March 28, 2017
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Atorvastatin

Brand Name: Lipitor

Generic Name: atorvastatin

Drug Class: Lipid-Lowering Agents, Statins; HMG-CoA Reductase Inhibitors

What Is Atorvastatin and How Does It Work?

Atorvastatin is a prescription medication used along with a proper diet to help people lower "bad" cholesterol and fats (such as LDL, triglycerides) and raise "good" cholesterol (HDL) in the blood. It belongs to a group of drugs known as "statins." It works by reducing the amount of cholesterol made by the liver. Lowering "bad" cholesterol and triglycerides and raising "good" cholesterol decreases the risk of heart disease and helps prevent strokes and heart attacks.

In addition to eating a proper diet (such as a low cholesterol and low fat diet), other lifestyle changes that may help this medication work better include exercising, weight loss, and stopping smoking. Consult your doctor for more details.

Atorvastatin is available under the following different brand names: Lipitor.

Dosages of Atorvastatin Should Be Given As Follows:

Adult and Pediatric Dosage Forms & Strengths

Tablets

  • 10 mg
  • 20 mg
  • 40 mg
  • 80 mg

Dosage Considerations

Hyperlipidemia

Primary hypercholesterolemia (high cholesterol) and mixed dyslipidemia

  • Indicated as an adjunct to diet for treatment of elevated total-C, Apo B, and TG levels and to increase HDL-C in patients with primary hypercholesterolemia (heterozygous familial and non-familial) and mixed dyslipidemia (Fredrickson type IIa and IIb)
  • 10-20 mg taken orally once daily initially
  • Starting dose in patients requiring larger LDL-C reduction (i.e., greater than 45%): 40 mg taken orally once daily
  • Maintenance: 10-80 mg taken orally once daily
  • After initiation and/or upon dose titration, check lipid levels after 2-4 weeks and adjust dose accordingly

Hypertriglyceridemia (High Triglycerides)

  • Adjunct to diet for elevated TG levels (Fredrickson type IV)
  • 10 mg taken orally once daily initially
  • Maintenance: 10-80 mg taken orally once daily maintenance
  • After initiation and/or upon dose titration, check lipid levels after 2-4 weeks and adjust dose accordingly

Primary Dysbetalipoproteinemia

  • Dysbetalipoproteinemia (Fredrickson type III) in patient with inadequate response to diet
  • Maintenance: 10-80 mg taken orally once daily
  • After initiation and/or upon dose titration, check lipid levels after 2-4 weeks and adjust dose accordingly

Homozygous Familial Hypercholesterolemia

  • Reduction of total-C and LDL-C in HoFH as an adjunct to other lip-lowering treatments (e.g., LDL apheresis) or if such treatments are unavailable
  • 10-80 mg taken orally once daily

Cardiovascular Disease Prevention

  • 10-80 mg taken orally once daily

Indications

  • Reduction of risk of stroke and heart attack in type 2 diabetes patients without evidence of heart disease but with other CV risk factors
  • Reduction of risk of stroke, heart attack, and revascularization procedures in patients without evidence of coronary heart disease (CHD) but with multiple risk factors other than diabetes (eg, smoking, HTN, low HDL-C, family history of early CHD)
  • Patients with CHD, to reduce risks of MI, stroke, revascularization procedures, hospitalization for CHF, and angina

Dosage Considerations

Co-administration with other drugs

  • Bile acid sequestrant: Administer atorvastatin/ezetimibe 2 hours or more before or 4 hours or more after administering bile acid sequestrant
  • Cyclosporine, tipranavir plus ritonavir, telaprevir, gemfibrozil: Avoid co-administration with atorvastatin (increased risk of rhabdomyolysis)
  • Lopinavir plus ritonavir: Use lowest dose of atorvastatin necessary
  • Clarithromycin, itraconazole, saquinavir plus ritonavir, darunavir plus ritonavir, fosamprenavir: Do not exceed atorvastatin dose of 20 mg/day
  • Nelfinavir, boceprevir: Do not exceed atorvastatin dose of 40 mg/day

Overdose management

  • Generally considered safe in acute overdose, although not formally studied
  • Adverse drug reactions from overdose may include peripheral neuropathy, diarrhea, increased K+, myopathy, rhabdomyolysis, acute renal failure, elevated LFTs, eye lens opacities
  • Treatment is supportive

Heterozygous Familial Hypercholesterolemia

Indicated as an adjunct to diet to reduce total-C, LDL-C, and apo B levels in boys and post-menarchal girls aged 10-17 years with HeFH who have an inadequate response to diet alone (i.e., LDL-C remains greater than or equal to 190 mg/dL or LDL-C remains greater than or equal to 160 mg/dL and there is positive family history or early CV disease or 2 or more other CVD risk factors present)

Younger than 10 years: Safety and efficacy not established

10 years and older: Initially, 10 mg taken orally once daily; titrate at 4-week intervals; not to exceed 20 mg taken orally once daily

Homozygous Familial Hypercholesterolemia (Off-label)

Younger than 10 years: Safety and efficacy not established

10 years and older: 10-40 mg taken orally once daily

Medically Reviewed by a Doctor on 3/10/2017



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