Discontinuation and withdrawal of Atorvastatin / Lipitor

Discontinuation of Atorvastatin / Lipitor should only take place with the guidance of a treating medical practitioner. A doctor will normally take a very conservative approach when it comes to potentially withdrawing a patient from Atorvastatin therapy. Discontinuation is likely to only happen as and when absolutely necessary.

Many patients are able to tolerate Atorvastatin / Lipitor reasonably well in the long-term. Patients who are particularly high risk for cardiovascular complications will likely require long-term therapy in order to avoid severe adverse reactions, or mortality. Discontinuation could prompt these reactions, especially if treatment ceases abruptly.

Discontinuation may be required temporarily due to an adverse reaction, such as an allergy or myopathic complication. Sometimes this medication is used in combination with others which may have the same therapeutic effect. Discontinuation in this instance may be as a result of duplicate therapy treatment achieving the same result.

General guidelines advise that if therapy is discontinued, a patient be prescribed treatment with the same medication at a later time or a different statin medication may be used in its place. ⁽⁵⁾ 

Permanent discontinuation will need to be very carefully assessed beforehand as this can severely raise risk for a patient, making an individual highly vulnerable to complications which are preventable.

Atorvastatin / Lipitor does have a longer half-life, meaning that lipid reduction is effective over an extended period of time. Should tolerance of the medication be something of an issue for a patient, an alternate day dosage strategy can be considered. The mean half-life for metabolism (i.e. how quickly a half dose is eliminated from the bloodstream) of this medication is 14 hours. The drug metabolises into two active metabolite forms – orthohydroxy and parahydroxy and contributes to about 70% drug activity. This continued lipid lowering activity thus helps to maintain the effect for a longer period of time. ⁽⁶⁾

Alternate day dosing will be carefully considered by a treating doctor as the lipid lowering capability is limited – meaning that lipid lowering percentages will be less than that of a daily dose. Alternate days may not be an option for very high-risk patients but can be considered as a secondary option should intolerance of the medication persist.

References:

^{5. US National Library of Medicine National Institutes of Health. April 2014. Discontinuation of statins in routine care settings: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692286/ [Accessed 05.02.2018]}

^{6. US National Library of Medicine National Institutes of Health. November - December 2013. Management of statin intolerance: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872714/ [Accessed 05.02.2018]}