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**Drug:** Atorvastatin ## Overview Atorvastatin is a statin medication used to lower cholesterol levels in the blood. It works by inhibiting HMG-CoA reductase, a key enzyme in cholesterol synthesis. ## Primary Indications * Hyperlipidemia (mixed dyslipidemia, hypercholesterolemia) * Prevention of cardiovascular events in patients with risk factors for coronary heart disease. ## Adult Dosing * **Hyperlipidemia:** Start at 10-20 mg once daily. Titrate up to a maximum of 80 mg once daily based on lipid response and patient tolerance. * **Cardiovascular Event Prevention:** 10-80 mg once daily. ## Pediatric Dosing * **Ages 10-17 years with Heterozygous Familial Hypercholesterolemia:** 10 mg once daily, titrate up to 20 mg once daily (maximum dose not established in this age group). ## Dose Adjustments * **Renal Impairment:** No dose adjustment necessary. * **Hepatic Impairment:** Use with caution. Contraindicated in active liver disease. ## Contraindications * Active liver disease, including unexplained elevations of serum transaminases. * Hypersensitivity to any component of the formulation. * Pregnancy and breastfeeding. ## Adverse Effects * **Common:** Myalgia, arthralgia, diarrhea, nausea, headache. * **Serious:** Rhabdomyolysis (muscle breakdown), hepatotoxicity, new-onset diabetes mellitus. ## Key Drug Interactions * **CYP3A4 Inhibitors:** Increased risk of myopathy and rhabdomyolysis (e.g., protease inhibitors, azole antifungals, macrolide antibiotics, grapefruit juice). * **Fibrates and Niacin:** Increased risk of myopathy. * **Colchicine:** Increased risk of myopathy and rhabdomyolysis. * **Warfarin:** May increase INR. Monitor INR closely. ## Monitoring * Liver function tests (ALT, AST) at baseline and as clinically indicated. * Lipid panel at baseline and periodically (e.g., 4-12 weeks after initiation or dose adjustment). * Creatine kinase (CK) if muscle pain or weakness occurs. ## Clinical Pearls * Take atorvastatin orally once daily, with or without food. * Maximum dose is 80 mg once daily. * Counsel patients on the risk of myopathy and to report any unexplained muscle pain, tenderness, or weakness. * Due to potential teratogenicity, ensure women of childbearing potential are not pregnant and are using effective contraception. *** **Disclaimer:** This information is intended for clinical use and does not replace the most current prescribing information. Always verify drug information with the official product monograph or other reliable sources before making prescribing decisions.