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# Atorvastatin
## Overview
Atorvastatin is a statin (HMG-CoA reductase inhibitor) used to lower cholesterol and triglycerides in the blood. It works by reducing the production of cholesterol in the liver.
## Primary Indications
* Hyperlipidemia (primary prevention and treatment)
* Prevention of cardiovascular events in patients with risk factors for coronary heart disease.
## Adult Dosing
* **Hyperlipidemia:** Usual starting dose is 10-20 mg once daily. Maintenance dose typically ranges from 10-80 mg once daily.
* **Cardiovascular Risk Reduction:** Usual dose is 10-80 mg once daily.
* Maximum daily dose: 80 mg.
## Pediatric Dosing
* **Ages 10-17 years with Heterozygous Familial Hypercholesterolemia:** 10 mg once daily, may increase to 20 mg once daily.
* Dosing in younger children is not established.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment necessary.
* **Hepatic Impairment:** Use with caution. Avoid in active liver disease or unexplained persistent elevations of LFTs.
## 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.
* **Serious:** Rhabdomyolysis (muscle breakdown, can lead to kidney failure), hepatotoxicity, hyperglycemia.
## Key Drug Interactions
* **CYP3A4 Inhibitors (e.g., azole antifungals, protease inhibitors, macrolide antibiotics):** Increased risk of myopathy and rhabdomyolysis. Dose of atorvastatin may need to be reduced.
* **Cyclosporine, Gemfibrozil, other fibrates:** Increased risk of myopathy. Avoid concurrent use or use with extreme caution.
* **Warfarin:** May increase INR. Monitor INR closely.
* **Colchicine:** Increased risk of myopathy and rhabdomyolysis. Use with caution.
## Monitoring
* **Baseline:** Liver function tests (ALT, AST), lipid panel (total cholesterol, LDL-C, HDL-C, triglycerides), creatine kinase (CK) if muscle symptoms develop.
* **Periodic:** Lipid panel as indicated to assess efficacy. Liver function tests may be monitored periodically. Monitor for signs and symptoms of muscle pain or weakness.
## Clinical Pearls
* Take at any time of day, with or without food.
* Counsel patients on the importance of reporting unexplained muscle pain, tenderness, or weakness, especially if accompanied by fever or malaise.
* Risk of myopathy is dose-dependent and increased with concomitant use of other medications that inhibit CYP3A4 or are known to cause myopathy.
* Risk of rhabdomyolysis is increased in patients with renal impairment, hypothyroidism, or certain genetic predispositions.
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**Disclaimer:** This information is intended for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment. Verify current prescribing information before making any treatment decisions.
