Atorvin Special Precautions

Secondary caused of hyperlipidemia should be ruled out prior to therapy that has not been studied when the primary lipid abnormality is chylomicron elevation (Fredrickson types I and V).
Liver enzyme tests should be obtained at baseline and as clinically indicated and if signs/symptoms of liver injury occur. Patients should be monitored closely. Use with caution in patients who consume large amounts of ethanol or have a history of liver disease. Use is contraindicated in patients with active liver disease or unexplained persistent elevations of serum transaminase.
Use long-term high dose atorvastatin (80 mg/day) with caution in patients with prior stroke or TIA may be at increased risk for hemorrhagic stroke.
Rhabdomyolysis with acute renal failure secondary to myoglobinuria and/or myopathy has occurred. Risk is dose related and is increased with concurrent use of lipid lowering agent which may cause rhabdomyolysis (fibric acid derivatives or niacin at dose ≥1 g/day) or strong CYP3A4 inhibitors (eg. clarithromycin, itraconazole, and protease inhibitor), cyclosporine. Ensure patient is on the lowest effective atorvastatin dose.
Do not use with cyclosporine, gemfibrozil, tipranavir plus ritonavir and glecaprevir/pibrentasvir.
Discontinue in any patient in which CPK levels are markedly elevated (≥10 times ULN) or if myopathy is suspected/diagnosis.
Discontinue for elective major surgery experiencing and acute or serious condition predisposing to renal failure (eg. sepsis, hypotension, trauma, uncontrolled seizures).
Based on current research, HMG-CoA reductase inhibitor should be continued in perioperative period.
Use in the Elderly: Use with caution in patients with advanced age (65 years and older), these patients are predisposed to myopathy.