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# 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
* Hypercholesterolemia (Primary and Secondary prevention)
* Cardiovascular disease prevention
## Adult Dosing
* **Hypercholesterolemia:** Starting dose is typically 10-20 mg once daily. Maintenance doses range from 10-80 mg once daily.
* **Cardiovascular disease prevention:** Starting dose is typically 10-80 mg once daily.
The maximum recommended dose is 80 mg once daily. Dosing should be individualized based on patient response and treatment goals.
## Pediatric Dosing
* **Ages 10-17 years with heterozygous familial hypercholesterolemia:** 10 mg once daily, not to exceed 20 mg once daily.
* Dosing for children under 10 years is not established.
## Dose Adjustments
* **Renal impairment:** No dose adjustment is typically required.
* **Hepatic impairment:** Use with caution. Patients with active liver disease should not use atorvastatin. For mild to moderate hepatic impairment, a dose reduction may be considered.
## 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 adverse effects include:
* Myalgia (muscle pain)
* Arthralgia (joint pain)
* Diarrhea
* Nausea
* Nasopharyngitis
Serious adverse effects include:
* Hepatotoxicity
* Myopathy (including rhabdomyolysis)
* New-onset diabetes mellitus
## Key Drug Interactions
* **CYP3A4 inhibitors:** Increased risk of myopathy and rhabdomyolysis with strong CYP3A4 inhibitors (e.g., itraconazole, ketoconazole, ritonavir, clarithromycin). Consider dose reduction or avoidance.
* **Gemfibrozil and other fibrates:** Increased risk of myopathy. Use with caution or consider alternative therapies.
* **Niacin:** Increased risk of myopathy.
* **Colchicine:** Increased risk of myopathy.
* **Grapefruit juice:** May increase atorvastatin levels; limit intake.
## Monitoring
* **Liver function tests (LFTs):** Baseline and as clinically indicated, especially if symptoms of liver dysfunction develop.
* **Creatine kinase (CK):** Baseline and as clinically indicated, especially in patients experiencing muscle symptoms.
* Lipid panel: Monitor efficacy at intervals of 2 to 4 weeks.
## Clinical Pearls
* For patients requiring high-intensity statin therapy, atorvastatin 40 mg or 80 mg may be used.
* Patients should be advised to report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever.
* Consider assessing risk factors for diabetes before initiating statin therapy.
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**Disclaimer:** This information is intended for healthcare professionals and does not replace comprehensive prescribing information. Always consult the most current drug monograph and relevant clinical guidelines for complete and up-to-date information before making any prescribing decisions.
