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# Atorvastatin
## Overview
Atorvastatin is a statin (HMG-CoA reductase inhibitor) used to lower cholesterol and triglycerides in the blood, and to reduce the risk of cardiovascular events.
## Primary Indications
* Hyperlipidemia (heterozygous familial and non-familial)
* Mixed dyslipidemia
* Hypertriglyceridemia
* Primary prevention of cardiovascular disease in patients with risk factors
## Adult Dosing
* **Hyperlipidemia/Dyslipidemia:** Start at 10-20 mg once daily. Titrate to effect.
* **Usual dose:** 10-80 mg once daily.
* **Maximum dose:** 80 mg once daily.
* **Cardiovascular Risk Reduction:** Start at 10-80 mg once daily.
## Pediatric Dosing
* **Age 10-17 years (heterozygous familial hypercholesterolemia):** 10 mg once daily.
* **Maximum dose:** 20 mg once daily (based on limited pediatric data).
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Consider lower doses or discontinuation in patients with active liver disease.
* **Renal Impairment:** No dose adjustment typically required.
## Contraindications
* Active liver disease or unexplained persistent elevations of serum transaminases.
* Hypersensitivity to atorvastatin or any component of the formulation.
* Pregnancy and breastfeeding.
## Adverse Effects
* **Common:** Myalgia, arthralgia, diarrhea, nausea, headache, nasopharyngitis.
* **Serious:** Rhabdomyolysis with myopathy, hepatotoxicity, hyperglycemia, cognitive impairment.
## Key Drug Interactions
* **CYP3A4 Inhibitors (e.g., itraconazole, ketoconazole, clarithromycin, protease inhibitors):** Increased risk of myopathy and rhabdomyolysis. Avoid concomitant use or use lowest atorvastatin dose.
* **CYP3A4 Inducers (e.g., rifampin):** Decreased atorvastatin levels.
* **Fibrates and Gemfibrozil:** Increased risk of myopathy. Use with caution.
* **Colchicine:** Increased risk of myopathy. Use with caution.
* **Warfarin:** May increase INR. Monitor INR closely.
* **Oral Contraceptives:** May increase levels of contraceptive hormones.
## Monitoring
* **Baseline:** Liver function tests (ALT, AST), lipid panel (total cholesterol, LDL-C, HDL-C, triglycerides), creatine kinase (CK) if muscle symptoms present.
* **During Therapy:** Lipid panel (typically within 4-12 weeks of initiation or dose change), liver function tests periodically, CK if myopathy suspected. Monitor for signs/symptoms of muscle pain, tenderness, or weakness.
## Clinical Pearls
* Take at any time of day, with or without food.
* Statin therapy is lifelong for most patients.
* Patient education regarding signs and symptoms of myopathy is crucial.
* Risk of myopathy increases with higher doses, concomitant medications, and in patients with certain risk factors.
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*Please consult the most current prescribing information for complete details and to verify this information before making any clinical decisions.*
