Educational use only. Drug cards are AI-assisted study material for NCLEX preparation.
Mechanism of action
Inhibits hepatic HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis. Lowers LDL cholesterol, modestly raises HDL, lowers triglycerides, and stabilizes atherosclerotic plaque. Used for primary and secondary prevention of cardiovascular disease and for hyperlipidemia.
Adverse effects
Life-threatening / NCLEX-tested
- Rhabdomyolysis — life-threatening; muscle pain plus dark/cola-colored urine plus elevated CK; can cause AKI
- Hepatotoxicity (rare; ALT elevations are usually mild and transient)
- New-onset diabetes (modest population-level risk)
- Memory/cognitive complaints (uncommon, usually reversible)
- Myopathy with normal CK (less severe than rhabdo but stops the drug)
Side effects
Common — what to teach
- Muscle aches and weakness (myalgia)
- Headache
- GI upset, nausea
- Constipation or diarrhea
- Mild liver enzyme elevation
Food & drug interactions
Grapefruit juice and CYP3A4 inhibitors (clarithromycin, erythromycin, itraconazole, certain HIV protease inhibitors, amiodarone, diltiazem) raise atorvastatin levels and rhabdo risk. Fibrates (especially gemfibrozil) and niacin compound myopathy risk. Warfarin INR may rise — monitor closely. Take in the evening for best LDL effect (cholesterol synthesis peaks at night).
Nursing implications
Assessment, monitoring, patient teaching
- Baseline LFTs and lipid panel; recheck lipids at 4–12 weeks after start or dose change
- Teach the rhabdomyolysis warning signs: unexplained muscle pain or weakness AND dark/cola urine — stop the statin and call the provider
- Counsel to avoid grapefruit juice
- Take in the evening (atorvastatin has a long half-life so timing matters less than for older statins, but evening dosing is the standard)
- Reinforce that lifestyle (diet, exercise, weight, smoking) still matters even with adherence
- Pregnancy contraindicated — counsel women of childbearing age
When to hold / contraindications
- Suspected rhabdomyolysis (muscle pain + dark urine, CK > 10× upper limit)
- Active liver disease or persistent LFT elevation > 3× upper limit
- Severe muscle pain even without CK rise — clinically intolerable
- Pregnancy or planning pregnancy
- Initiating high-risk CYP3A4 inhibitor (re-evaluate dose and timing)
Memory anchor
Statins end in "-statin" — evening dose, watch for muscle pain + dark urine = rhabdo. Liver and muscle are the two organs that complain.
Practice Atorvastatin questions
Test your recall on real NCLEX-style pharmacology questions — with full rationales and an AI Coach for the parts you miss.