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# Atorvastatin
## Overview
Atorvastatin is a statin medication used to lower cholesterol and triglycerides in the blood. It works by inhibiting HMG-CoA reductase, a key enzyme in cholesterol synthesis.
## Primary Indications
* Hyperlipidemia (heterozygous familial and nonfamilial)
* Mixed dyslipidemia
* Hypertriglyceridemia
* Primary prevention of cardiovascular disease in patients with risk factors for coronary heart disease.
## Adult Dosing
* **Hyperlipidemia:** Initial dose: 10-20 mg once daily. Maintenance dose: 10-80 mg once daily.
* **Cardiovascular disease prevention:** 10-80 mg once daily.
## Pediatric Dosing
* **Pediatric patients (10 to 17 years of age) with heterozygous familial hypercholesterolemia:**
* Starting dose: 10 mg once daily.
* Maximum dose: 40 mg once daily (doses above 40 mg in pediatric patients have not been studied).
## Dose Adjustments
* **Hepatic impairment:** Use with caution. Avoid in active liver disease.
* **Renal impairment:** No dose adjustment necessary.
## 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.
* **Serious:** Rhabdomyolysis with acute kidney injury, hepatotoxicity, pancreatitis, peripheral neuropathy.
## Key Drug Interactions
* **CYP3A4 inhibitors (e.g., clarithromycin, itraconazole, protease inhibitors):** Increase atorvastatin levels, increasing the risk of myopathy. Consider lower atorvastatin doses or temporary discontinuation.
* **Fibrates and niacin:** Increased risk of myopathy.
* **Colchicine:** Increased risk of myopathy and rhabdomyolysis.
* **Warfarin:** May increase INR. Monitor INR closely.
* **Oral contraceptives:** May increase levels of ethinyl estradiol and norgestrel.
## Monitoring
* Liver function tests (transaminases) at baseline and as clinically indicated.
* Creatine kinase (CK) if myopathy is suspected.
* Lipid panel at baseline and typically 4-12 weeks after initiation or dose change.
## Clinical Pearls
* Atorvastatin can be taken with or without food.
* Take at bedtime to potentially minimize myopathy risk, although evidence is limited.
* Counsel patients to report unexplained muscle pain, tenderness, or weakness, especially if accompanied by fever or malaise.
* Consider the risk of rhabdomyolysis when initiating or increasing the dose, especially in patients with risk factors (e.g., older age, renal impairment, hypothyroidism, concomitant medications).
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*Please verify this information with the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
