Adult Dosing
Hyperlipidemia (heterozygous familial or nonfamilial) and Mixed dyslipidemia (Fredrickson types IIa and IIb)
- Initial: 10-20 mg PO daily; increase as per response; usual: 10-80 mg PO daily; MAX: 80 mg/day
- If LDL-C levels need to reduced > 45 %: 40 mg PO daily
- If on cyclosporine: Avoid therapy
- Assess for doses exceeding 20 mg PO daily in
- Patients on clarithromycin and itraconazole
- HIV Patients on combination of ritonavir and saquinavir, darunavir and ritonavir, fosamprenavir and ritonavir
- HIV Patients on fosamprenavir
- Assess for doses exceeding 40 mg PO daily in
- Patients on HIV protease inhibitor nelfinavir or the hepatitis C protease inhibitor boceprevir
- Note: Individualize the starting dose and maintenance doses according to patient characteristics such as goal of therapy and response. After initiation and/or upon titration analyze lipid levels within 2-4 wks and adjust dose accordingly
Homozygous familial hypercholesterolemia
- 10-80 mg PO daily
- Note: Use as an adjunct to other lipid-lowering treatments
Pediatric Dosing
Heterozygous familial hypercholesterolemia
- Child (10-17 yrs): Start with 10 mg PO daily; MAX: 20 mg/day
Homozygous familial hypercholesterolemia (FDA unapproved)
- Child ( > 6 yrs): Start 10-20 mg PO daily; usual: 10-80 mg PO daily; Max: 80 mg/day
[Outline]
- For reducing the risk of MI, stroke, revascularization procedures, and angina in patients without CHD, but with multiple risk factors for CHD
- To reduce the risk of MI and stroke in patients with type 2 diabetes without CHD, but with multiple risk factors for CHD
- For reducing the risk of non-fatal MI, fatal and non-fatal stroke, revascularization procedures, hospitalization for CHF, and angina in patients with CHD
- To reduce elevated total-C, LDL-C, apo B, and TG levels and increase HDL-C in adults with primary hyperlipidemia (heterozygous familial and nonfamilial) and mixed dyslipidemia
- For decreasing elevated TG in patients with hypertriglyceridemia and primary dysbetalipoproteinemia
- To reduce total-C and LDL-C in patients with homozygous familial hypercholesterolemia
- For reducing elevated total-C, LDL-C, and apo B levels in boys and postmenarchal girls, patients with 10-17 years of age with heterozygous familial hypercholesterolemia after failure of an adequate trial of diet therapy
Note: Use as an adjunct therapy to diet
See Supplemental Patient Information
- Rare cases of rhabdomyolysis with acute renal failure secondary to myoglobinuria have occurred; closely monitor skeletal muscle effects in patients with renal impairment
- Myopathy with increase in creatine phosphokinase (CPK) values >10 times ULN have occurred; concomitant use with cyclosporine and strong CYP3A4 inhibitors increases the risk of myopathy/rhabdomyolysis
- Immune-mediated necrotizing myopathy (IMNM) characterized by proximal muscle weakness and elevated serum creatine kinase has been reported with statin use, and may persist despite discontinuation of statin treatment
- Discontinue drug on occurrence of elevated CPK levels or if myopathy is diagnosed or suspected
- Weigh the potential benefits and risks if considering combined therapy with fibric acid derivatives, erythromycin, clarithromycin, a combination of ritonavir plus saquinavir or lopinavir plus ritonavir, immunosuppressive drugs, azole antifungals, or lipid-modifying doses of niacin. Carefully monitor patients during the initial months of therapy and during any periods of upward dosage titration of either drug for any signs or symptoms of muscle pain, tenderness, or weakness
- Consider lower initial and maintenance doses of atorvastatin when taken concomitantly with drugs that induce interactions
- Periodically perform creatine phosphokinase (CPK)
- Temporarily suspend or discontinue this drug in patients with an acute, serious condition suggestive of a myopathy or having a risk factor predisposing to the development of renal failure secondary to rhabdomyolysis
- On occurrence of persistent elevations (>3 times the upper limit of normal [ULN]) in serum transaminases consider reduction of dose or withdrawal of this drug
- Perform liver function tests prior to and at 12 weeks following initiation of therapy and any elevation of dose, and semiannually thereafter. Monitor patients with increased transaminase levels until the abnormalities are resolved
- Interferes with cholesterol synthesis might blunt adrenal and/or gonadal steroid production
- A higher incidence of hemorrhagic stroke have occurred in patients without CHD but with stroke or TIA within the previous 6 months in the atorvastatin 80 mg group vs. placebo
- Risk of CNS toxicity exists
Cautions: Use cautiously in:
- Renal impairment
- Hepatic impairment
- History of liver disease
- Stroke within 6 months
- CHF
- Severe CAD
- Hypothyroidism
- Alcohol abuse
- Recent Stroke
- TIA
- Alcohol use
- Concomitant use with drugs lowering the levels or activity of endogenous steroid hormones
- Lopinavir/ritonavir or ritonavir/saquinavir or clarithromycin use (use lower initial dose)
- Geriatric population (greater risk of myopathy, use lower initial dose)
Supplemental Patient Information
- Advise patients to report promptly on occurrence of unexplained muscle pain, tenderness or weakness, particularly if accompanied by malaise or fever
Pregnancy Category:X
Breastfeeding: Data on atorvastatin during breastfeeding is not published. Disrupts infant's lipid metabolism; avoid use during breastfeeding. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 4 February 2011). Unknown whether the atorvastatin is excreted in human milk. Another drug of this class is excreted in human milk. Statins have potential to cause serious adverse reactions in nursing infants. Manufacturer advises to discontinue nursing.
Pricing data from www.DrugStore.com in U.S.A.
- Lipitor 20 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $164.99
90 mg = $478.97 - Lipitor 40 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $166.99
90 mg = $482.97 - Lipitor 10 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $119.99
90 mg = $336.97 - Lipitor 80 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $164.99
90 mg = $474.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
