Atorvastatin
LIPITOR
Pronunciation: a-TOR-va-sta-tin (LIP-i-tor)
“Lippy Tornado”
What it isHMG-CoA reductase inhibitor; high-intensity LDL lowering for hyperlipidemia and ASCVD prevention.
Why this onePotent, inexpensive and usable without renal dose adjustment; unlike simvastatin, it can be taken at any hour.
What limits itCYP3A4 inhibitors raise myopathy risk. Check baseline liver enzymes; investigate muscle symptoms rather than routinely checking CK.
FDA-approved for
- hyperlipidemia (1996)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| CV risk reduction (MI, stroke, revascularization) / primary hyperlipidemia / HeFH / HoFH / dysbetalipoproteinemia / hypertriglyceridemia | Adults | 10–20 mg QD (40 mg QD if LDL-C reduction >45% needed) | 10–80 mg QD | 80 mg QD |
| Heterozygous familial hypercholesterolemia (HeFH) | Pediatric ≥10 y | 10 mg QD | 10–20 mg QD | 20 mg QD |
| Homozygous familial hypercholesterolemia (HoFH) | Pediatric ≥10 y | 10–20 mg QD | 10–80 mg QD | 80 mg QD |
Titration Assess LDL-C as early as 4 weeks after initiation, then adjust
Renal No dosage adjustment (plasma concentrations unaffected); renal impairment is a myopathy risk factor — monitor
Hepatic Contraindicated in acute liver failure or decompensated cirrhosis; Child-Pugh A AUC 4-fold, Child-Pugh B ~11-fold higher
Instructions
- Take orally once daily at any time of day, with or without food
- Missed dose: skip and resume at next scheduled dose
- Avoid >1.2 L/day grapefruit juice
- Interaction caps: ≤20 mg QD with clarithromycin, itraconazole, saquinavir/ritonavir, darunavir/ritonavir, fosamprenavir, elbasvir/grazoprevir, letermovir; ≤40 mg QD with nelfinavir
Available strengths
- tab 10, 20, 40, 80 mg
- susp 20 mg/5 mL
Contraindications
- Acute liver failure or decompensated cirrhosis
Cautions
- Myopathy and rhabdomyolysis
- Immune-mediated necrotizing myopathy
- Hepatic dysfunction
- Increases in HbA1c and fasting serum glucose
- Hemorrhagic stroke risk with 80 mg after recent hemorrhagic stroke
Adverse reactions
- Nasopharyngitis
- Arthralgia
- Diarrhea
- Pain in extremity
- Urinary tract infection
- Dyspepsia
- Nausea
- Musculoskeletal pain
- Muscle spasms
- Myalgia
- Insomnia
- Pharyngolaryngeal pain
Pregnancy May cause fetal harm by mechanism — discontinue when pregnancy is recognized; observational statin data have not identified a major-malformation risk.
Lactation Breastfeeding not recommended during treatment.
Cost
Generic entry2011
NO BOXED WARNINGS
Principal riskMyopathy, rarely rhabdomyolysis
Classes and tags
Clinical profile
Legacy pregnancy categoryX
Defining liabilityMyopathy/rhabdomyolysis and hepatotoxicity; interaction burden varies by agent.
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