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# Atorvastatin ## Overview Atorvastatin is a statin used to lower cholesterol levels and reduce the risk of cardiovascular events. It works by inhibiting HMG-CoA reductase, an enzyme involved in cholesterol synthesis. ## Primary Indications * Hyperlipidemia (primary and secondary prevention) * Prevention of cardiovascular disease in patients with risk factors ## Adult Dosing * **Hyperlipidemia:** Start at 10-20 mg once daily. Titrate to 10-80 mg once daily based on LDL-C goals and patient response. * **Cardiovascular Disease Prevention:** Start at 10-80 mg once daily. ## Pediatric Dosing * **Ages 10-17 years with Heterozygous Familial Hypercholesterolemia:** 10 mg once daily. May titrate up to 20 mg once daily. * Dosing in younger children is not established. ## Dose Adjustments * **Hepatic Impairment:** Use with caution. Contraindicated in active liver disease. * **Renal Impairment:** No specific dose adjustment is generally required. ## Contraindications * Active liver disease or unexplained 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, liver dysfunction, memory impairment. ## Key Drug Interactions * **CYP3A4 Inhibitors (e.g., clarithromycin, ritonavir, itraconazole):** Increase atorvastatin levels, increasing the risk of myopathy. Use with caution or consider dose reduction. * **CYP3A4 Inducers (e.g., rifampin):** May decrease atorvastatin levels. * **Grapefruit Juice:** May increase atorvastatin levels. ## Monitoring * **Baseline:** Liver function tests (ALT, AST), Creatine Kinase (CK). * **Regularly:** Lipid panel (total cholesterol, LDL-C, HDL-C, triglycerides), liver function tests, CK if muscle symptoms develop. ## Clinical Pearls * Take at any time of day, with or without food. * Patients experiencing muscle pain or weakness should report it immediately. * The risk of myopathy is increased with higher doses, concomitant use of certain medications, and in patients with risk factors for muscle disease. *** **Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and institutional guidelines for complete details and to ensure patient safety.