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## Atorvastatin ### Overview Atorvastatin is a HMG-CoA reductase inhibitor (statin) that lowers cholesterol by inhibiting HMG-CoA reductase, a rate-limiting enzyme in cholesterol synthesis. ### Primary Indications * Hyperlipidemia (adjunct to diet) * Prevention of cardiovascular events in patients with risk factors for cardiovascular disease ### Adult Dosing * **Hyperlipidemia:** 10-80 mg once daily. * **Cardiovascular event prevention:** 10-80 mg once daily. * **Maximum dose:** 80 mg once daily. ### Pediatric Dosing * **Ages 10-17 years with heterozygous familial hypercholesterolemia:** 10 mg once daily, titrate to 20 mg once daily (maximum 40 mg once daily). ### Dose Adjustments * **Renal impairment:** No dose adjustment necessary. * **Hepatic impairment:** Use with caution; dose reduction or discontinuation may be necessary. Avoid in active liver disease. * **Concomitant medications:** May require dose adjustment (see Key Drug Interactions). ### 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:** Myopathy, rhabdomyolysis, hepatotoxicity, memory impairment, increased blood glucose. ### Key Drug Interactions * **CYP3A4 inhibitors (e.g., itraconazole, ketoconazole, clarithromycin, ritonavir):** Increased risk of myopathy and rhabdomyolysis. Consider lower atorvastatin doses or avoid concomitant use. * **Gemfibrozil:** Increased risk of myopathy and rhabdomyolysis. Avoid concomitant use. * **Cyclosporine:** Increased atorvastatin exposure. Limit atorvastatin dose to 10 mg daily. * **Digoxin:** May increase digoxin levels. Monitor digoxin levels. * **Oral contraceptives:** May increase ethinyl estradiol and levonorgestrel levels. ### Monitoring * **Liver function tests (ALT, AST):** Baseline and as clinically indicated. * **Creatine kinase (CK):** Baseline and as clinically indicated, especially if myopathy is suspected. * **Lipid panel:** Before initiating therapy and periodically thereafter. * **HbA1c/blood glucose:** Monitor for potential increases. ### Clinical Pearls * Take at any time of day, with or without food. * Advise patients to report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever. * Risk of myopathy increases with higher doses, concomitant use of other lipid-lowering agents, and in patients with hypothyroidism or renal impairment. *** *This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details.*