LIPITOR - Counseling Essentials

Summary:
1. Lipitor or Atorvastatin is the number 1 drug prescribed in Canada. It belongs to a class of drugs called HMG CoA Inhibtors and is indicated for a variety of disorders related to reduction of Cholesterol in the body.

HMG-CoA Inhibitors:
1. Atorvastatin
2. Simvastatin
3. Lovastatin
4. Pravastatin
5. Rosuvastatin
6. Fluvastatin
7. Ceruvastatin - Discontinued (LIPOBAY) due to the side effects of Rhabdomylosis

Important Points to Remember:
1. Atorvastatin is the only agent approved for peadiatric patients.
2. All statins can be taken without regard to meals but Lovastatin is better absorbed when taken with meals.
3. CYP3A4 Inhibtors and substrates interact with Lovastatin, Atorvastatin and Simvastatin. (You can use Fluvastatin or Pravastatin)
4. Fluvastatin interacts with CYP2C9 substrates
5. Patients should avoid taking grapefruit juice, Sour (Seville)orange juice and lime juice while on this medications as this inhibits the CYP3A4 enzyme system; thereby increasing the levels of the statins in the body making the patient more prone to adverse side effects due to increased levels of the statin
6. Major Drug –drug interactions include:
a. Bile acid sequestrants – decreased bioavailability of statins – Administer the bile acid sequestrants one hour before or 6 hours after statins
b. CYP3A4 substrates and Inhibitors (Amiodarone, Erythromycin, Clarithromycin, Cyclosporin, Diltiazem, Grapefruit juice, Itraconazole, ketoconazole, Protease Inhibitors)
- In certain situations discontinue statins during CYP3A4 interacting substance therapy
- You could use fluvastatin or pravastatin
- Use concurrently but monitor for side effects – unexplained muscle pain, tenderness, muscle weakness, Darken urine
c. CYP2C9 substrates – (NSAID’s, Phenytoin) – Monitor for side effects
d. Fibric Acid Derivatives- (Benfibrate, Fenofibrate, Gemfibrozil)
- Avoid combination if possible
- Educate patients to watch signs of myopathy
e. Niacin – Monitor for side effects
f. Rifampicin – Decreases plasma levels of statins
- Monitor for therapeutic effect or clinical response
- use pravastatin
g. Warfarin – Inhibition of warfarin metabolism, increased anti coagulant effect, increased risk of bleeding
- close monitoring of INR
- discontinue or change dose of statin
7. Pregnancy – Its contraindicated in Pregnancy and lactation as cholesterol is required for fetal development. Discontinuation of statin during pregnancy does not pose an immediate risk to the mother

LIPITOR – Counseling Essentials

Thank you for waiting Mr / Ms……………………
Your Doctor has prescribed you Lipitor 20mg tablets which contains Atorvastatin 20mg as the active ingredient and you have been dispensed 90 tablets
This has been prescribed to reduce your cholesterol. It belongs to a group of drugs called statins and it blocks cholesterol production by the liver by inhibiting an enzyme called HMG CoA reductase
Did the doctor mention to you how to take this medication?
Oh ok…Well that’s right / That’s okay…This medication is supposed to be taken once daily with or without food preferably in the evening as the liver produces most cholesterol in the early hours of the morning
You should start seeing an effect after 4 weeks.
Its important you avoid taking grapefruit juice along with this medication as it will increase the drug levels in the body exposing you more to the more serious side effects of the drug
Medications, in additional to beneficial effects, unfortunately also carry some side effects which you may or may not experience. Did the doctor mention anything in this regard?
Okay…some people may experience abdominal pain / cramps, nausea and vomiting , diarrhea or constipation, flatulence or a headache. These should not cause any major problems but if they persist or become bothersome, please contact us and we can discuss them further.
However if you experience unexplained muscle pain, tenderness, muscle weakness or your urine darkens, you are experiencing a serious side effect to the drug and you need to get in touch with your doctor immediately
This medication should be stored in a cool and dry place away from reach of children.
Along with your medication, ensure that you drink plenty of water to remain hydrated and that you eat a well balanced diet with a lot of fibre, avoiding foods containing saturated fats and / or cholesterol. Also ensure that you exercise regularly as all these will keep you healthy and fit.
I am giving you a drug information sheet that will explain more about your medication.
Do you have any questions or concerns?
Please do not hesitate to contact us if you have any concern.
If you don’t see any improvement or if you experience the serious side effects explained earlier, you should get in touch with your doctor.
If you don’t mind I will call you in a few days to see how you are doing.
I hope you feel better soon. Thank you for choosing our pharmacy and have a good day / evening.