ATORVASTATIN CALCIUM- atorvastatin calcium_tablet, film coated

Atorvastatin is a selective, competitive inhibitor of HMG-CoA reductase, the rate-limiting enzyme that converts 3-hydroxy-3-methylglutaryl-coenzyme A to mevalonate, a precursor of sterols, including cholesterol. In animal models, atorvastatin lowers plasma cholesterol and lipoprotein levels by inhibiting HMG-CoA reductase and cholesterol synthesis in the liver and by increasing the number of hepatic LDL receptors on the cell surface to enhance uptake and catabolism of LDL; atorvastatin also reduces LDL production and the number of LDL particles. Atorvastatin, as well as some of its metabolites, are pharmacologically active in humans. The liver is the primary site of action and the principal site of cholesterol synthesis and LDL clearance. Drug dosage, rather than systemic drug concentration, correlates better with LDL-C reduction. Individualization of drug dosage should be based on therapeutic response [see Dosage and Administration (2) Absorption Atorvastatin is rapidly absorbed after oral administration; maximum plasma concentrations occur within 1 to 2 hours. Extent of absorption increases in proportion to atorvastatin dose. The absolute bioavailability of atorvastatin (parent drug) is approximately 14% and the systemic availability of HMG-CoA reductase inhibitory activity is approximately 30%. The low systemic availability is attributed to presystemic clearance in gastrointestinal mucosa and/or hepatic first-pass metabolism. Although food decreases the rate and extent of drug absorption by approximately 25% and 9%, respectively, as assessed by Cmax and AUC, LDL-C reduction is similar whether atorvastatin is given with or without food. Plasma atorvastatin concentrations are lower (approximately 30% for Cmax and AUC) following evening drug administration compared with morning. However, LDL-C reduction is the same regardless of the time of day of drug administration. Distribution: Mean volume of distribution of atorvastatin is approximately 381 liters. Atorvastatin is >=98% bound to plasma proteins. A blood/plasma ratio of approximately 0. 25 indicates poor drug penetration into red blood cells. Elimination Metabolism In vitro In vitro [see Drug Interactions (7. 1) Excretion Specific Populations Geriatric Pediatric Apparent oral clearance of atorvastatin in pediatric subjects appeared similar to that of adults when scaled allometrically by body weight as the body weight was the only significant covariate in atorvastatin population PK model with data including pediatric HeFH patients (ages 10 years to 17 years of age, n=29) in an open-label, 8-week study. Gender Plasma concentrations of atorvastatin in women differ from those in men (approximately 20% higher for Cmax and 10% lower for AUC); however, there is no clinically significant difference in LDL-C reduction with atorvastatin between men and women. Renal Impairment Renal disease has no influence on the plasma concentrations or LDL-C reduction of atorvastatin [see Use in Specific Populations (8. 6) While studies have not been conducted in patients with end-stage renal disease, hemodialysis is not expected to significantly enhance clearance of atorvastatin since the drug is extensively bound to plasma proteins. Hepatic Impairment [see Use in Specific Populations (8. 7) Drug Interaction Atorvastatin is a substrate of the hepatic transporters, OATP1B1 and OATP1B3 transporter. Metabolites of atorvastatin are substrates of OATP1B1. Atorvastatin is also identified as a substrate of the efflux transporter BCRP, which may limit the intestinal absorption and biliary clearance of atorvastatin. Table 5: Effect of Co-administered Drugs on the Pharmacokinetics of Atorvastatin Co-administered drug and dosing regimen Atorvastatin Dose (mg) Ratio of AUC Represents ratio of treatments (co-administered drug plus atorvastatin vs. atorvastatin alone). Ratio of Cmax See Sections 5. 1 and 7 for clinical significance. 10 mg QD Once daily 8. 66 Tipranavir 500 mg BID Twice daily 10 mg, SD Single dose 9. 58 Glecaprevir 400 mg QD/pibrentasvir 120 mg QD, 7 days 10 mg QD for 7 days 8. 00 Telaprevir 750 mg q8h Every 8 hours 20 mg SD 7. 60 , The dose of saquinavir plus ritonavir in this study is not the clinically used dose. The increase in atorvastatin exposure when used clinically is likely to be higher than what was observed in this study. Therefore, caution should be applied and the lowest dose necessary should be used. 40 mg QD for 4 days 3. 31 Elbasvir 50 mg QD/grazoprevir 200 mg QD, 13 days 10 mg SD 1. 34 Simeprevir 150 mg QD, 10 days 40 mg SD 2. 70 Clarithromycin 500 mg BID, 9 days 80 mg QD for 8 days 4. 38 Darunavir 300 mg BID/ritonavir 100 mg BID, 9 days 10 mg QD for 4 days 3. 25 Itraconazole 200 mg QD, 4 days 40 mg SD 3. 20 Letermovir 480 mg QD, 10 days 20 mg SD 3. 17 Fosamprenavir 700 mg BID/ritonavir 100 mg BID, 14 days 10 mg QD for 4 days 2. 84 Fosamprenavir 1400 mg BID, 14 days 10 mg QD for 4 days 2. 04 Nelfinavir 1250 mg BID, 14 days 10 mg QD for 28 days 1. 22 Grapefruit Juice, 240 mL QD , Greater increases in AUC (ratio of AUC up to 2. 5) and/or Cmax (ratio of Cmax up to 1. 71) have been reported with excessive grapefruit consumption (>= 750 mL en dash 1. 2 liters per day). 40 mg, SD 1. 16 Diltiazem 240 mg QD, 28 days 40 mg SD 1. 00 Erythromycin 500 mg QID Four times daily 10 mg SD 1. 38 Amlodipine 10 mg, single dose 80 mg SD 1. 91 Cimetidine 300 mg QID, 2 weeks 10 mg QD for 2 weeks 1. 89 Colestipol 10 g BID, 24 weeks 40 mg QD for 8 weeks NA 0. 74 Ratio based on a single sample taken 8en dash16 h post dose. Maalox TC registered 10 mg QD for 15 days 0. 67 Efavirenz 600 mg QD, 14 days 10 mg for 3 days 0. 01 Rifampin 600 mg QD, 7 days (co-administered) Due to the dual interaction mechanism of rifampin, simultaneous co-administration of atorvastatin with rifampin is recommended, as delayed administration of atorvastatin after administration of rifampin has been associated with a significant reduction in atorvastatin plasma concentrations. 90 Rifampin 600 mg QD, 5 days (doses separated) Due to the dual interaction mechanism of rifampin, simultaneous co-administration of atorvastatin with rifampin is recommended, as delayed Administration of atorvastatin after administration of rifampin has been associated with a significant reduction in atorvastatin plasma concentrations. 60 Gemfibrozil 600 mg BID, 7 days 40 mg SD 1. 00 Fenofibrate 160 mg QD, 7 days 40 mg SD 1. 02 Boceprevir 800 mg TID Three times daily 40 mg SD 2. 66 Table 6: Effect of Atorvastatin on the Pharmacokinetics of Co-administered Drugs Atorvastatin Co-administered drug and dosing regimen Drug/Dose (mg) Ratio of AUC Ratio of Cmax 80 mg QD Once daily Antipyrine, 600 mg SD Single dose 1. 89 80 mg QD for 10 days See Section 7 for clinical significance. 20 40 mg QD for 22 days Oral contraceptive QD, 2 months 1. 23 10 mg, SD Tipranavir 500 mg BID Twice daily 1. 96 10 mg QD for 4 days Fosamprenavir 1400 mg BID, 14 days 0. 82 10 mg QD for 4 days Fosamprenavir 700 mg BID/ritonavir 100 mg BID, 14 days 0. 94 Atorvastatin had no clinically significant effect on prothrombin time when administered to patients receiving chronic warfarin treatment.

Atorvastatin calcium tablets are indicated: To reduce the risk of: Myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD) but without clinically evident CHD MI and stroke in adults with type 2 diabetes mellitus with multiple risk factors for CHD but without clinically evident CHD Non-fatal MI, fatal and non-fatal stroke, revascularization procedures, hospitalization for congestive heart failure, and angina in adults with clinically evident CHD As an adjunct to diet to reduce low-density lipoprotein cholesterol (LDL-C) in: Adults with primary hyperlipidemia. Adults and pediatric patients aged 10 years and older with heterozygous familial hypercholesterolemia (HeFH). As an adjunct to other LDL-C-lowering therapies, or alone if such treatments are unavailable, to reduce LDL-C in adults and pediatric patients aged 10 years and older with homozygous familial hypercholesterolemia (HoFH). As an adjunct to diet for the treatment of adults with: Primary dysbetalipoproteinemia Hypertriglyceridemia Atorvastatin calcium tablets are an HMG-CoA reductase inhibitor (statin) indicated ( 1 To reduce the risk of: o Myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD) but without clinically evident CHD. o MI and stroke in adults with type 2 diabetes mellitus with multiple risk factors for CHD but without clinically evident CHD. o Non-fatal MI, fatal and non-fatal stroke, revascularization procedures, hospitalization for congestive heart failure, and angina in adults with clinically evident CHD. As an adjunct to diet to reduce low-density lipoprotein (LDL-C) in: o Adults with primary hyperlipidemia. o Adults and pediatric patients aged 10 years and older with heterozygous familial hypercholesterolemia (HeFH). As an adjunct to other LDL-C-lowering therapies to reduce LDL-C in adults and pediatric patients aged 10 years and older with homozygous familial hypercholesterolemia. As an adjunct to diet for the treatment of adults with: o Primary dysbetaliproteinemia. o Hypertriglyceridemia.

Take orally once daily with or without food ( 2. 1 Assess LDL-C when clinically appropriate, as early as 4 weeks after initiating atorvastatin calcium tablets, and adjust dosage if necessary (2. 2 Pediatric Patients Aged 10 Years of Age and Older with HeFH: 2. 3 Pediatric Patients Aged 10 Years of Age and Older with HoFH: 2. 4 See full prescribing information for atorvastatin calcium tablets dosage modifications due to drug interactions ( 2. 5 Take atorvastatin calcium tablets orally once daily at any time of the day, with or without food. Assess LDL-C when clinically appropriate, as early as 4 weeks after initiating atorvastatin calcium tablets, and adjust the dosage if necessary. The recommended starting dosage of atorvastatin calcium tablets is 10 mg to 20 mg once daily. The dosage range is 10 mg to 80 mg once daily. Patients who require reduction in LDL-C greater than 45% may be started at 40 mg once daily. The recommended starting dosage of atorvastatin calcium tablets is 10 mg once daily. The dosage range is 10 mg to 20 mg once daily. Concomitant use of atorvastatin calcium tablets with the following drugs requires dosage modification of atorvastatin calcium tablets [see Warnings and Precautions (5. 1) and Drug Interactions (7. Anti-Viral Medications In patients taking saquinavir plus ritonavir, darunavir plus ritonavir, fosamprenavir, fosamprenavir plus ritonavir, elbasvir plus grazoprevir or letermovir, do not exceed atorvastatin calcium tablets 20 mg once daily. In patients taking nelfinavir, do not exceed atorvastatin calcium tablets 40 mg once daily. Select Azole Antifungals or Macrolide Antibiotics In patients taking clarithromycin or itraconazole, do not exceed atorvastatin calcium tablets 20 mg once daily. For additional recommendations regarding concomitant use of atorvastatin calcium tablets with other anti-viral medications, azole antifungals or macrolide antibiotics, see Drug Interactions (7.

The following important adverse reactions are described below and elsewhere in the labeling: Myopathy and Rhabdomyolysis [see Warnings and Precautions (5. 1) Immune-Mediated Necrotizing Myopathy [see Warnings and Precautions (5. 2) Hepatic Dysfunction [see Warnings and Precautions (5. 3) Increases in HbA1c and Fasting Serum Glucose Levels [see Warnings and Precautions (5. 4) Most common adverse reactions (incidence >=5%) are nasopharyngitis, arthralgia, diarrhea, pain in extremity, and urinary tract infection ( 6. 1 To report SUSPECTED ADVERSE REACTIONS, contact Biocon Pharma Inc. , at 1-866-924-6266 or FDA at 1-800-FDA-1088 or www. gov/medwatch. Because clinical trials are conducted under widely varying conditions, the adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. In the atorvastatin placebo-controlled clinical trial database of 16,066 patients (8755 atorvastatin vs. 7311 placebo; age range 10en dash93 years, 39% women, 91% White, 3% Black, 2% Asian, 4% other) with a median treatment duration of 53 weeks, the most common adverse reactions in patients treated with atorvastatin that led to treatment discontinuation and occurred at a rate greater than placebo were: myalgia (0. 7%), diarrhea (0. 5%), nausea (0. 4%), alanine aminotransferase increase (0. 4%), and hepatic enzyme increase (0. Table 1 summarizes adverse reactions reported in >= 2% and at a rate greater than placebo in patients treated with atorvastatin (n=8755), from seventeen placebo-controlled trials. Table 1: Adverse Reactions Occuring in >= 2% in Patients Atorvastatin-Treated with any Dose and Greater than Placebo Adverse Reaction % Placebo % 10 mg % 20 mg % 40 mg % 80 mg % Any dose N=8755 Nasopharyngitis 8. 3 Arthralgia 6. 9 Diarrhea 6. 8 Pain in extremity 5. 0 Urinary tract infection 5. 7 Dyspepsia 4. 0 Musculoskeletal pain 3. 8 Muscle spasms 3. 6 Myalgia 3. 5 Insomnia 2. 0 Pharyngolaryngeal pain 2. 3 Other adverse reactions reported in placebo-controlled trials include: Body as a whole Digestive system: Musculoskeletal system Metabolic and nutritional system Nervous system Respiratory system: Skin and appendages Special senses Urogenital system: Elevations in Liver Enzyme Tests Persistent elevations in serum transaminases, defined as more than 3 times the ULN and occurring on 2 or more occasions, occurred in 0. 7% of patients who received atorvastatin in clinical trials. The incidence of these abnormalities was 0. 3% for 10, 20, 40, and 80 mg, respectively. One patient in clinical trials developed jaundice. Increases in liver enzyme tests in other patients were not associated with jaundice or other clinical signs or symptoms. Upon dose reduction, drug interruption, or discontinuation, transaminase levels returned to or near pretreatment levels without sequelae. Eighteen of 30 patients with persistent liver enzyme elevations continued treatment with a reduced dose of atorvastatin. Treating to New Targets Study (TNT) In TNT, [see Clinical Studies (14. 1) Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) In SPARCL, 4731 patients (age range 21en dash92 years, 40% women; 93% White, 3% Black, 1% Asian, 3% other) without clinically evident CHD but with a stroke or transient ischemic attack (TIA) within the previous 6 months were treated with atorvastatin 80 mg (n=2365) or placebo (n=2366) for a median follow-up of 4. There was a higher incidence of persistent hepatic transaminase elevations (>= 3 x ULN twice within 4en dash10 days) in the atorvastatin group (0. 9%) compared to placebo (0. Elevations of CK (>10 x ULN) were rare, but were higher in the atorvastatin group (0. 1%) compared to placebo (0. Diabetes was reported as an adverse reaction in 6. 1% of subjects in the atorvastatin group and 3. 8% of subjects in the placebo group. In a post-hoc analysis, atorvastatin 80 mg reduced the incidence of ischemic stroke (9. 6%) and increased the incidence of hemorrhagic stroke (2. 4%) compared to placebo. The incidence of fatal hemorrhagic stroke was similar between groups (17 atorvastatin vs. 18 placebo). The incidence of non-fatal hemorrhagic strokes was significantly greater in the atorvastatin group (38 non-fatal hemorrhagic strokes) as compared to the placebo group (16 non-fatal hemorrhagic strokes). Patients who entered the trial with a hemorrhagic stroke appeared to be at increased risk for hemorrhagic stroke (16% atorvastatin vs. 4% placebo). Adverse Reactions from Clinical Studies of Atorvastatin in Pediatric Patients with HeFH In a 26-week controlled study in pediatric patients with HeFH (ages 10 years to 17 years) (n=140, 31% female; 92% White, 1. 6% Blacks, 1. 6% Asians, 4. 8% other), the safety and tolerability profile of atorvastatin 10 to 20 mg daily, as an adjunct to diet to reduce total cholesterol, LDL-C, and apo B levels, was generally similar to that of placebo [see Use in Specific Populations (8. 4) Clinical Studies (14. 6) The following adverse reactions have been identified during post-approval use of atorvastatin. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Gastrointestinal disorders: General disorders: Hepatobiliary Disorders Immune system disorders Injury: Musculoskeletal and connective tissue disorders: There have been rare reports of immune-mediated necrotizing myopathy associated with statin use. Nervous system disorders: There have been rare reports of cognitive impairment (e. , memory loss, forgetfulness, amnesia, memory impairment, confusion) associated with the use of all statins. Cognitive impairment was generally nonserious, and reversible upon statin discontinuation, with variable times to symptom onset (1 day to years) and symptom resolution (median of 3 weeks). Psychiatric disorders: Respiratory disorders: Skin and subcutaneous tissue disorders:.

Acute liver failure or decompensated cirrhosis [see Warnings and Precautions (5. 3) Hypersensitivity to atorvastatin or any excipients in atorvastatin calcium tablets. Hypersensitivity reactions, including anaphylaxis, angioneurotic edema, erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis, have been reported [see Adverse Reactions (6. 2) Acute liver failure or decompensated cirrhosis ( 4 Hypersensitivity to atorvastatin or any excipient in atorvastatin calcium tablets ( 4.

Pregnancy 8. 1 Lactation 8. 2 Risk Summary Discontinue atorvastatin when pregnancy is recognized. Alternatively, consider the ongoing therapeutic needs of the individual patient. Atorvastatin decreases synthesis of cholesterol and possibly other biologically active substances derived from cholesterol; therefore, atorvastatin may cause fetal harm when administered to pregnant patients based on the mechanism of action [see Clinical Pharmacology (12. 1) Available data from case series and prospective and retrospective observational cohort studies over decades of use with statins in pregnant women have not identified a drug-associated risk of major congenital malformations. Published data from prospective and retrospective observational cohort studies with atorvastatin use in pregnant women are insufficient to determine if there is a drug-associated risk of miscarriage (see Data) 2 (see Data) The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively. Data Human Data A Medicaid cohort linkage study of 1152 statin-exposed pregnant women compared to 886,996 controls did not find a significant teratogenic effect from maternal use of statins in the first trimester of pregnancy, after adjusting for potential confounders en dash including maternal age, diabetes mellitus, hypertension, obesity, and alcohol and tobacco use en dash using propensity score-based methods. The relative risk of congenital malformations between the group with statin use and the group with no statin use in the first trimester was 1. 07 (95% confidence interval 0. 37) after controlling for confounders, particularly pre-existing diabetes mellitus. There were also no statistically significant increases in any of the organ-specific malformations assessed after accounting for confounders. In the majority of pregnancies, statin treatment was initiated prior to pregnancy and was discontinued at some point in the first trimester when pregnancy was identified. Study limitations include reliance on physician coding to define the presence of a malformation, lack of control for certain confounders such as body mass index, use of prescription dispensing as verification for the use of a statin, and lack of information on non-live births. Animal Data Atorvastatin was administered to pregnant rats and rabbits during organogenesis at oral doses up to 300 mg/kg/day and 100 mg/kg/day, respectively. Atorvastatin was not teratogenic in rats at doses up to 300 mg/kg/day or in rabbits at doses up to 100 mg/kg/day. These doses resulted in multiples of about 30 times (rat) or 20 times (rabbit) the human exposure at the MRHD based on surface area (mg/m 2 In a study in pregnant rats administered 20, 100, or 225 mg/kg/day from gestation day 7 through to lactation day 20 (weaning), there was decreased survival at birth, postnatal day 4, weaning, and post-weaning in pups of mothers dosed with 225 mg/kg/day, a dose at which maternal toxicity was observed. Pup body weight was decreased through postnatal day 21 at 100 mg/kg/day, and through postnatal day 91 at 225 mg/kg/day. Pup development was delayed (rotorod performance at 100 mg/kg/day and acoustic startle at 225 mg/kg/day; pinnae detachment and eye-opening at 225 mg/kg/day). These doses correspond to 6 times (100 mg/kg) and 22 times (225 mg/kg) the human exposure at the MRHD, based on AUC. Atorvastatin crosses the rat placenta and reaches a level in fetal liver equivalent to that of maternal plasma. Risk Summary There is no information about the presence of atorvastatin in human milk, the effects of the drug on the breastfed infant or the effects of the drug on milk production. However, it has been shown that another drug in this class passes into human milk. Studies in rats have shown that atorvastatin and/or its metabolites are present in the breast milk of lactating rats. When a drug is present in animal milk, it is likely that the drug will be present in human milk (see Data) Because of the potential for serious adverse reactions in a breastfed infant, based on the mechanism of action, advise patients that breastfeeding is not recommended during treatment with atorvastatin [see Use in Specific Populations (8. 1) , Clinical Pharmacology (12. 1)] Data Following a single oral administration of 10 mg/kg of radioactive atorvastatin to lactating rats, the concentration of total radioactivity was determined. Atorvastatin and/or its metabolites were measured in the breast milk and pup plasma at a 2:1 ratio (milk:plasma). The safety and effectiveness of atorvastatin as an adjunct to diet to reduce LDL-C have been established pediatric patients 10 years of age and older with HeFH. Use of atorvastatin for this indication is based on a double-blind, placebo-controlled clinical trial in 187 pediatric patients 10 years of age and older with HeFH. In this limited controlled trial, there was no significant effect on growth or sexual maturation in the boys or girls, or on menstrual cycle length in girls. The safety and effectiveness of atorvastatin as an adjunct to other LDL-C-lowering therapies to reduce LDL-C have been established pediatric patients 10 years of age and older with HoFH. Use of atorvastatin for this indication is based on a trial without a concurrent control group in 8 pediatric patients 10 years of age and older with HoFH [see Clinical Studies (14) The safety and effectiveness of atorvastatin have not been established in pediatric patients younger than 10 years of age with HeFH or HoFH, or in pediatric patients with other types of hyperlipidemia (other than HeFH or HoFH). Of the total number of atorvastatin-treated patients in clinical trials, 15,813 (40%) were >=65 years old and 2,800 (7%) were >=75 years old. No overall differences in safety or effectiveness were observed between these patients and younger patients. Advanced age (>=65 years) is a risk factor for atorvastatin-associated myopathy and rhabdomyolysis. Dose selection for an elderly patient should be cautious, recognizing the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy and the higher risk of myopathy. Monitor geriatric patients receiving atorvastatin for the increased risk of myopathy [see Warnings and Precautions (5. 1 Renal impairment is a risk factor for myopathy and rhabdomyolysis. Monitor all patients with renal impairment for development of myopathy. Renal impairment does not affect the plasma concentrations of atorvastatin, therefore there is no dosage adjustment in patients with renal impairment [see Warnings and Precautions (5. 1 ) and Clinical Pharmacology (12. 3)] In patients with chronic alcoholic liver disease, plasma concentrations of atorvastatin are markedly increased. C max max [see Contraindications (4).

See full prescribing information for details regarding concomitant use of atorvastatin calcium tablets with other drugs or grapefruit juice that increase the risk of myopathy and rhabdomyolysis ( 2. 1 Rifampin 7. 2 Oral Contraceptives 7. 3 Digoxin 7. 3 Atorvastatin is a substrate of CYP3A4 and transporters (e. , OATP1B1/1B3, P-gp, or BCRP). Atorvastatin plasma levels can be significantly increased with concomitant administration of inhibitors of CYP3A4 and transporters. Table 2 includes a list of drugs that may increase exposure to atorvastatin and may increase the risk of myopathy and rhabdomyolysis when used concomitantly and instructions for preventing or managing them [see Warnings and Precautions (5. 1) Clinical Pharmacology (12. 3) Table 2: Drug Interactions that may Increase the Risk of Myopathy and Rhabdomyolysis with Atorvastatin Cyclosporine or Gemfibrozil Clinical Impact: Atorvastatin plasma levels were significantly increased with concomitant administration of atorvastatin and cyclosporine, an inhibitor of CYP3A4 and OATP1B1 [see Clinical Pharmacology (12. 3) Intervention: Concomitant use of cyclosporine or gemfibrozil with atorvastatin is not recommended. Anti-Viral Medications Clinical Impact: Atorvastatin plasma levels were significantly increased with concomitant administration of atorvastatin with many anti-viral medications, which are inhibitors of CYP3A4 and/or transporters (e. , BCRP, OATP1B1/1B3, P-gp, MRP2, and/or OAT2) [see Clinical Pharmacology (12. 3) Intervention: Concomitant use of tipranavir plus ritonavir or glecaprevir plus pibrentasvir with atorvastatin is not recommended. In patients taking lopinavir plus ritonavir, or simeprevir, consider the risk/benefit of concomitant use with atorvastatin. In patients taking saquinavir plus ritonavir, darunavir plus ritonavir, fosamprenavir, fosamprenavir plus ritonavir, elbasvir plus grazoprevir or letermovir, do not exceed atorvastatin 20 mg. In patients taking nelfinavir, do not exceed atorvastatin 40 mg [see Dosage and Administration (2. 5) Consider the risk/benefit of concomitant use of ledipasvir plus sofosbuvir with atorvastatin. Monitor all patients for signs and symptoms of myopathy particularly during initiation of therapy and during upward dose titration of either drug. Examples: Tipranavir plus ritonavir, glecaprevir plus pibrentasvir, lopinavir plus ritonavir, simeprevir, saquinavir plus ritonavir, darunavir plus ritonavir, fosamprenavir, fosamprenavir plus ritonavir, elbasvir plus grazoprevir, letermovir, nelfinavir, and ledipasvir plus sofosbuvir. Select Azole Antifungals or Macrolide Antibiotics Clinical Impact: Atorvastatin plasma levels were significantly increased with concomitant administration of atorvastatin with select azole antifungals or macrolide antibiotics, due to inhibition of CYP3A4 and/or transporters [see Clinical Pharmacology (12. 3) Intervention: In patients taking clarithromycin or itraconazole, do not exceed atorvastatin 20 mg [see Dosage and Administration (2. 5) Examples: Erythromycin, clarithromycin, itraconazole, ketoconazole, posaconazole, and voriconazole. Niacin Clinical Impact: Cases of myopathy and rhabdomyolysis have been observed with concomitant use of lipid modifying dosages of niacin (>=1 gram/day niacin) with atorvastatin. Intervention: Consider if the benefit of using lipid modifying dosages of niacin concomitantly with atorvastatin outweighs the increased risk of myopathy and rhabdomyolysis. If concomitant use is decided, monitor patients for signs and symptoms of myopathy particularly during initiation of therapy and during upward dose titration of either drug. Fibrates (other than Gemfibrozil) Clinical Impact: Fibrates may cause myopathy when given alone. The risk of myopathy and rhabdomyolysis is increased with concomitant use of fibrates with atorvastatin. Intervention: Consider if the benefit of using fibrates concomitantly with atorvastatin outweighs the increased risk of myopathy and rhabdomyolysis. Colchicine Clinical Impact: Cases of myopathy and rhabdomyolysis have been reported with concomitant use of colchicine with atorvastatin. Intervention: Consider the risk/benefit of concomitant use of colchicine with atorvastatin. Grapefruit Juice Clinical Impact: Grapefruit juice consumption, especially excessive consumption, more than 1. 2 liters/daily, can raise the plasma levels of atorvastatin and may increase the risk of myopathy and rhabdomyolysis. Intervention: Avoid intake of large quantities of grapefruit juice, more than 1. 2 liters daily, when taking atorvastatin. Table 3 presents drug interactions that may decrease exposure to atorvastatin and instructions for preventing or managing them. Table 3: Drug Interactions that may Decrease Exposure to Atorvastatin Rifampin Clinical Impact: Concomitant administration of atorvastatin with rifampin, an inducer of cytochrome P450 3A4 and inhibitor of OATP1B1, can lead to variable reductions in plasma concentrations of atorvastatin. Due to the dual interaction mechanism of rifampin, delayed administration of atorvastatin after administration of rifampin has been associated with a significant reduction in atorvastatin plasma concentrations. Intervention: Administer atorvastatin and rifampin simultaneously. Table 4 presents atorvastatin's effect on other drugs and instructions for preventing or managing them. Table 4: Atorvastatin Effects on Other Drugs Oral Contraceptives Clinical Impact: Co-administration of atorvastatin and an oral contraceptive increased plasma concentrations of norethindrone and ethinyl estradiol [see Clinical Pharmacology (12. 3) Intervention: Consider this when selecting an oral contraceptive for patients taking atorvastatin. Digoxin Clinical Impact: When multiple doses of atorvastatin and digoxin were co-administered, steady state plasma digoxin concentrations increased [see Clinical Pharmacology (12. 3) Intervention: Monitor patients taking digoxin appropriately.

OVERDOSAGE
No specific antidotes for atorvastatin are known. Contact Poison Control (1-800-222-1222) for latest recommendations. Due to extensive drug binding to plasma proteins, hemodialysis is not expected to significantly enhance atorvastatin clearance.
NONCLINICAL TOXICOLOGY
In a 2-year carcinogenicity study in rats at dose levels of 10, 30, and 100 mg/kg/day, 2 rare tumors were found in muscle in high-dose females: in one, there was a rhabdomyosarcoma and, in another, there was a fibrosarcoma. This dose represents a plasma AUC (0en dash24) value of approximately 16 times the mean human plasma drug exposure after an 80 mg oral dose. A 2-year carcinogenicity study in mice given 100, 200, or 400 mg/kg/day resulted in a significant increase in liver adenomas in high-dose males and liver carcinomas in high-dose females. These findings occurred at plasma AUC (0en dash24) values of approximately 6 times the mean human plasma drug exposure after an 80 mg oral dose. In vitro, Salmonella typhimurium Escherichia coli, in vivo In female rats, atorvastatin at doses up to 225 mg/kg (56 times the human exposure) did not cause adverse effects on fertility. Studies in male rats performed at doses up to 175 mg/kg (15 times the human exposure) produced no changes in fertility. There was aplasia and aspermia in the epididymis of 2 of 10 rats treated with 100 mg/kg/day of atorvastatin for 3 months (16 times the human AUC at the 80 mg dose); testis weights were significantly lower at 30 and 100 mg/kg and epididymal weight was lower at 100 mg/kg. Male rats given 100 mg/kg/day for 11 weeks prior to mating had decreased sperm motility, spermatid head concentration, and increased abnormal sperm. Atorvastatin caused no adverse effects on semen parameters, or reproductive organ histopathology in dogs given doses of 10, 40, or 120 mg/kg for 2 years.
CLINICAL STUDIES
Prevention of Cardiovascular Disease In the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), the effect of atorvastatin on fatal and non-fatal coronary heart disease was assessed in 10,305 patients with hypertension, 40en dash80 years of age (mean of 63 years; 19% women; 95% White, 3% Black, 1% South Asian, 1% other), without a previous myocardial infarction and with total cholesterol (TC) levels <=251 mg/dL. Additionally, all patients had at least 3 of the following cardiovascular risk factors: male gender (81%), age >55 years (85%), smoking (33%), diabetes (24%), history of CHD in a first-degree relative (26%), TC:HDL >6 (14%), peripheral vascular disease (5%), left ventricular hypertrophy (14%), prior cerebrovascular event (10%), specific ECG abnormality (14%), proteinuria/albuminuria (62%). In this double-blind, placebo-controlled trial, patients were treated with anti-hypertensive therapy (goal BP <140/90 mm Hg for patients without diabetes; <130/80 mm Hg for patients with diabetes) and allocated to either atorvastatin 10 mg daily (n=5168) or placebo (n=5137), using a covariate adaptive method which took into account the distribution of nine baseline characteristics of patients already enrolled and minimized the imbalance of those characteristics across the groups. Patients were followed for a median duration of 3. The effect of 10 mg/day of atorvastatin on lipid levels was similar to that seen in previous clinical trials. Atorvastatin significantly reduced the rate of coronary events [either fatal coronary heart disease (46 events in the placebo group vs. 40 events in the atorvastatin group) or non-fatal MI (108 events in the placebo group vs. 60 events in the atorvastatin group)] with a relative risk reduction of 36% [(based on incidences of 1. 9% for atorvastatin vs. 0% for placebo), p=0. 0005 (see Figure 1)]. The risk reduction was consistent regardless of age, smoking status, obesity, or presence of renal dysfunction. The effect of atorvastatin was seen regardless of baseline LDL levels. Figure 1: Effect of Atorvastatin 10 mg/day on Cumulative Incidence of Non-Fatal Myocardial Infarction or Coronary Heart Disease Death (in ASCOT-LLA) Atorvastatin also significantly decreased the relative risk for revascularization procedures by 42% (incidences of 1. 4% for atorvastatin and 2. 5% for placebo). Although the reduction of fatal and non-fatal strokes did not reach a pre-defined significance level (p=0. 01), a favorable trend was observed with a 26% relative risk reduction (incidences of 1. 7% for atorvastatin and 2. 3% for placebo). There was no significant difference between the treatment groups for death due to cardiovascular causes (p=0. 51) or noncardiovascular causes (p=0. In the Collaborative Atorvastatin Diabetes Study (CARDS), the effect of atorvastatin on cardiovascular disease (CVD) endpoints was assessed in 2838 subjects (94% White, 2% Black, 2% South Asian, 1% other; 68% male), ages 40en dash75 with type 2 diabetes based on WHO criteria, without prior history of cardiovascular disease and with LDL <=160 mg/dL and triglycerides (TG) <=600 mg/dL. In addition to diabetes, subjects had 1 or more of the following risk factors: current smoking (23%), hypertension (80%), retinopathy (30%), or microalbuminuria (9%) or macroalbuminuria (3%). No subjects on hemodialysis were enrolled in the trial. In this multicenter, placebo-controlled, double-blind clinical trial, subjects were randomly allocated to either atorvastatin 10 mg daily (1429) or placebo (1411) in a 1:1 ratio and were followed for a median duration of 3. The primary endpoint was the occurrence of any of the major cardiovascular events: myocardial infarction, acute CHD death, unstable angina, coronary revascularization, or stroke. The primary analysis was the time to first occurrence of the primary endpoint. Baseline characteristics of subjects were: mean age of 62 years, mean HbA 1c The effect of atorvastatin 10 mg/day on lipid levels was similar to that seen in previous clinical trials. Atorvastatin significantly reduced the rate of major cardiovascular events (primary endpoint events) (83 events in the atorvastatin group vs. 127 events in the placebo group) with a relative risk reduction of 37%, HR 0. 63, 95% CI (0. 001) (see Figure 2). An effect of atorvastatin was seen regardless of age, sex, or baseline lipid levels. Atorvastatin significantly reduced the risk of stroke by 48% (21 events in the atorvastatin group vs. 39 events in the placebo group), HR 0. 52, 95% CI (0. 016) and reduced the risk of MI by 42% (38 events in the atorvastatin group vs. 64 events in the placebo group), HR 0. There was no significant difference between the treatment groups for angina, revascularization procedures, and acute CHD death. There were 61 deaths in the atorvastatin group vs. 82 deaths in the placebo group (HR 0. Figure 2: Effect of Atorvastatin 10 mg/day on Time to Occurrence of Major Cardiovascular Event (myocardial infarction, acute CHD death, unstable angina, coronary revascularization, or stroke) in CARDS In the Treating to New Targets Study (TNT), the effect of atorvastatin 80 mg/day vs. atorvastatin 10 mg/day on the reduction in cardiovascular events was assessed in 10,001 subjects (94% White, 81% male, 38% >=65 years) with clinically evident coronary heart disease who had achieved a target LDL-C level <130 mg/dL after completing an 8-week, open-label, run-in period with atorvastatin 10 mg/day. Subjects were randomly assigned to either 10 mg/day or 80 mg/day of atorvastatin and followed for a median duration of 4. The primary endpoint was the time-to-first occurrence of any of the following major cardiovascular events (MCVE): death due to CHD, non-fatal myocardial infarction, resuscitated cardiac arrest, and fatal and non-fatal stroke. The mean LDL-C, TC, TG, non-HDL, and HDL cholesterol levels at 12 weeks were 73, 145, 128, 98, and 47 mg/dL during treatment with 80 mg of atorvastatin and 99, 177, 152, 129, and 48 mg/dL during treatment with 10 mg of atorvastatin. Treatment with atorvastatin 80 mg/day significantly reduced the rate of MCVE (434 events in the 80 mg/day group vs. 548 events in the 10 mg/day group) with a relative risk reduction of 22%, HR 0. 78, 95% CI (0. 0002 (see Figure 3 and Table 7). The overall risk reduction was consistent regardless of age (<65, >=65) or sex. Figure 3: Effect of Atorvastatin 80 mg/day vs. 10 mg/day on Time to Occurrence of Major Cardiovascular Events (TNT) Table 7: Overview of Efficacy Results in TNT Endpoint Atorvastatin 10 mg (N=5006) Atorvastatin 80 mg (N=4995) HR a PRIMARY ENDPOINT n (%) n (%) First major cardiovascular endpoint 548 (10. 89) Components of the Primary Endpoint CHD death 127 (2. 03) Non-fatal, non-procedure related MI 308 (6. 93) Resuscitated cardiac arrest 26 (0. 67) Stroke (fatal and non-fatal) 155 (3. 96) SECONDARY ENDPOINTS* First CHF with hospitalization 164 (3. 94) First PVD endpoint 282 (5. 15) First CABG or other coronary revascularization procedure b 904 (18. 80) First documented angina endpoint b 615 (12. 99) All-cause mortality 282 (5. 19) Components of All-Cause Mortality Cardiovascular death 155 (3. 03) Noncardiovascular death 127 (2. 57) Cancer death 75 (1. 55) Other non-CV death 43 (0. 00) Suicide, homicide, and other traumatic non-CV death 9 (0. 82) a b * Secondary endpoints not included in primary endpointHR=hazard ratio; CHD=coronary heart disease; CI=confidence interval; MI=myocardial infarction; CHF=congestive heart failure; CV=cardiovascular; PVD=peripheral vascular disease; CABG=coronary artery bypass graft Confidence intervals for the Secondary Endpoints were not adjusted for multiple comparisons Of the events that comprised the primary efficacy endpoint, treatment with atorvastatin 80 mg/day significantly reduced the rate of non-fatal, non-procedure related MI and fatal and non-fatal stroke, but not CHD death or resuscitated cardiac arrest (Table 7). Of the predefined secondary endpoints, treatment with atorvastatin 80 mg/day significantly reduced the rate of coronary revascularization, angina, and hospitalization for heart failure, but not peripheral vascular disease. The reduction in the rate of CHF with hospitalization was only observed in the 8% of patients with a prior history of CHF. There was no significant difference between the treatment groups for all-cause mortality (Table 7). The proportions of subjects who experienced cardiovascular death, including the components of CHD death and fatal stroke, were numerically smaller in the atorvastatin 80 mg group than in the atorvastatin 10 mg treatment group. The proportions of subjects who experienced noncardiovascular death were numerically larger in the atorvastatin 80 mg group than in the atorvastatin 10 mg treatment group. Primary Hyperlipidemia in Adults Atorvastatin reduces total-C, LDL-C, apo B, and TG, and increases HDL-C in patients with hyperlipidemia (heterozygous familial and nonfamilial) and mixed dyslipidemia. Therapeutic response is seen within 2 weeks, and maximum response is usually achieved within 4 weeks and maintained during chronic therapy. In two multicenter, placebo-controlled, dose-response trials in patients with hyperlipidemia, atorvastatin given as a single dose over 6 weeks, significantly reduced total-C, LDL-C, apo B, and TG. (Pooled results are provided in Table 8. ) Table 8: Dose Response in Patients with Primary Hyperlipidemia (Adjusted Mean % Change From Baseline) a Dose N TC LDL-C Apo B TG HDL-C Placebo 21 4 4 3 10 -3 10 22 -29 -39 -32 -19 6 20 20 -33 -43 -35 -26 9 40 21 -37 -50 -42 -29 6 80 23 -45 -60 -50 -37 5 a In three multicenter, double-blind trials in patients with hyperlipidemia, atorvastatin was compared to other statins. After randomization, patients were treated for 16 weeks with either atorvastatin 10 mg per day or a fixed dose of the comparative agent (Table 9). Table 9: Mean Percentage Change From Baseline at Endpoint (Double-Blind, Randomized, Active-Controlled Trials) Treatment (Daily Dose) N Total-C LDL-C Apo B TG HDL-C Trial 1 Atorvastatin 10 mg 707 -27 a -36 a -28 a -17 a +7 Lovastatin 20 mg 191 -19 -27 -20 -6 +7 95% CI for Diff 1 -9. 0 Trial 2 Atorvastatin 10 mg 222 -25 b -35 b -27 b -17 b +6 Pravastatin 20 mg 77 -17 -23 -17 -9 +8 95% CI for Diff 1 -10. 6 Trial 3 Atorvastatin 10 mg 132 -29 c -37 c -34 c -23 c +7 Simvastatin 10 mg 45 -24 -30 -30 -15 +7 95% CI for Diff 1 -8. 9 1 a b c Table 9 does not contain data comparing the effects of atorvastatin 10 mg and higher doses of lovastatin, pravastatin, and simvastatin. The drugs compared in the trials summarized in the table are not necessarily interchangeable. Hypertriglyceridemia in Adults The response to atorvastatin in 64 patients with isolated hypertriglyceridemia treated across several clinical trials is shown in the table below (Table 10). For the atorvastatin-treated patients, median (min, max) baseline TG level was 565 (267en dash1502). Table 10: Combined Patients with Isolated Elevated TG: Median (min, max) Percentage Change From Baseline Placebo (N=12) Atorvastatin 10 mg (N=37) Atorvastatin 20 mg (N=13) Atorvastatin 80 mg (N=14) Triglycerides -12. 3) Total-C -2. 2) non-HDL-C -2. 3) Dysbetalipoproteinemia in Adults The results of an open-label crossover trial of 16 patients (genotypes: 14 apo E2/E2 and 2 apo E3/E2) with dysbetalipoproteinemia are shown in the table below (Table 11). Table 11: Open-Label Crossover Trial of 16 Patients with Dysbetalipoproteinemia (Fredrickson Type III) Median % Change (min, max) Median (min, max) at Baseline (mg/dL) Atorvastatin 10 mg Atorvastatin 80 mg Total-C 442 (225, 1320) -37 (-85, 17) -58 (-90, -31) Triglycerides 678 (273, 5990) -39 (-92, -8) -53 (-95, -30) IDL-C + VLDL-C 215 (111, 613) -32 (-76, 9) -63 (-90, -8) non-HDL-C 411 (218, 1272) -43 (-87, -19) -64 (-92, -36) HoFH in Adults and Pediatric Patients In a trial without a concurrent control group, 29 patients (mean age of 22 years, median age of 24 years, 31% <18 years) with HoFH received maximum daily doses of 20 to 80 mg of atorvastatin. The mean LDL-C reduction in this trial was 18%. Twenty-five patients with a reduction in LDL-C had a mean response of 20% (range of 7% to 53%, median of 24%); the remaining 4 patients had 7% to 24% increases in LDL-C. Five of the 29 patients had absent LDL-receptor function. Of these, 2 patients also had a portacaval shunt and had no significant reduction in LDL-C. The remaining 3 receptor-negative patients had a mean LDL-C reduction of 22%. HeFH in Pediatric Patients In a double-blind, placebo-controlled trial followed by an open-label phase, 187 boys and post-menarchal girls 10 years to 17 years of age (mean age 14. 1 years; 31% female; 92% White, 1. 6% Blacks, 1. 6% Asians, 4. 8% other) with heterozygous familial hypercholesterolemia (HeFH) or severe hypercholesterolemia, were randomized to atorvastatin (n=140) or placebo (n=47) for 26 weeks and then all received atorvastatin for 26 weeks. Inclusion in the trial required 1) a baseline LDL-C level >=190 mg/dL or 2) a baseline LDL-C level >=160 mg/dL and positive family history of FH or documented premature cardiovascular disease in a first or second-degree relative. The mean baseline LDL-C value was 219 mg/dL (range: 139en dash385 mg/dL) in the atorvastatin group compared to 230 mg/dL (range: 160en dash325 mg/dL) in the placebo group. The dosage of atorvastatin (once daily) was 10 mg for the first 4 weeks and uptitrated to 20 mg if the LDL-C level was >130 mg/dL. The number of atorvastatin-treated patients who required uptitration to 20 mg after Week 4 during the double-blind phase was 78 (56%). Atorvastatin significantly decreased plasma levels of total-C, LDL-C, triglycerides, and apolipoprotein B during the 26-week double-blind phase (see Table 12). Table 12: Lipid-altering Effects of Atorvastatin in Adolescent Boys and Girls with Heterozygous Familial Hypercholesterolemia or Severe Hypercholesterolemia (Mean Percentage Change From Baseline at Endpoint in Intention-to-Treat Population) DOSAGE N Total-C LDL-C HDL-C TG Apolipoprotein B Placebo 47 -1. 7 Atorvastatin 140 -31. 0 The mean achieved LDL-C value was 130. 7 mg/dL (range: 70. 0en dash242. 0 mg/dL) in the atorvastatin group compared to 228. 5 mg/dL (range: 152. 0en dash385. 0 mg/dL) in the placebo group during the 26-week double-blind phase. Atorvastatin was also studied in a three year open-label, uncontrolled trial that included 163 patients with HeFH who were 10 years to 15 years old (82 boys and 81 girls). All patients had a clinical diagnosis of HeFH confirmed by genetic analysis (if not already confirmed by family history). Approximately 98% were White, and less than 1% were Black or Asian. Mean LDL-C at baseline was 232 mg/dL. The starting atorvastatin dosage was 10 mg once daily and doses were adjusted to achieve a target of <130 mg/dL LDL-C. The reductions in LDL-C from baseline were generally consistent across age groups within the trial as well as with previous clinical trials in both adult and pediatric placebo-controlled trials. jpg Figure 2. jpg Figure 3.
Patient Information
Patient Information ATORVASTATIN CALCIUM (a tor" va stat'' in kal'' see um) TABLETS, USP for oral use Do not take atorvastatin calcium tablets if you: have liver problems (acute liver failure or decompensated cirrhosis) are allergic to atorvastatin or any of the ingredients in atorvastatin calcium tablets. Stop using atorvastatin calcium tablets and get medical help right away if you have symptoms of a serious allergic reaction including: swelling of your face, lips, tongue or throat problems breathing or swallowing fainting or feeling dizzy very rapid heartbeat severe skin rash or itching flu-like symptoms including fever, sore throat, cough, tiredness, and joint pain Before you take atorvastatin calcium tablets, tell your doctor about all of your medical conditions, including if you: have unexplained muscle aches or weakness drink more than 2 glasses of alcohol daily have diabetes have thyroid problems have kidney problems had a stroke are pregnant or plan to become pregnant. Atorvastatin calcium tablets may harm your unborn baby. If you become pregnant, stop taking atorvastatin calcium tablets and call your doctor right away. are breastfeeding or plan to breastfeed. You and your doctor should decide if you will take atorvastatin calcium tablets or breastfeed. You should not do both. Talk to your doctor about the best way to feed your baby if you take atorvastatin calcium tablets. Tell your doctor about all the medicines you take, your immune system (cyclosporine) cholesterol (gemfibrozil) infections (erythromycin, clarithromycin, itraconazole, ketoconazole, posaconazole, and voriconazole) birth control pills heart failure (digoxin) gout (colchicine) niacin fibrates viruses that treat HIV, AIDS, or hepatitis C (anti-virals) tipranavir plus ritonavir glecaprevir plus pibrentasvir ledipasvir plus sofosbuvir simeprevir saquinavir plus ritonavir darunavir plus ritonavir fosamprenavir fosamprenavir plus ritonavir elbasvir plus grazoprevir letermovir nelfinavir How should I take atorvastatin calcium tablets? Take atorvastatin calcium tablets exactly as your doctor tells you to take it. Do not change your dose or stop atorvastatin calcium tablets without talking to your doctor. Your doctor may do blood tests to check your cholesterol levels during your treatment with atorvastatin calcium tablets. Your dose of atorvastatin calcium tablets may be changed based on these blood test results. Take atorvastatin calcium tablets each day at any time of day. atorvastatin calcium tablets can be taken with or without food. Your doctor may start you on a cholesterol lowering diet before giving you atorvastatin calcium tablets. Stay on this low-fat diet when you take atorvastatin calcium tablets. If you miss a dose of atorvastatin calcium tablets, take it as soon as you remember. Do not take atorvastatin calcium tablets if it has been more than 12 hours since you missed your last dose. Wait and take the next dose at your regular time. Do not take 2 doses of atorvastatin calcium tablets at the same time. If you take too much atorvastatin calcium tablets or overdose, call your doctor or Poison Control Center at 1-800-222-1222 or go to the nearest emergency room right away. What should I avoid while taking atorvastatin calcium tablets? Avoid drinking more than 1.2 liters of grapefruit juice each day. What are the possible side effects of atorvastatin calcium tablets? Atorvastatin calcium tablets may cause serious side effects including: Muscle pain, tenderness and weakness (myopathy). Tell your doctor right away if you have: unexplained muscle pain, tenderness, or weakness, especially if you also have a fever or feel more tired than usual while you take atorvastatin calcium tablets. muscle problems that do not go away after your doctor has told you to stop taking atorvastatin calcium tablets. Your doctor may do further tests to diagnose the cause of your muscle problems. are taking certain other medicines while you take atorvastatin calcium tablets drink large amounts of grapefruit juice are 65 years of age or older have thyroid problems (hypothyroidism) that are not controlled have kidney problems are taking higher doses of atorvastatin calcium tablets Liver problems. feel tired or weak nausea or vomiting loss of appetite upper belly pain dark amber colored urine yellowing of your skin or the whites of your eyes Increase in blood sugar level. The most common side effects of atorvastatin calcium tablets include: nasal congestion, sore throat, runny nose muscle and joint pain diarrhea pain in extremity urinary tract infection upset stomach nausea musculoskeletal pain muscle spasms trouble sleeping throat pain How do I store atorvastatin calcium tablets? Store at 20°C to 25°C (68°F to 77°F) [see USP Controlled Room Temperature]. Do not keep medicine that is out of date or that you no longer need. Keep atorvastatin calcium tablets and all medicines out of the reach of children. General information about the safe and effective use of atorvastatin calcium tablets. What are the ingredients in atorvastatin calcium tablets? Active Ingredient: Inactive Ingredients: The 90’s count Bottles comes in child resistant package. Repackaged and Distributed By: Remedy Repack, Inc. 625 Kolter Dr. Suite #4 Indiana, PA 1-724-465-8762 This Patient Package Information has been approved by the U.S. Food and Drug Administration 04/2023 What are atorvastatin calcium tablets? to reduce the risk of: heart attack, stroke, certain types of heart surgery and chest pain in adults who do not have heart disease but have other multiple risk factors for heart disease. heart attack and stroke in adults with type 2 diabetes mellitus who do not have heart disease but have other multiple risk factors. heart attack that does not cause death, stroke, certain types of heart surgery, hospitalization for congestive heart failure, and chest pain in adults with heart disease. along with diet to reduce low density lipoprotein cholesterol (LDL-C) or bad cholesterol: in adults with primary hyperlipidemia. in adults and children aged 10 years and older with heterozygous familial hypercholesterolemia (HeFH). This is an inherited condition that causes high levels of bad cholesterol. along with other cholesterol lowering treatments or alone if such treatments are unavailable in adults and children aged 10 years and older with homozygous familial hypercholesterolemia (HoFH). This is an inherited condition that causes high levels of bad cholesterol. along with diet for the treatment of adults with: primary dysbetalipoproteinemia (an inherited condition that causes high levels of cholesterol and fat). hypertriglyceridemia.

REMEDYREPACK INC.

ATORVASTATIN CALCIUM- atorvastatin calcium_tablet, film coated Product manual source documgent