How does atorvastatin leave the body?
Atorvastatin is eliminated mainly through the liver. After it’s metabolized, much of the drug is cleared in bile and leaves the body in feces rather than through the kidneys [1].
What role do the liver and bile play?
Atorvastatin undergoes extensive hepatic (liver) metabolism, and the resulting metabolites are excreted via bile into the gastrointestinal tract. Because this clearance route depends on liver function, impaired liver function can affect atorvastatin exposure [1].
Is any atorvastatin eliminated in urine?
Only a small fraction of atorvastatin-related material is eliminated through the kidneys, so urine is not the dominant elimination pathway [1].
How do metabolism and enzymes affect elimination?
Like other statins, atorvastatin is broken down in the liver by metabolic enzymes (including CYP3A4), and those metabolic products then follow the biliary (bile-to-feces) elimination pathway [1]. This is one reason drug interactions that inhibit or induce these pathways can change how much atorvastatin stays in the body.
What happens with liver disease?
Because atorvastatin is cleared largely by the liver, people with significant liver impairment may have higher drug levels and different elimination, which can increase the risk of adverse effects. Clinicians may adjust use or monitor more closely in these cases [1].
Sources
- DrugBank – Atorvastatin (Elimination)