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# Atorvastatin
## Overview
Atorvastatin is a statin medication that inhibits HMG-CoA reductase, an enzyme involved in cholesterol synthesis. This action lowers serum cholesterol levels, including LDL cholesterol, triglycerides, and to a lesser extent, raises HDL cholesterol.
## Primary Indications
* Hyperlipidemia (adjunct to diet to reduce elevated total-C, LDL-C, and TG levels and to increase HDL-C in patients with primary hypercholesterolemia and mixed dyslipidemia).
* Prevention of cardiovascular disease in patients with risk factors for heart attack and stroke.
* Familial hypercholesterolemia.
## Adult Dosing
* **Hyperlipidemia:** Starting dose is typically 10 mg to 20 mg once daily. Titrate dose based on patient response and LDL-C goals. Usual maintenance dose is 10 mg to 80 mg once daily.
* **Cardiovascular Disease Prevention:** 10 mg to 80 mg once daily.
## Pediatric Dosing
* **Hyperlipidemia (10 to 17 years):** 10 mg once daily. Titrate to a maximum of 20 mg once daily.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Avoid in patients with active liver disease or unexplained persistent elevations of serum transaminases.
* **Renal Impairment:** No dose adjustment is 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.
* Serious: Rhabdomyolysis with or without acute kidney injury, hepatotoxicity.
## Key Drug Interactions
* **CYP3A4 Inhibitors (e.g., azole antifungals, macrolide antibiotics, protease inhibitors, grapefruit juice):** May increase atorvastatin plasma concentrations, increasing the risk of myopathy and rhabdomyolysis. Monitor closely and consider dose reduction.
* **Cyclosporine, gemfibrozil, fibrates:** Increased risk of myopathy and rhabdomyolysis. Use with caution or consider alternative agents.
* **Warfarin:** May increase INR. Monitor INR closely when initiating or changing atorvastatin dose.
* **Oral Contraceptives:** May increase AUC of ethinyl estradiol and norgestrel.
## Monitoring
* Liver function tests (ALT, AST) at baseline and as clinically indicated.
* Serum lipid panel (total cholesterol, LDL-C, HDL-C, triglycerides) at baseline and typically within 4 to 12 weeks of initiation or dose adjustment.
* Creatine kinase (CK) if muscle pain, tenderness, or weakness occurs.
## Clinical Pearls
* Patients should be advised to report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever.
* Limit concurrent use with strong CYP3A4 inhibitors.
* Grapefruit juice can increase atorvastatin levels; advise patients to avoid consuming large quantities.
* Atorvastatin can be taken at any time of day, with or without food.
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**Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to ensure the information provided is accurate, complete, and appropriate for your specific circumstances. Refer to the most current prescribing information for definitive guidance.
