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# Atorvastatin ## Overview Atorvastatin is a statin medication used to lower cholesterol levels and reduce the risk of cardiovascular events. ## Primary Indications * Hyperlipidemia (primary hypercholesterolemia and mixed dyslipidemia) * Prevention of cardiovascular disease in patients with risk factors ## Adult Dosing * **Hyperlipidemia:** Start with 10-20 mg once daily. Titrate up to a maximum of 80 mg once daily based on LDL-C response and patient tolerance. * **Cardiovascular Disease Prevention:** 10-80 mg once daily. ## Pediatric Dosing * **Ages 10-17 years with Heterozygous Familial Hypercholesterolemia:** 10 mg once daily, not to exceed 20 mg once daily. ## Dose Adjustments * **Renal Impairment:** No dose adjustment is generally required. * **Hepatic Impairment:** Use with caution. Contraindicated in active liver disease. Consider dose reduction or interruption in patients with severe hepatic impairment. ## 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, arthralgia, diarrhea, nausea, headache, nasopharyngitis. * **Serious:** Rhabdomyolysis, hepatotoxicity, pancreatitis, memory impairment. ## Key Drug Interactions * **CYP3A4 Inhibitors (e.g., ketoconazole, itraconazole, clarithromycin, protease inhibitors):** Increase atorvastatin levels, increasing risk of myopathy. * **CYP3A4 Inducers (e.g., rifampin):** Decrease atorvastatin levels. * **Fibrates and Gemfibrozil:** Increased risk of myopathy and rhabdomyolysis. * **Colchicine:** Increased risk of myopathy and rhabdomyolysis. * **Grapefruit Juice:** May increase atorvastatin levels; avoid excessive consumption. ## Monitoring * Lipid panel (total cholesterol, LDL-C, HDL-C, triglycerides) at baseline and periodically thereafter (e.g., 4-12 weeks after initiation or dose change). * Liver function tests (ALT, AST) at baseline and as clinically indicated. * Monitor for signs and symptoms of myopathy (muscle pain, tenderness, weakness). ## Clinical Pearls * Atorvastatin is typically taken once daily, with or without food. * Maximum dose for pediatric patients with heterozygous familial hypercholesterolemia is 20 mg daily. * Patients should be advised to report any unexplained muscle pain, tenderness, or weakness immediately, especially if accompanied by malaise or fever. --- **Disclaimer:** This information is intended for clinical use and does not replace the need to consult the official prescribing information or other authoritative sources for complete details and to verify current recommendations.