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# Atorvastatin
## Overview
Atorvastatin is a HMG-CoA reductase inhibitor (statin) used to lower cholesterol and triglycerides in the blood. It works by reducing cholesterol production in the liver.
## Primary Indications
* Hyperlipidemia (primary hypercholesterolemia and mixed dyslipidemia)
* Prevention of cardiovascular events (secondary prevention in patients with established cardiovascular disease, primary prevention in patients with risk factors)
## Adult Dosing
* **Hyperlipidemia:** Usual starting dose is 10-20 mg once daily. Titrate as needed to a maximum of 80 mg once daily.
* **Cardiovascular event prevention:** Usual dose is 10-80 mg once daily.
## Pediatric Dosing
* **Heterozygous Familial Hypercholesterolemia (HeFH):**
* **10 to 17 years:** 10 mg once daily. May titrate up to 20 mg once daily.
* Dosing for pediatric patients <10 years is not established.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. Avoid in active liver disease.
* **Renal Impairment:** No dose adjustment generally required.
## 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:** Myalgia, diarrhea, nausea, arthralgia, nasopharyngitis.
* **Serious:** Rhabdomyolysis with acute kidney injury, hepatotoxicity.
## Key Drug Interactions
* **CYP3A4 Inhibitors (e.g., itraconazole, ketoconazole, clarithromycin):** Increased atorvastatin levels, increased risk of myopathy and rhabdomyolysis. Limit atorvastatin dose or avoid concomitant use.
* **CYP3A4 Inducers (e.g., rifampin):** Decreased atorvastatin levels.
* **Fibrates and other fibrids, Gemfibrozil, Fenofibrate:** Increased risk of myopathy and rhabdomyolysis. Use with caution, consider lower statin dose.
* **Colchicine:** Increased risk of myopathy and rhabdomyolysis. Use with caution.
* **Niacin:** Increased risk of myopathy and rhabdomyolysis.
* **Digoxin:** Atorvastatin may increase digoxin levels. Monitor digoxin levels.
* **Oral Contraceptives:** Atorvastatin may increase levels of progestin and estrogen.
## Monitoring
* Liver function tests (ALT, AST) at baseline and as clinically indicated.
* Creatine kinase (CK) if myopathy is suspected.
* Lipid panel at baseline and regularly thereafter (typically 4-12 weeks after initiation or dose change).
## Clinical Pearls
* The risk of myopathy and rhabdomyolysis is dose-dependent.
* Advise patients to report unexplained muscle pain, tenderness, or weakness, especially if accompanied by fever or malaise.
* Atorvastatin can be taken with or without food.
* Grapefruit juice can increase atorvastatin levels; advise patients to avoid excessive consumption.
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*Disclaimer: This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider and refer to the most current prescribing information for definitive guidance.*
