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# Atorvastatin
## Overview
Atorvastatin is a statin (HMG-CoA reductase inhibitor) used to lower cholesterol and triglycerides in the blood, thereby reducing the risk of cardiovascular events such as heart attack and stroke.
## Primary Indications
* Hyperlipidemia (adjunct to diet)
* Prevention of cardiovascular disease
## Adult Dosing
* **Hyperlipidemia:** Initial dose: 10-20 mg once daily. Titrate as needed. Maintenance dose: 10-80 mg once daily.
* **Prevention of Cardiovascular Disease:** 10-80 mg once daily.
## Pediatric Dosing
* **Children 10-17 years:** 10 mg once daily. Titrate as needed, not to exceed 80 mg daily.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Contraindicated in active liver disease.
* **Renal Impairment:** No dose adjustment typically needed.
## Contraindications
* Active liver disease
* 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, hyperglycemia, memory impairment.
## Key Drug Interactions
* **CYP3A4 inhibitors (e.g., itraconazole, ketoconazole, clarithromycin):** Increased risk of myopathy and rhabdomyolysis. Use caution and consider dose reduction.
* **Fibrates (e.g., gemfibrozil) and niacin:** Increased risk of myopathy and rhabdomyolysis. Avoid concurrent use if possible.
* **Warfarin:** May increase INR. Monitor INR closely when initiating, changing dose, or discontinuing atorvastatin.
* **Colchicine:** Increased risk of myopathy and rhabdomyolysis. Use with caution.
## Monitoring
* **Baseline:** Liver function tests (ALT, AST), creatine kinase (CK), lipid panel.
* **Routine:** Lipid panel, liver function tests, CK if myopathy is suspected.
## Clinical Pearls
* Administer at any time of day, with or without food.
* Risk of myopathy is dose-dependent and increased with concomitant medications that inhibit CYP3A4 or with fibrates.
* Counsel patients on signs and symptoms of myopathy (muscle pain, tenderness, or weakness) and to report them immediately.
* Consider a 40 mg dose in patients at high risk for cardiovascular events.
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**Disclaimer:** This information is intended for clinical pharmacists and healthcare professionals. It is essential to consult the most current prescribing information and relevant guidelines for complete and up-to-date details before making any treatment decisions.
