The Lowdown on Lipitor: What You Need To Know
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on May 10, 2021.
The World's Top Selling Drugs at One Time
Lipitor (atorvastin) was once the world's top selling drug. When it hit the market in 1997, it was the fifth approved statin, a class of blockbuster drugs that revolutionized the treatment of high cholesterol.
Within just a few years, Lipitor was the top selling statin, generating sales for Pfizer of over $120 billion in a 14-year run.
At that time, Lipitor joined other statins on the market, like:
Lipitor is still on the market today. Yet, millions more now take generic statins due to patent losses of these blockbuster drugs. In fact, generic statins can save you hundreds of dollars each month.
Let's review this life-saving class of drugs many people depend upon to help lower cholesterol levels and prevent life-threatening heart disease.
Statins: How They Work and What's Available
Statins are a group of drugs which lower levels of cholesterol and triglycerides in the blood. Statins may also reduce the risk of heart attack or stroke in those who have risk factors like heart disease or type 2 diabetes. They may be approved treat a serious, inherited form of high cholesterol called Homozygous familial hypercholesterolemia (HoFH). They are approved for use in adults but some statins are also approved to be used in children.
Statins work by blocking an enzyme in your body used to make cholesterol. These drugs work best when they are combined with a healthy diet low in saturated fat and salt, high in fruits and vegetables, plus at least 30 minutes of moderate-intensity exercise most days of the week.
Besides Lipitor, other common brand names of statins include:
- Livalo, Zypitamag (generic name: pitavastatin)
- Crestor, Ezzalor Sprinkle capsule (generic name: rosuvastatin)
- Zocor, FloLipid (generic name: simvastatin)
- Lescol XL (generic name: fluvastatin)
- Pravachol (generic name: pravastatin)
- Altoprev (generic name: lovastatin)
Today, most statin brand name drugs are available in generic form and are typically affordable. For example, using a Drugs.com online coupon, a month's supply of atorvastatin 40 mg will cost from $18 to $30, compared to over $250 for the brand. Prices can vary based on any coupons, your pharmacy, and your location.
Is Cholesterol Still An Important Target for Heart Health?
Absolutely. Studies show that high cholesterol contributes to plaque building in the arteries that can lead to a heart attack or stroke.
Lipid guidelines are patient-specific based on your level of heart risk, and blood tests that measure lipids such as LDL ("bad") and HDL ("good") cholesterol are needed.
Your doctor may look at your overall risk for heart disease or a heart attack in the future (possibly by using a specific calculator to determine a risk number). They'll also consider if you've had a heart attack or stroke in the past, rather than focus solely on your cholesterol numbers to determine your drug treatment.
Risk factors for heart disease that may come into play include:
- smoking status
- blood pressure
- family history of heart disease.
Generics Can Lower Cholesterol and Your Overall Healthcare Bill
Most -- but not all -- statins like Lipitor are now available as cost-saving generics.
- Generic statins like atorvastatin, pravastatin, lovastatin, rosuvastatin, or simvastatin are available at a lower cost than their brand-name alternatives and can lower your cholesterol equally well.
- Talk to your insurance company to see which cholesterol treatments are the most affordable based on their list of covered drugs known as a Formulary.
Also, have a frank discussion with your doctor and pharmacist to keep your treatment costs within reach. If you can't afford your statin, you're much less likely to fill your prescription. And your risk for a dangerous heart event goes up.
Need-To-Know: Statin Advice
The latest guidelines for statin side effects suggest:
- Memory loss and confusion have been reported with statin use.
- Routine liver enzyme lab tests are no longer necessary, but should be checked when treatment is started.
- Blood sugar levels should be checked regularly.
- Statins can increase the risk of muscle pain and muscle damage (myopathy). If this occurs, tell your doctor. Dose adjustments or a trial of another statin may be an option.
- Drugs interactions can be frequent and a drug interaction screen should always be checked.
Statins and Blood Sugar Levels
Statins have been linked with an increased risk for type 2 diabetes in several studies. Side effect information for atorvasatin warns that elevated blood sugar (hyperglycemia) is common and can be seen in up to 10% of patients.
In fact, a large study out of Finland found that statins were associated with between a 28% to a 44% higher risk of developing type 2 diabetes.
- Statins appear to do this by increasing a your insulin resistance and by impairing the ability of the pancreas to secrete insulin.
- In the study, the higher the dose of the statin, the more closely associated it was with diabetes development.
So what does this mean? You should discuss with your doctor and weigh the benefit compared to harms of statin treatment if you are at risk for diabetes, especially if you have blood sugar levels at the higher end and are at risk for prediabetes or diabetes already.
The Concern Over Muscle Injury
Side effects and drug interactions are possible with all statins. For example, some statins are broken down (metabolized) through some of the same pathways that many other drugs follow.
Arthralagia (joint pain) and muscle pain are listed as very common and common side effects in atorvastatin formation, and is common with other statins.
- Competition for these pathways can increase the amount of statin in your blood and the risk for myopathy, a rare muscle injury.
- Myopathy causes muscle pain, tenderness or weakness, and can be serious, rarely resulting in a condition called rhabdomyolysis. This is a rare but serious side effect that is reported in <0.1% of patients taking atorvastatin.
- Contact your doctor about any unusual muscle pain or weakness, a general tired feeling, or fever.
- Always have your pharmacist run a drug interaction screen each time you start (or even stop) any medication. Drug interactions may lead to higher-than- normal blood levels of statins, too.
Learn more: Rhabdomyolysis from statins: What's the risk?
One of the benefits of statins is that they can be taken orally as a tablet, usually only once a day.
Studies have shown that if you only have to take a medication once daily, you're much more likely to stick with it over time.
Most patients start taking statins at low doses. Your doctor may decide to increase your dose, if needed. You may need to take your medication at bedtime, so be sure to check your directions.
If you have active liver disease or unexplained elevated liver enzymes tests (LFTs), statin treatment should usually not be started.
Talking Points About Statins
The information on risks for type 2 diabetes, memory lapses, muscle injury, and possible drug interactions should not scare you away from the cholesterol-lowering statins. These events are uncommon and, in general, reversible once detected. Always discuss your individual risk for side effects with your doctor.
Statins have been shown to lower the risk for heart attack and stroke, and the benefit of statins in preventing heart disease has been clearly established. They are a major breakthrough in the prevention and treatment of cardiovascular disease.
Here's a few talking points for when you meet with your doctor:
- Ask what your overall cardiac risk is, and consider lifestyle changes that are needed, such as diet and exercise. Ask your doctor to calculate your 10-year risk for heart disease, and discuss what this number means specifically for your situation.
- It's always important to review your family history of heart disease with your doctor. This is especially important if a member of your family (parent or sibling) was diagnosed with coronary artery disease under age 55 years (for men) or 65 years (for women).
- Have a discussion about the value of statins or other cholesterol-lowering agents as part of your overall heart risk reduction plan. Be sure to discuss possible side effects over the long-term. Tell your doctor if you prefer generics or have used any other statin before.
- Tell your doctor if you smoke, have diabetes / pre-diabetes, or have high blood pressure.
Statin Use: Do You Fall Within These Parameters?
The latest USPSTF statin recommendations state the following:
- Initiate use of low- to moderate-dose statins in adults aged 40 to 75 years without a history of heart disease who have 1 or more heart risk factors, like high lipids levels, diabetes, high blood pressure (hypertension), or smoking and a calculated 10-year cardiovascular disease event risk of 10% or greater.
- The USPSTF also recommends that clinicians selectively offer low- to moderate-dose statins to adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 7.5% to 10%.
- Identification of cholesterol risk and calculation of 10-year CVD event risk requires universal lipids screening in adults aged 40 to 75 years.
- The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use in adults 76 years and older.
- The USPSTF states the ACC/AHA Pooled Cohort Equations are used to calculate 10-year risk of CVD events, but may overestimate risk. It can be used as a starting point to determine the patient's desire for lifelong statin therapy. Initiation of statin therapy is an individual decision and patients should always discuss their particular risk factors with their doctor.
- These guidelines are under review and update as of May 2021.
What Else Can I Do to Lower Cholesterol?
Sometimes it's easy to blame ourselves when our calculated 10-year heart risk or lipid numbers are high, especially when we've been sticking to diet and exercise.
But family history and genetics can play a large part in elevated cholesterol, too, and we can't always control that. It may be that a cholesterol-lowering medication, like a statin -- even at a low dose -- may be beneficial to lower your risk.
Statins are often recommended as first-line treatments, but not everyone can tolerate or use a statin. Other options include:
- cholesterol absorption inhibitors such as ezetimibe (Zetia). Ezetimibe is also found combined with the statin simvastatin (brand name: Vytorin).
- bile acid binding resins (used less today because they also lower HDL, your good cholesterol)
- nicotinic acid (niacin) - flushing is a common side effect
- fibrates like gemfibrozil (Lopid) or fenofibrate (Tricor)
- PCSK9 inhibitors, a unique class of injectable medicines, may be useful in patients who have very high cholesterol levels and an inherited type of high cholesterol. These agents include alirocumab (Praluent) and evolocumab (Repatha).
- Bempedoic acid (Nexletol) and bempedoic acid and ezetimibe (Nexlizet) are more recent oral non-statin options approved in 2020.
- Evinacumab-dgnb (Evkeeza), approved in Feb. 2021, and lomitapid (Juxtapid) are approved for an inherited, rare and serious form of high LDL cholesterol called Homozygous familial hypercholesterolemia (HoFH). These agenst are often used with other lipid-lowering treatments. Patients with HoFH often die from a heart attack before the age of 30.
Fish oil (omega-3 fatty acids) from one or two servings per week of an oily fish or a supplement may help to reduce blood triglyceride levels. Oily fish include salmon, mackeral, herring, bluefish, and sardines (baked or broiled, not fried). Review use of fish oil dietary supplements to lower your heart disease risk with your doctor prior to starting this option.
Finished: The Lowdown on Lipitor: What You Need To Know
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- Lipitor (atorvastatin) product label. FDA. Accessed May 10, 2021 at https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/020702s077lbl.pdf
- Final Update Summary: Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication. U.S. Preventive Services Task Force. November 2016. Accessed May 10, 2021.
- U.S. Food and Drug Administration (FDA). Controlling cholesterol-lowering with statins. Accessed May 10, 2021 at https://www.fda.gov/consumers/consumer-updates/controlling-cholesterol-statins
- Cholesterol and statins. U.S. Food and Drug Administration (FDA). Accessed May 10, 2021 at https://www.fda.gov/media/82811/download
- Cholesterol. American Heart Association. Accessed May 10, 2021 at https://www.heart.org/en/health-topics/cholesterol
- Metabolic syndrome. Mayo Clinic. Drugs.com. Accessed May 10, 2021 at https://www.drugs.com/mcd/metabolic-syndrome