia and A1c levels in people with diabetes. The American Diabetic Association (ADA) guidelines suggest that, rather than prescribe a fixed-dose, healthcare professionals prescribe and adjust statin doses based on target LDL levels to minimize Lipitor’s effects on blood sugar levels. It is important to tell your doctor if you have a history or risk of diabetes before taking Lipitor. 

• Recent stroke: In people who have recently experienced a stroke or transient ischemic attack (TIA, or “mini-stroke”), Lipitor may increase the risk of bleeding in the brain (hemorrhagic stroke). There may be an increased risk of hemorrhagic stroke in people taking at least 80 mg of Lipitor within six months of a stroke or TIA. 

• Advanced age: People older than 65 are more likely to experience muscle pain, muscle weakness, and muscle damage. Studies suggest Lipitor be used cautiously in older patients due to an increased risk of myopathy. However, providers may recommend Lipitor to prevent future medical problems caused by high cholesterol levels. The balance of long-term benefits versus short-term risks evolves as people get older and their expected lifespan shortens. When a person reaches a certain age, a healthcare professional may suggest reducing or stopping statin therapy. 

Lipitor interactions

Lipitor may not be safe to take with certain drugs. Certain combinations should be avoided, but others may require monitoring or treatment adjustments. Some of these drugs include:

• Azole antifungal medications (such as itraconazole and ketoconazole)
• Certain antibiotics (such as clarithromycin and rifampin)
• AIDS/HIV or hepatitis antiviral medications (such as ritonavir, saquinavir, and darunavir)
• Fibrates (such as gemfibrozil)
• Certain immune suppressant drugs (such as cyclosporine)
• Certain heart failure medications (such as digoxin)
• Niacin (vitamin B3)
• Birth control pills

Lipitor is mainly metabolized, or processed, in the liver by the CYP3A4 enzyme. Drugs that block this enzyme, also known as CYP3A4 inhibitors, can decrease the metabolism of Lipitor and increase the overall blood levels of Lipitor. Certain azole antifungals, some macrolide antibiotics, and many antivirals can increase the risk of Lipitor side effects when taken with Lipitor. 

Drugs that promote the actions of the CYP3A4 enzyme, also known as CYP3A4 inducers, can increase the metabolism and decrease the effectiveness of Lipitor. When combined with Lipitor, drugs like rifampin may decrease the effectiveness of Lipitor. 

Lipitor may also affect how other drugs work in the body. For example, Lipitor can increase the blood levels of birth control pills, which may increase the risk of side effects from the birth control pills. Lipitor may also increase the blood levels of digoxin, a heart failure medication that is usually taken with other drugs. People taking birth control pills or digoxin may need to be monitored for potential adverse effects if they are also taking Lipitor. 

Avoid large amounts of grapefruit or grapefruit juice. Grapefruit can block the CYP3A4 enzyme and interfere with the breakdown of Lipitor in the body. Statin toxicity is a possibility if a statin is mixed with grapefruit. 

It is recommended to avoid high-fat or high-cholesterol foods while taking Lipitor. These foods may increase cholesterol levels and make Lipitor less effective. 

Always talk to your doctor or another healthcare provider before taking Lipitor to help avoid interactions with foods or other medications.

How to avoid Lipitor side effects

Lipitor can prevent life-threatening problems when it is taken every day over the long term. As with all medications, however, Lipitor can cause unwanted side effects. Since Lipitor may be a lifelong treatment, it’s helpful to learn a few ways to both minimize adverse effects and promote the potential benefits of the drug.

1. Take Lipitor as directed

Most importantly, take Lipitor as directed at the same time every day. Follow all the directions given by a healthcare provider or those that come with the prescription drug pamphlet. Healthcare providers typically prescribe 10 to 80 mg of Lipitor per day, and they usually prescribe it to be taken as a long-term treatment. Do not change the dose, skip a dose, or stop the medicine without talking to a doctor or healthcare professional. 

2. Use an alarm or reminder

To avoid missing a dose or accidentally taking extra doses, use a medication diary, calendar, or smartphone app. It can help to schedule your daily dose into your daily routine, such as before breakfast, after dinner, or before bedtime.

3. Tell the doctor about all medical conditions and medications

Before taking Lipitor, make sure the doctor or other healthcare professional prescribing Lipitor is fully informed about your medical history including:

• Any current or past medical conditions, including kidney disease, liver disease, diabetes, and thyroid problems
• Pregnancy, breastfeeding, or plans to get pregnant or breastfeed
• All over-the-counter and prescription drugs, supplements, and herbal remedies being taken
• Daily alcohol consumption

4. Keep all follow-up appointments 

Lipitor’s effects cannot be felt or monitored at home. Be sure to keep all follow-up appointments with your healthcare provider. Blood tests may be necessary to ensure the drug is working and not causing side effects. Tracking any side effects you experience may help prevent serious medical complications.

5. Watch for signs of possible side effects

Many of Lipitor’s most serious side effects may not be evident until they’ve become serious problems. Keep watch for any muscle problems, including muscle aches, tenderness, or unusual weakness. Even if the muscle pain seems mild, tell a doctor who can order special lab tests to see if there is any muscle damage. 

Rarely, Lipitor can cause changes in thinking or memory. If mental abilities seem to be deteriorating, talk to your prescribing doctor. Lipitor can also damage the liver, so look for signs of liver impairment, such as jaundice (yellowing of the skin, eyes, or mucous membranes), dark urine, tiredness, or pain in the upper right part of the stomach area. 

You may need to switch to a different medication or discontinue statins altogether if you experience any muscle, liver, or cognitive problems.