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# Atorvastatin
## Overview
Atorvastatin is a statin (HMG-CoA reductase inhibitor) used to lower cholesterol and triglycerides in the blood, and to increase HDL cholesterol.
## Primary Indications
* Hypercholesterolemia (adjunct to diet)
* Prevention of cardiovascular disease in patients with risk factors
## Adult Dosing
* **Hypercholesterolemia:** Initiate at 10-20 mg orally once daily. Titrate up to 80 mg once daily as needed.
* **Cardiovascular Disease Prevention:** 10-80 mg orally once daily.
## Pediatric Dosing
* **Heterozygous Familial Hypercholesterolemia:**
* **10 to 17 years:** 10 mg orally once daily, may titrate up to 20 mg once daily.
* **1 to 9 years:** Dosing is not established.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment necessary.
* **Hepatic Impairment:** Use with caution; avoid in active liver disease or unexplained persistent elevations of serum transaminases.
## 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, nasopharyngitis.
* **Serious:** Rhabdomyolysis, hepatotoxicity, hyperglycemia, cognitive impairment.
## Key Drug Interactions
* **CYP3A4 Inhibitors:** (e.g., itraconazole, ketoconazole, protease inhibitors, macrolide antibiotics, grapefruit juice) Increased risk of myopathy and rhabdomyolysis. Dose of atorvastatin should not exceed 10 mg when used with lopinavir/ritonavir or ritonavir.
* **Fibrates and Gemfibrozil:** Increased risk of myopathy and rhabdomyolysis. Avoid concurrent use if possible.
* **Colchicine:** Increased risk of myopathy and rhabdomyolysis. Use with caution.
* **Warfarin:** May alter INR. Monitor INR closely when initiating or changing atorvastatin dose.
* **Antacids:** May decrease atorvastatin bioavailability. Separate administration by at least 2 hours.
* **Digoxin:** May increase digoxin levels. Monitor digoxin levels.
* **Oral Contraceptives:** May increase AUC of ethinyl estradiol and norgestrel.
## Monitoring
* **Liver Function Tests (LFTs):** Baseline and as clinically indicated.
* **Creatine Kinase (CK):** If myopathy is suspected.
* **Lipid Panel:** Before initiating therapy and at intervals (typically 4-12 weeks) to assess efficacy.
* **HbA1c and Blood Glucose:** Especially in patients with diabetes or risk factors for diabetes.
## Clinical Pearls
* Take with or without food.
* Grapefruit juice intake should be limited to avoid increasing atorvastatin levels and risk of side effects.
* Patients should report any unexplained muscle pain, tenderness, or weakness, especially if accompanied by fever or malaise.
* For patients requiring higher doses of atorvastatin, consider the potential for increased drug interactions.
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**Disclaimer:** This information is intended for healthcare professionals and does not replace comprehensive prescribing information. Always verify current prescribing information and consult with a qualified healthcare provider before making any treatment decisions.
