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# Atorvastatin
## Overview
Atorvastatin is a statin medication used to lower cholesterol levels in the blood. It works by inhibiting HMG-CoA reductase, a key enzyme in cholesterol synthesis.
## Primary Indications
* Hyperlipidemia (primary hypercholesterolemia, mixed dyslipidemia)
* Prevention of cardiovascular events in patients with risk factors for coronary heart disease
## Adult Dosing
* **Hyperlipidemia:** 10-80 mg orally once daily.
* **Cardiovascular Event Prevention:** 10-80 mg orally once daily.
* Maximum dose: 80 mg daily.
## Pediatric Dosing
* **Heterozygous Familial Hypercholesterolemia:**
* Children 10-17 years: 10 mg orally once daily. Doses may be increased to 20 mg orally once daily, then 40 mg orally once daily, and then up to a maximum of 80 mg orally once daily based on response.
* Dosing for children younger than 10 years is not established.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment needed.
* **Hepatic Impairment:** Use with caution. Patients with active liver disease should not use atorvastatin.
## Contraindications
* Active liver disease
* Unexplained persistent elevations of serum transaminases
## Adverse Effects
* **Common:** Myalgia, arthralgia, diarrhea, nausea, headache.
* **Serious:** Rhabdomyolysis, hepatotoxicity, immune-mediated necrotizing myopathy.
## Key Drug Interactions
* **CYP3A4 Inhibitors (e.g., itraconazole, ketoconazole, clarithromycin):** Increased risk of myopathy and rhabdomyolysis. Limit atorvastatin dose.
* **CYP3A4 Inducers (e.g., rifampin):** May decrease atorvastatin levels.
* **Fibrates, gemfibrozil, ezetimibe, colchicine:** Increased risk of myopathy and rhabdomyolysis.
* **Grapefruit Juice:** May increase atorvastatin levels. Avoid large quantities.
## Monitoring
* **Baseline:** Liver function tests (ALT, AST), creatine kinase (CK).
* **Routine:** Lipid panel (total cholesterol, LDL-C, HDL-C, triglycerides) at baseline and typically 4-12 weeks after initiation or dose change, then every 3-12 months. Monitor for signs/symptoms of myopathy and liver dysfunction.
## Clinical Pearls
* Administer orally, with or without food, at any time of day.
* Consider risk factors for myopathy (e.g., age >65, renal impairment, hypothyroidism, concomitant medications).
* If CK levels are significantly elevated or myopathy is suspected, discontinue atorvastatin.
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**Disclaimer:** This information is intended for clinical decision support and does not replace the need for professional clinical judgment. Always consult the most current prescribing information and institutional guidelines before administering any medication.
