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# Atorvastatin
## Overview
Atorvastatin is a statin medication used to lower cholesterol levels and reduce the risk of cardiovascular events. It works by inhibiting HMG-CoA reductase, a key enzyme in cholesterol synthesis.
## Primary Indications
* Hypercholesterolemia (primary and mixed dyslipidemias)
* Prevention of cardiovascular disease in patients with risk factors
## Adult Dosing
* **Hypercholesterolemia:** Start with 10-20 mg once daily. Titrate up to 40-80 mg once daily as needed.
* **Cardiovascular disease prevention:** 10-80 mg once daily.
## Pediatric Dosing
* **Children 10-17 years:** 10 mg once daily, titrated up to 20 mg once daily as needed for heterozygous familial hypercholesterolemia. Higher doses are generally not recommended in this age group due to limited long-term data.
## Dose Adjustments
* **Renal impairment:** No dose adjustment is typically needed.
* **Hepatic impairment:** Use with caution. Avoid in active liver disease.
## 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:** Myopathy, rhabdomyolysis with acute kidney injury, hepatotoxicity, allergic reactions.
## Key Drug Interactions
* **CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, protease inhibitors):** May increase atorvastatin levels, increasing risk of myopathy.
* **Cyclosporine, gemfibrozil, fibrates:** Increased risk of myopathy.
* **Warfarin:** May increase INR. Monitor INR closely.
* **Digoxin:** May increase digoxin levels.
## Monitoring
* Lipid panel (baseline and periodically)
* Liver function tests (baseline and periodically, especially with dose increases or symptoms)
* Creatine kinase (CK) if myopathy symptoms develop
## Clinical Pearls
* Take at any time of day, with or without food.
* Patients should be advised to report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever.
* Consider a lower starting dose in elderly patients or those predisposed to myopathy.
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*This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the best course of treatment for your specific condition. Verify current prescribing information for complete details.*
