Atorvastatin
LIPITOR
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 |
|---|---|---|---|---|
| Hyperlipidemia / CV risk reduction | 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 when appropriate, as early as 4 weeks after initiation, then adjust dosage
Renal No dosage adjustment (renal impairment does not affect plasma concentrations); monitor for myopathy
Hepatic Contraindicated in acute liver failure or decompensated cirrhosis
Instructions
- Take orally once daily, with or without food, at any time of day
- If a dose is missed, skip it and resume at the next scheduled dose
- Avoid >1.2 L/day of grapefruit juice
- Dose caps apply with certain antivirals, azole antifungals, and macrolides
Contraindications
- Acute liver failure or decompensated cirrhosis
Cautions
- Myopathy and rhabdomyolysis (higher risk: age ≥65, hypothyroidism, renal impairment, interacting drugs, higher dose)
- Immune-mediated necrotizing myopathy
- Hepatic dysfunction (transaminase elevations, rare hepatic failure)
- Increases in HbA1c and fasting glucose
- Increased hemorrhagic-stroke risk with 80 mg after recent hemorrhagic stroke
Adverse reactions
- Nasopharyngitis
- Arthralgia
- Diarrhea
- Pain in extremity
- Urinary tract infection
- Myalgia
Pregnancy Discontinue when pregnancy is recognized; may cause fetal harm based on mechanism; statin data have not identified malformation risk
Lactation Breastfeeding not recommended during treatment
NO BOXED WARNINGS
Principal riskMyopathy, rarely rhabdomyolysis
Cost, est. cash$4–$80/month
Generic entry2011
Classes and tags
Clinical profile
Legacy pregnancy categoryX
Defining liabilityMyopathy/rhabdomyolysis and hepatotoxicity; interaction burden varies by agent.
Mechanism of action: Atorvastatin ballicule
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