Lipitor (atorvastatin)

Lipitor is a brand-name prescription medication. It’s approved by the Food and Drug Administration (FDA) for the uses listed below.

• Lowering cholesterol levels. Lipitor is used to lower cholesterol in adults and children ages 10 years and older with certain forms of high cholesterol. Doctors can prescribe Lipitor for this use in combination with a low cholesterol diet.
• Reducing cardiovascular risks. Lipitor is used to lower the risk of blood vessel and heart problems or the need for certain heart surgeries. Doctors can prescribe Lipitor for this use in certain adults.

For details about these conditions and how the drug treats them, see the “Lipitor: Uses” section below.

The following table provides some key facts about Lipitor.

If you’re interested in taking this drug, search here to find a doctor who might prescribe it.

Lipitor is a brand-name medication. It contains the active drug atorvastatin, which also comes in a generic form. A generic is an identical copy of the active drug found in a brand-name medication.

The Food and Drug Administration (FDA) ensures that generic drugs are as safe and effective as their original drug. Generics tend to be less expensive than brand-name drugs.

If you’d like to know about using the generic version of Lipitor, ask your doctor or pharmacist. They can tell you if the generic medication comes in forms and strengths recommended for your condition or situation.

As with most drugs, it’s possible to have adverse effects (side effects) with Lipitor. These can include some mild side effects, but also some serious ones.

To learn more about Lipitor’s side effects, talk with your doctor or pharmacist. They may also provide information about managing certain side effects of this drug.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Lipitor, you can do so through MedWatch.

Mild and serious side effects of Lipitor are listed in the table below. This table does not include all of Lipitor’s possible side effects.

* This is not a complete list of Lipitor’s mild side effects. To learn about other mild side effects of this drug, ask your doctor or pharmacist. Or you can view the drug’s prescribing information.
† For more information about this side effect, see “Lipitor’s side effects explained” below.
‡ Allergic reaction wasn’t reported in clinical studies of Lipitor. However, it is still possible with this drug.

Most times, mild side effects of a drug go away within a few days or a couple of weeks. Talk with your doctor or pharmacist if any side effects become severe or don’t go away.

Serious side effects from Lipitor aren’t common, but they are possible. If you have serious side effects, call your doctor right away. However, if you’re having a medical emergency or your symptoms feel life threatening, call 911 or a local emergency number.

Below, you can find detailed information about some of Lipitor’s side effects. To learn more about other side effects of this medication, talk with your doctor.

Mild muscle pain and joint pain are common side effects of Lipitor. However, in rare cases, Lipitor may cause severe muscle pain or muscle weakness. To learn more about how often these side effects occurred in clinical studies, see the drug’s prescribing information.

Severe muscle pain or weakness can also be symptoms of more serious side effects of Lipitor. These include:

• immune-mediated necrotizing myopathy (a rare condition in which the immune system attacks your muscles and causes them to break down)
• rhabdomyolysis (a rare but serious type of muscle injury)

For most people, muscle or joint pain will go away when they stop taking Lipitor.

What to do

If you have muscle or joint pain with Lipitor, talk with your doctor. If your symptoms are mild, your doctor may lower your dosage of the drug.

However, if you have severe muscle or joint pain, tell your doctor right away. They may have you stop taking the drug and order tests to check for more severe muscle damage. If you have more severe muscle damage with Lipitor, your doctor will likely prescribe a different drug to treat your condition.

Lipitor may cause high blood sugar levels, which could lead to new or worsened diabetes. This side effect isn’t common but has been reported with statin drugs, such as Lipitor. To learn more about how often this side effect occurred in clinical studies, see the drug’s prescribing information.

Below are possible symptoms of high blood sugar and diabetes:

• increased thirst or hunger
• blurry vision
• dry mouth
• frequent urination

What to do

If you have diabetes, talk with your doctor before starting Lipitor treatment. They can tell you about your risk of high blood sugar or worsened diabetes with the drug.

If you have symptoms of high blood sugar or diabetes while taking Lipitor, talk with your doctor. They may order certain tests to check your average blood sugar levels over time. Your doctor will advise what to do if you have high blood sugar or develop diabetes.

Here are some common questions about Lipitor and brief answers to them. If you’d like to know more about these topics, ask your doctor.

It’s not likely. In clinical studies of Lipitor, there were no differences in side effects among females and males.*

However, certain precautions for Lipitor’s use are specific to females. These are related to Lipitor’s use while pregnant or breastfeeding. To learn more, see the “Lipitor: Taking while pregnant” and “Lipitor: Taking while breastfeeding” sections below.

* Sex and gender exist on spectrums. In this article, use of the terms “male” and “female” refers to sex assigned at birth.

Clinical studies have found Lipitor to be safe when used for certain conditions in adults and children ages 10 years and older. (For details about its uses, see the “Lipitor: Uses” section below.)

In rare cases, serious side effects are possible with Lipitor. For this reason, some people may feel that Lipitor is “bad” for them. However, most of Lipitor’s side effects in studies were mild. To learn more about the drug’s side effects, see the “Lipitor: Side effects” section above.

If you have questions about the safety of Lipitor, talk with your doctor or pharmacist.

No, Lipitor isn’t a blood thinner, angiotensin-converting enzyme (ACE) inhibitor, or beta-blocker. Instead, Lipitor belongs to a class of drugs called statins.

Blood thinners are used to help prevent blood clots, while ACE inhibitors and beta-blockers are used for high blood pressure. Statins can be used to treat high cholesterol and reduce cardiovascular risks. (For more information about Lipitor’s uses, see the “Lipitor: Uses” section below.)

Doctors may prescribe Lipitor in combination with blood thinners, ACE inhibitors, or beta-blockers. Your doctor can recommend if these other medications are needed for your condition or situation.

Probably not. Weight gain and weight loss weren’t reported as side effects in clinical studies of Lipitor.

However, when used to treat high cholesterol, Lipitor is prescribed in combination with a low cholesterol diet. And certain dietary changes may lead to weight loss in some people.

If you’re concerned about weight gain or weight loss with Lipitor, talk with your doctor. They can recommend ways to maintain a body weight that’s healthy for you.

Memory loss, erectile dysfunction (ED), and tiredness weren’t reported as side effects in clinical studies of Lipitor.

However, memory loss has been reported as a side effect of statin drugs since they became available for use. Lipitor is a statin drug. So, it’s possible you could have memory loss while taking Lipitor.

Fatigue has also been reported as a side effect of statins, including Lipitor, since they became available for use. And tiredness can be a symptom of fatigue.

Keep in mind that high cholesterol can cause ED. Lipitor is used to treat high cholesterol. So, you could have ED because of the condition you’re using Lipitor to treat.

If you have questions about memory loss, ED, or tiredness with Lipitor, talk with your doctor or pharmacist.

Stopping Lipitor isn’t known to cause any side effects.

However, the condition you’re using Lipitor to treat could worsen or come back after you stop taking the drug. For this reason, it’s best to talk with your doctor before stopping Lipitor. They’ll likely prescribe a different medication to replace it.

Below, you’ll find dosages that are commonly recommended for Lipitor. However, you should take the dosage your doctor prescribes for you. They’ll recommend the dosage that’s best for your needs.

Most often, doctors start by prescribing a low dosage of Lipitor. Then, they’ll change the dosage over time to an amount that’s right for the condition being treated. Doctors typically prescribe the smallest dosage that gives the desired outcome.

The dosage of Lipitor that your doctor prescribes will depend on factors such as:

• your age
• any health conditions you have
• other medications you may be taking
• the condition or situation you’re using Lipitor for and its severity

Lipitor is available as follows.

• Form: oral tablet
• Strengths: 10 milligrams (mg), 20 mg, 40 mg, and 80 mg

Recommended dosages for Lipitor in adults and children are described below.

Lipitor is used to lower cholesterol levels in adults with certain forms of high cholesterol. Lipitor is also used to reduce cardiovascular risks in certain adults. To learn more about these conditions, see the “Lipitor: Uses” section below.

Lipitor’s recommended dosage for high cholesterol is as follows.

• Dose range: 10 mg to 80 mg
• Frequency: once per day

Lipitor’s recommended dosage for reducing cardiovascular risks is as follows.

• Dose range: 10 mg to 80 mg
• Frequency: once per day

Lipitor is used to lower cholesterol in children ages 10 years and older with a certain form of high cholesterol called heterozygous familial hypercholesterolemia (HeFH). To learn more about this condition, see the “Lipitor: Uses” section below.

Lipitor’s recommended dosage for HeFH in children is as follows.

• Dose range: 10 mg to 20 mg
• Frequency: once per day

Below are some things to consider about Lipitor’s dosage.

• Missing a dose. If you miss a dose of Lipitor, take it as soon as you remember. However, if it’s been more than 12 hours since your missed dose, skip it. Then take your next dose at its usual time. Don’t take two doses at once to make up for a missed dose. Doing so can increase your risk of side effects from Lipitor. View these medication reminder options to help avoid missing doses. You could also set an alarm, use a timer, or download a reminder app on your phone.
• Length of treatment. Doctors typically prescribe Lipitor as a long-term treatment. You’ll likely take it long term if you and your doctor feel it’s safe and effective for your condition or situation.

Prescription drugs, such as Lipitor, are approved by the Food and Drug Administration (FDA) to treat certain conditions. Doctors sometimes prescribe drugs off-label for other conditions. With off-label use, doctors prescribe a drug for a purpose other than what it’s approved for.

The FDA has approved Lipitor to lower cholesterol levels in certain people.

Having high cholesterol doesn’t typically cause symptoms. Doctors can determine if you have high cholesterol by using a blood test called a lipid panel.

Doctors can prescribe Lipitor to lower cholesterol in:

• Adults with certain forms of high cholesterol. This includes familial (inherited) and non-familial forms, such as primary hyperlipidemia, mixed dyslipidemia, and homozygous familial hypercholesterolemia (HoFH). Lipitor is also prescribed to lower triglyceride levels in adults with hypertriglyceridemia.
• Children ages 10 years and older with heterozygous familial hypercholesterolemia (HeFH).

For high cholesterol, doctors will prescribe Lipitor in combination with a low cholesterol diet.

The FDA has approved Lipitor to reduce cardiovascular risks in certain adults.

Examples of cardiovascular risks include heart attack, stroke, and chest pain. These risks also include the need for hospitalization due to heart failure and the need for certain heart surgeries, such as bypass surgery.

High cholesterol can increase the likelihood of these cardiovascular risks. By lowering cholesterol, Lipitor helps reduce their likelihood.

High cholesterol doesn’t typically cause symptoms. However, cardiovascular problems can cause symptoms. For example, heart attack can cause squeezing, crushing, tightness, or pressure in the chest. And stroke may cause headache, blurry vision, or weakness on one side of the body.

Doctors can prescribe Lipitor for reducing cardiovascular risks in adults with any of the following conditions:

• coronary artery disease (CAD)
• risk factors for CAD, such as smoking and high blood pressure
• type 2 diabetes with risk factors for CAD

Lipitor is used to lower cholesterol levels in people with certain forms of high cholesterol. It’s also used to reduce cardiovascular risks in certain people.

Doctors may prescribe Lipitor in combination with a low cholesterol diet. Or they may prescribe Lipitor with other cholesterol-lowering drugs. An example is bile acid resins, such as colesevelam (Welchol) and colestipol (Colestid).

Your doctor can recommend whether you’ll need to use any of these therapies with Lipitor.

The FDA has approved Lipitor to lower cholesterol in children with a certain form of high cholesterol. For details, see “Using Lipitor for lowering cholesterol in certain people” above.

If you’re interested in taking Lipitor, you can find a doctor who might prescribe it by searching here. You can prepare for your appointment by viewing Healthgrades’ appointment guide for high cholesterol.

Doctors may prescribe drugs other than Lipitor for your condition or situation. Certain drugs may work better for you than others.

In addition to reducing certain cardiovascular risks, Lipitor is used to lower cholesterol. Here’s a summary of other drugs that doctors sometimes prescribe for this purpose.

To learn more about alternatives to Lipitor, read on. Also, ask your doctor about other treatment options you can consider. They can tell you about other medications that could be prescribed for your condition.

To learn more about some alternatives to Lipitor, including Crestor, view the following articles:

• Lipitor vs. rosuvastatin (Crestor)
• Lipitor vs. simvastatin (Zocor)
• Lipitor vs. pravastatin

Your doctor will recommend how you should take Lipitor. It’s important that you take the drug exactly as your doctor instructs.

Lipitor comes as an oral tablet. You’ll take it by swallowing the tablets.

Here’s a list of common questions related to taking Lipitor.

• Do I need to take Lipitor with food? You can take Lipitor with food or without it.
• Can Lipitor be chewed, split, or crushed? The manufacturer of Lipitor hasn’t stated whether the drug can be chewed, split, or crushed. If you have trouble swallowing Lipitor tablets, talk with your doctor or pharmacist.
• When should I take Lipitor? Is there a best time of day to take it, or should I take it at night? You’ll likely take Lipitor once per day. You can take the drug at any time of day, including nighttime. However, keep in mind that Lipitor may cause insomnia for some people. If the drug causes insomnia for you, it may be best to avoid taking it at night. You’ll know more about how Lipitor affects you after you’ve taken several doses of the drug. View these medication reminder options to help avoid missing doses. You could also set an alarm, use a timer, or download a reminder app on your phone.

There aren’t any known interactions between Lipitor and alcohol.

However, both alcohol and Lipitor can cause liver problems. Your risk of liver problems with Lipitor may be higher if you drink large amounts of alcohol while taking the drug.

If you drink alcohol, talk with your doctor about the amount that’s safe for you to drink while taking Lipitor. The Dietary Guidelines for Americans Trusted Source Dietary Guidelines for Americans (USDA) Governmental authority Go to source recommend that females* have fewer than one alcoholic drink per day and that males* have fewer than two per day.

Doctors can determine if Lipitor is safe for use by people who drink more than this amount each day.

* Sex and gender exist on spectrums. In this article, use of the terms “male” and “female” refers to sex assigned at birth.

Lipitor may interact with other medications, certain supplements, and certain foods.

Different interactions can cause different effects. Some interactions can interfere with a drug’s effectiveness. Others can increase a drug’s side effects or cause them to be severe.

If any of the interactions listed below might pertain to you, talk with your doctor. They can tell you what you need to do to avoid the interaction.

Lipitor and other medications. Because Lipitor may interact with the following drugs, your doctor may recommend that you don’t take it with these drugs. Examples include:

• birth control pills
• the gout drug colchicine (Colcrys, Mitigare)
• the heart condition drug digoxin (Lanoxin)
• the immunosuppressant drug cyclosporine (Gengraf, Neoral)
• certain cholesterol-lowering drugs, such as:
  • niacin (Niacor)
  • gemfibrozil (Lopid)
• certain antiviral drugs, such as:
  • ritonavir (Norvir)
  • letermovir (Prevymis)
  • fosamprenavir (Lexiva)
  • nelfinavir (Viracept)
  • glecaprevir/pibrentasvir (Mavyret)
  • elbasvir/grazoprevir (Zepatier)
  • ledipasvir/sofosbuvir (Harvoni)
• certain antibiotics, such as:
  • clarithromycin
  • erythromycin (Eryc, Ery-Tab, Eryped)
  • rifampin (Rifadin, Rimactane)
• certain antifungals, such as:
  • itraconazole (Sporanox, Tolsura)
  • ketoconazole, oral tablet form
  • posaconazole (Noxafil)
  • voriconazole (Vfend)

Lipitor and herbs and supplements. No herbs or supplements are known to interact with Lipitor. However, be sure to talk with your doctor or pharmacist before using any of these products while taking Lipitor.

Lipitor and foods. Certain medications interact with foods. Examples of foods that may affect Lipitor include grapefruit and grapefruit juice.

Lipitor is approved to:

• lower cholesterol in people with certain forms of high cholesterol
• reduce cardiovascular risks in certain people

To learn more about how Lipitor is used, see the “Lipitor: Uses” section above.

Cholesterol is a fatty substance found naturally in your body. Cholesterol is made in your liver. It can also be found in foods such as cheese, meat, and eggs.

Cholesterol helps your body with important functions, such as making vitamins. However, having higher levels of cholesterol than your body uses can lead to serious problems. These include cardiovascular risks, such as heart attack and stroke.

Lipitor belongs to a class of drugs called statins. Its mechanism of action (how it works) is to block a certain enzyme (type of protein) called HMG-CoA reductase. This enzyme helps your body make cholesterol.

By blocking this enzyme, Lipitor helps lower your cholesterol levels. As a result, it also helps reduce cardiovascular risks.

Lipitor may stay in your system for about 3 days.

This is based on the half-life of Lipitor, which is 14 hours. (The half-life of a drug is the time it takes the body to get rid of half of a drug’s dose.)

Typically, it takes about five half-lives for a drug to leave your system entirely. For Lipitor, this means that the drug stays in your body for about 70 hours, which is about 3 days.

It may take several weeks for a lipid panel to show lower cholesterol levels in your blood after you’ve started Lipitor.

Remember that having high cholesterol doesn’t typically cause symptoms. For this reason, you aren’t likely to notice Lipitor working for your condition.

Like other medications, prices for Lipitor may vary. The drug’s price will depend on factors such as:

• the pharmacy you use
• your insurance coverage

Here’s a list of things to consider when looking into the cost of Lipitor.

• Option for a 90-day supply. For some drugs, it’s possible to get a 90-day supply. If this option is approved by your insurance company, it can help lower the cost of the drug. It can also help you avoid frequent trips to your pharmacy. If you’d like to learn more about this option, ask your doctor, pharmacist, or insurance company.
• Need for prior authorization. Before insurance coverage for Lipitor is approved, your insurance company may require prior authorization. In this case, your doctor and insurance company will communicate about your prescription for Lipitor. Then, the insurance company will decide if the drug will be covered. To find out if you need prior authorization for Lipitor, contact your insurance company.
• Possible cost assistance options. Financial assistance to help lower the cost of Lipitor is available. Viatris, Inc., the manufacturer of the drug, offers a savings card on this drug. To learn more and see if you’re eligible for support, visit the manufacturer’s website. Also, check out this article to learn about ways to save on prescription drugs.
• Use of a mail-order pharmacy. Lipitor may be dispensed through mail-order pharmacies. Getting your prescription through a mail-order pharmacy could lower its cost. It can also allow you to get the drug without leaving home. To find out more about this option, check with your doctor, pharmacist, or insurance company.
• Availability of a generic form. Lipitor comes in a generic form called atorvastatin. A generic drug is an exact copy of the active drug in a brand-name medication. Generics are typically less expensive than brand-name drugs. If your doctor prescribes Lipitor but you want to know about using atorvastatin, talk with your doctor about which option might be better for you. Also, check your insurance plan because it might cover just one form or the other.

Tell your doctor about your health history before starting treatment with Lipitor. Your doctor may not recommend this medication if you have certain factors affecting your health or specific medical conditions.

These factors and conditions include those listed below.

• Diabetes. Lipitor may cause high blood sugar levels, which could lead to new or worsened diabetes. If you already have high blood sugar or diabetes, taking Lipitor could worsen these conditions. Talk with your doctor about whether it’s safe for you to take Lipitor.
• Kidney problems. Lipitor may cause rhabdomyolysis (a rare but serious type of muscle injury). Your risk of this side effect may be higher if you have kidney problems. Your doctor can advise if Lipitor is safe for you to take.
• Liver disease. Having liver disease is a contraindication for taking Lipitor. (A contraindication is a factor or condition that could prevent your doctor from prescribing a drug due to risk of harm.) People who have or have had liver disease may be at higher risk of side effects from Lipitor. Due to this risk, doctors typically will not prescribe Lipitor for people with liver disease. Talk with your doctor about other treatment options for your condition.
• Thyroid problems. Lipitor may cause muscle pain or muscle weakness. Your risk of these side effects may be higher if you have an underactive thyroid. Be sure to tell your doctor if you have this condition before taking Lipitor. They can recommend if it’s safe for you to take Lipitor.
• Recent stroke. Rarely, Lipitor may cause hemorrhagic stroke (bleeding in the brain). You may have a higher risk of this condition if you’ve had a stroke or ministroke in the past 6 months. Before starting Lipitor treatment, tell your doctor if you’ve had a stroke. They can advise if it’s safe for you to take Lipitor.
• Allergic reaction. Your doctor will likely not prescribe Lipitor if you’ve had an allergic reaction to it or any of its ingredients. To find out about other treatment options, talk with your doctor.
• Pregnancy. It’s not safe to take Lipitor during pregnancy. If you’d like to learn more information about taking Lipitor while pregnant, view the “Lipitor: Taking while pregnant” section below.
• Breastfeeding. It’s not safe to take Lipitor while breastfeeding. If you’d like to learn more information about taking Lipitor while breastfeeding, view the “Lipitor: Taking while breastfeeding” section below.

To learn more about effects of Lipitor that could be harmful, see the “Lipitor: Side effects” section above.

For some drugs, taking more than the recommended dosage may lead to unwanted side effects or overdose. Do not use more Lipitor than your doctor advises.

Call your doctor if you think you’ve taken too much of this drug. Also, you can call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. However, if your symptoms are severe, call 911 or your local emergency number. Or go to the nearest emergency room right away.

It’s not safe to take Lipitor during pregnancy. This is because statin drugs, such as Lipitor, may cause congenital anomalies (commonly known as birth defects).

If you become pregnant while taking Lipitor, stop taking the drug and tell your doctor right away. They can recommend other ways to manage your cholesterol during pregnancy.

If you’re pregnant or planning a pregnancy, talk with your doctor about treatment options other than Lipitor.

It’s not safe to take Lipitor during pregnancy. Talk with your doctor about your birth control needs with Lipitor if you’re sexually active and you or your partner can become pregnant.

If you’d like to learn more about taking Lipitor during pregnancy, see the “Lipitor: Taking while pregnant” section above.

Note: Sex and gender exist on spectrums. In this article, use of the terms “male” and “female” refers to sex assigned at birth.

If you’re a female who’s able to become pregnant, it’s important to use an effective form of birth control while taking Lipitor.

However, remember that Lipitor can make certain birth control pills less effective. Talk with your doctor about a birth control option that won’t interact with Lipitor.

The manufacturer of Lipitor hasn’t given birth control recommendations for males using the drug. If you’re a male taking Lipitor and you’re sexually active with a partner who’s able to become pregnant, talk with your doctor. They can discuss whether you’ll need to use birth control while taking this drug.

It’s not safe to take Lipitor while breastfeeding. This is because statin drugs, such as Lipitor, may pass into breast milk and cause side effects in a breastfed child.

If you’re breastfeeding or planning to breastfeed, talk with your doctor before taking Lipitor. They can recommend safe ways to feed a child.

Here’s some information about Lipitor’s expiration date, as well as how to store and dispose of the drug.

• Expiration. Your pharmacist will add an expiration date to the label on Lipitor’s bottle. This date is usually 1 year from the date the medication was dispensed to you. Expiration dates help ensure that a medication is effective during a period of time. The Food and Drug Administration (FDA) advises Trusted Source Food and Drug Administration (FDA) Governmental authority Go to source that you avoid using expired drugs. If you have an unused medication and it’s past the drug’s expiration date, talk with your pharmacist. They can let you know whether you might still be able to use the medication.
• Storage. Many factors determine how long a medication remains good to use. These factors include how and where you store the drug. Lipitor tablets should be stored at room temperature between 68°F and 77°F (20°C and 25°C). Avoid storing it in areas where it could get damp or wet, such as bathrooms.
• Disposal. It’s important to safely dispose of Lipitor if you no longer need to take it and have unused medication. Doing so helps prevent others, including children and pets, from accidentally taking the drug. It also helps avoid causing harm to the environment. Ask your pharmacist for information about disposing of Lipitor. Also, check out this page for several tips on safe medication disposal.

If you have questions about Lipitor, talk with your doctor. They can help advise you on whether Lipitor could be a good treatment option for you.

Here’s a list of questions you may want to ask your doctor:

• Does my age increase my risk of any side effects with Lipitor?
• Can I take Lipitor if I’ve had muscle pain with other statin drugs?
• Will Lipitor cure my condition?

Your doctor may also tell you about other treatment options for your condition or situation. You may find this article helpful in learning about alternative drugs for lowering cholesterol. And check out our selection of videos on heart health.

Disclaimer: Healthgrades has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.