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# Atorvastatin
## Overview
Atorvastatin is a statin medication used to lower cholesterol and triglycerides in the blood. It works by inhibiting HMG-CoA reductase, an enzyme involved in cholesterol synthesis.
## Primary Indications
* Hyperlipidemia (adjunct to diet to reduce elevated total-C, LDL-C, TG, and Apo B levels, and to increase HDL-C in patients with primary hypercholesterolemia and mixed dyslipidemia)
* Prevention of cardiovascular disease in patients with risk factors
## Adult Dosing
* **Hyperlipidemia:** Start at 10-20 mg orally once daily. Titrate up to 80 mg once daily as needed.
* **Cardiovascular Disease Prevention:** Start at 10-80 mg orally once daily.
## Pediatric Dosing
* **Ages 10-17 years with Heterozygous Familial Hypercholesterolemia:** 10 mg orally once daily, titrate up to 20-40 mg once daily.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment necessary.
* **Hepatic Impairment:** Use with caution. See Contraindications.
## 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:** Diarrhea, nausea, arthralgia, nasopharyngitis, pain in extremity.
* **Serious:** Myopathy (including rhabdomyolysis with acute kidney injury), hepatotoxicity, immune-mediated necrotizing myopathy.
## Key Drug Interactions
* **CYP3A4 inhibitors (e.g., erythromycin, ketoconazole, ritonavir):** Increased risk of myopathy.
* **Grapefruit juice:** May increase atorvastatin levels.
* **Colchicine:** Increased risk of myopathy.
## Monitoring
* Liver function tests (LFTs) at baseline and as clinically indicated.
* Lipid panel at baseline and periodically thereafter.
* Monitor for signs and symptoms of myopathy (muscle pain, tenderness, weakness).
## Clinical Pearls
* Take with or without food.
* Patients should be advised to report unexplained muscle pain, tenderness, or weakness.
* Consider a baseline LFT prior to initiating therapy.
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**Disclaimer:** This information is intended for clinical professionals. Always consult the most current prescribing information and relevant guidelines for complete details and to verify dosage and safety before prescribing.
