Overview
Atorvastatin is a statin medication used to lower LDL cholesterol and reduce cardiovascular risk. It works by inhibiting HMG-CoA reductase, decreasing cholesterol production in the liver. It is indicated for primary and secondary prevention of cardiovascular events in appropriate patient populations.
Mechanism of Action
Atorvastatin competitively inhibits HMG-CoA reductase, the rate-limiting enzyme in cholesterol biosynthesis. This inhibition reduces hepatic cholesterol production, leading to upregulation of LDL receptors and increased clearance of LDL cholesterol from the bloodstream.
Indications
- Reduce risk of myocardial infarction, stroke, revascularization procedures, and angina in adults with multiple CHD risk factors
- Reduce risk of MI and stroke in adults with type 2 diabetes and multiple CHD risk factors
- Reduce LDL-C in adults with primary hyperlipidemia
- Reduce LDL-C in adults and pediatric patients (≥10 years) with heterozygous familial hypercholesterolemia
- Reduce LDL-C in adults and pediatric patients (≥10 years) with homozygous familial hypercholesterolemia
- Treat primary dysbetalipoproteinemia
- Treat hypertriglyceridemia
Common Doses
- 10 mg
- 20 mg
- 40 mg
- 80 mg
Dosage
Initial dose typically 10-20 mg once daily, may be increased to maximum 80 mg daily based on LDL-C response. Administer at any time of day with or without food.
Contraindications
- Acute liver failure or decompensated cirrhosis
- Hypersensitivity to atorvastatin or any tablet excipients
Side Effects
- Myalgia, arthralgia, diarrhea, nasopharyngitis
- Increased liver enzymes
- Muscle pain, tenderness, or weakness (potential myopathy)
- Rhabdomyolysis (rare but serious)
- Hyperglycemia
- Hypersensitivity reactions including anaphylaxis, angioedema, erythema multiforme
Interactions
- Strong CYP3A4 inhibitors (e.g., clarithromycin, itraconazole, HIV protease inhibitors) increase atorvastatin exposure and risk of myopathy
- Cyclosporine, gemfibrozil, and other fibrates increase myopathy risk
- Colchicine may increase risk of myopathy
- Warfarin: monitor INR as atorvastatin may potentiate anticoagulant effect
Counseling Points
- Take once daily at any time, with or without food
- Report unexplained muscle pain, tenderness, or weakness immediately
- Avoid excessive alcohol consumption
- Maintain standard cholesterol-lowering diet during treatment
- Inform healthcare provider of all medications, especially antibiotics and antifungals
- Routine monitoring of liver enzymes may be recommended