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# Atorvastatin
## Overview
Atorvastatin is a statin medication used to lower cholesterol and triglyceride levels in the blood. It works by inhibiting HMG-CoA reductase, a key enzyme in cholesterol synthesis.
## Primary Indications
* Hyperlipidemia (adjunct to diet to lower elevated total cholesterol, LDL-C, triglycerides, and Apo B; increase HDL-C)
* Prevention of cardiovascular disease in patients with risk factors for primary or secondary cardiovascular disease.
## Adult Dosing
* **Hyperlipidemia:** Recommended starting dose is 10-20 mg once daily. Patients requiring significant LDL-C reduction (>45%) may need 40 mg once daily.
* **Maximum dose:** 80 mg once daily.
* **Cardiovascular disease prevention:** 10-80 mg once daily.
## Pediatric Dosing
* **Children 10-17 years:** Dosing is typically initiated at 10 mg once daily and titrated up to 20 mg once daily (range 10-40 mg/day).
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically required.
* **Hepatic Impairment:** Use with caution. See Contraindications.
## Contraindications
* Active liver disease or unexplained persistent elevations of serum transaminases (exceeding 3 times the upper limit of normal).
* Hypersensitivity to atorvastatin or any component of the formulation.
* Pregnancy and breastfeeding.
## Adverse Effects
* **Common:** Diarrhea, nausea, myalgia, arthralgia, nasopharyngitis, headache.
* **Serious:** Rhabdomyolysis with acute kidney injury (rare), hepatotoxicity.
## Key Drug Interactions
* **CYP3A4 Inhibitors:** (e.g., itraconazole, ketoconazole, clarithromycin, ritonavir) can increase atorvastatin plasma concentrations, increasing the risk of myopathy. Coadministration generally not recommended if doses of inhibitor exceed those required for HIV treatment.
* **CYP3A4 Inducers:** (e.g., rifampin) may decrease atorvastatin plasma concentrations.
* **Cyclosporine:** Significantly increased atorvastatin exposure; use with caution and consider dose limitation.
* **Gemfibrozil, Fenofibrate:** Increased risk of myopathy.
* **Colchicine:** Increased risk of myopathy.
* **Digoxin:** May increase digoxin levels.
* **Oral Contraceptives:** May increase levels of oral contraceptive hormones.
## Monitoring
* **Liver function tests (LFTs):** Baseline and periodically as clinically indicated.
* **Creatine kinase (CK):** If patient reports muscle pain, tenderness, or weakness.
* **Lipid panel:** Prior to initiating therapy and after 4-12 weeks of therapy or dose adjustment.
## Clinical Pearls
* Take atorvastatin with or without food.
* It can be taken at any time of day.
* Advise patients to report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever.
* Grapefruit juice may increase atorvastatin levels; consumption should be limited.
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*This information is intended for healthcare professionals. Please consult the most current prescribing information and relevant literature for complete details and to ensure patient safety.*
