Side effects of atorvastatin
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Side Effects of Atorvastatin
Atorvastatin, a widely used statin for lowering cholesterol, is generally well-tolerated but can have several side effects. This article synthesizes findings from multiple studies to provide a comprehensive overview of the side effects associated with atorvastatin.
Common Side Effects: Headache, Nausea, and Digestive Issues
The most frequently reported side effects of atorvastatin include headaches, nausea, and digestive issues such as diarrhea and flatulence. These side effects are generally mild and occur at similar rates to those observed with placebo treatments . In a study involving healthy subjects, atorvastatin was well tolerated at doses up to 80 mg, with headaches being the most common complaint.
Serious Side Effects: Myopathy and Rhabdomyolysis
One of the most serious side effects of atorvastatin is myopathy, which can progress to rhabdomyolysis, a condition characterized by severe muscle damage. Patients with atorvastatin-induced myopathy show increased levels of lactone and acid metabolites, although the exposure to atorvastatin itself remains unchanged. Despite these risks, the incidence of myopathy and rhabdomyolysis is relatively low.
Hepatic Effects: Liver Enzyme Elevations
Atorvastatin can cause elevations in liver enzymes, indicating potential liver damage. In a large analysis of 44 trials, persistent elevations in hepatic transaminases were observed in 0.5% of patients. Another study found that atorvastatin induced hepatic oxidative stress and apoptotic damage via multiple pathways, including mitochondrial dysfunction and increased reactive oxygen species (ROS) production.
Muscle-Related Symptoms: Myalgia and Muscle Weakness
Muscle-related symptoms such as myalgia (muscle pain) and muscle weakness are common reasons for discontinuing statin therapy. Atorvastatin has been shown to induce muscle cell damage through mechanisms involving ferroptosis, a type of programmed cell death dependent on iron and characterized by lipid peroxidation and mitochondrial dysfunction . In patients with knee osteoarthritis, atorvastatin was associated with a trend towards increased myalgia, although no significant adverse effects on muscle strength or size were observed.
Metabolic Effects: Insulin Resistance and Increased Glycemia
Atorvastatin has been linked to metabolic side effects, including insulin resistance and increased blood sugar levels. A study found that atorvastatin significantly increased fasting plasma insulin and glycated hemoglobin levels, indicating reduced insulin sensitivity and higher ambient glycemia in hypercholesterolemic patients.
Conclusion
While atorvastatin is effective in lowering cholesterol and generally well-tolerated, it can cause a range of side effects, from mild issues like headaches and digestive problems to more serious conditions such as myopathy, liver enzyme elevations, and metabolic disturbances. Patients on atorvastatin should be monitored for these potential side effects to ensure safe and effective treatment.
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