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Lipitor
atorvastatin
Adult Dosing .
Dosage forms: TAB: 10 mg, 20 mg, 40 mg, 80 mg
primary hyperlipidemia
- [10-80 mg PO qd]
- Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Tx Selector decision tool
heterozygous familial hypercholesterolemia
- [10-80 mg PO qd]
- Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Tx Selector decision tool
homozygous familial hypercholesterolemia
- [10-80 mg PO qd]
- Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Tx Selector decision tool
hypertriglyceridemia
- [10-80 mg PO qd]
- Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Tx Selector decision tool
primary dysbetalipoproteinemia
- [10-80 mg PO qd]
- Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Tx Selector decision tool
cardiovascular event risk reduction
- [10-80 mg PO qd]
- Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Tx Selector decision tool
atherosclerotic cardiovascular dz
- [10-80 mg PO qd]
- Info: may adjust dose q4wk; search 'cholesterol' for epocrates Adult Cholesterol Tx Selector decision tool
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [see below]
- acute hepatic failure or decompensated cirrhosis: contraindicated
Peds Dosing .
- Dosage forms: TAB: 10 mg, 20 mg, 40 mg, 80 mg
heterozygous familial hypercholesterolemia
- [10 yo and older]
- Dose: 10-20 mg PO qd; Start: 10 mg PO qd, may adjust dose q4wk
homozygous familial hypercholesterolemia
- [10 yo and older]
- Dose: 10-80 mg PO qd; Start: 10-20 mg PO qd, may adjust dose q4wk
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [see below]
- acute hepatic failure or decompensated cirrhosis: contraindicated
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- pregnancy (except high-risk pts)
- myopathy
- cirrhosis, decompensated
- hepatic failure, acute
- avoid: breastfeeding (high-risk pts)
- caution: alcohol abuse
- caution: pts 65 yo and older
- caution: pts of childbearing potential
- caution: renal impairment
- caution: hepatic dz hx
- caution: diabetes mellitus
- caution: hypothyroidism, uncontrolled
- caution: high-dose use
- caution: rhabdomyolysis risk
- caution: stroke w/in 6mo
- caution: immune-mediated necrotizing myopathy hx
Drug Interactions .
Overview
atorvastatin
statin
- CYP3A4 substrate
- BCRP substrate
- OATP1B1 substrate
- OATP1B3 substrate
- OATP2B1 substrate
- P-gp substrate
- CYP3A4 inhibitor, weak
- P-gp inhibitor, weak
- binds to polyvalent cations
- rhabdomyolysis
Contraindicated
- cisapride
- colchicine
- eliglustat
- lonafarnib
- posaconazole
Avoid/Use Alternative
- alprazolam
- atazanavir
- atorvastatin
- ceritinib
- clarithromycin
- cobicistat
- codeine
- cyclosporine
- erythromycin
- fenofibrate
- fenofibric acid
- fluvastatin
- gemfibrozil
- glecaprevir
- hydrocodone
- ledipasvir
- letermovir
- lovastatin
- meperidine
- methadone
- mifepristone
- netupitant
- niacin (vitamin B3)
- oxycodone
- pibrentasvir
- pimozide
- pitavastatin
- pralsetinib
- pravastatin
- propafenone
- quinine
- red yeast rice
- rosuvastatin
- simvastatin
- tipranavir
Monitor/Modify Tx
- abemaciclib
- abiraterone acetate
- abrocitinib
- acalabrutinib
- adagrasib
- alfentanil
- aluminum hydroxide
- amiodarone
- aprepitant
- asciminib
- avacopan
- avanafil
- avapritinib
- belumosudil
- bempedoic acid
- berotralstat
- bisoprolol
- brigatinib
- canagliflozin
- cannabidiol
- capivasertib
- capmatinib
- captopril
- carbamazepine
- carvedilol
- ceftobiprole
- chloramphenicol
- ciprofloxacin
- clofazimine
- clopidogrel
- clozapine
- conivaptan
- crisaborole topical
- crizotinib
- danazol
- danicopan
- daptomycin
- daridorexant
- darolutamide
- darunavir
- digoxin
- diltiazem
- diosmin
- disopyramide
- docetaxel
- dofetilide
- domperidone
- dronedarone
- duvelisib
- elacestrant
- elafibranor
- elagolix
- elbasvir
- elexacaftor/tezacaftor/ivacaftor
- eltrombopag
- eluxadoline
- enasidenib
- encorafenib
- entrectinib
- enzalutamide
- erdafitinib
- everolimus
- febuxostat
- fedratinib
- felodipine
- fentanyl
- finerenone
- flibanserin
- fluconazole
- fluvoxamine
- fosamprenavir
- fostamatinib
- fostemsavir
- futibatinib
- gepirone
- gepotidacin
- gilteritinib
- grapefruit
- grazoprevir
- ibrutinib
- idelalisib
- imatinib
- indomethacin
- infigratinib
- irbesartan
- isavuconazonium
- istradefylline
- itraconazole
- ivabradine
- ivacaftor
- ivosidenib
- ixabepilone
- ketoconazole
- lanthanum
- lapatinib
- lasmiditan
- lazertinib
- lefamulin
- leflunomide
- lemborexant
- lenacapavir
- leniolisib
- levacetylleucine
- levoketoconazole
- lomitapide
- lopinavir/ritonavir
- lumacaftor/ivacaftor
- lumateperone
- lurasidone
- lurbinectedin
- magnesium hydroxide
- maribavir
- mavacamten
- mavorixafor
- midazolam
- midostaurin
- milk thistle
- mirabegron
- mitapivat
- mobocertinib
- momelotinib
- naproxen
- nefazodone
- nelfinavir
- neratinib
- nifedipine
- nilotinib
- nimodipine
- nirogacestat
- nisoldipine
- oliceridine
- osimertinib
- oteseconazole
- pacritinib
- paroxetine
- pemigatinib
- pirtobrutinib
- ponatinib
- pretomanid
- quercetin
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- raltegravir
- ranolazine
- regorafenib
- resmetirom
- ribociclib
- rifampin
- ritonavir
- rolapitant
- rucaparib
- sacubitril
- sarecycline
- selpercatinib
- selumetinib
- sirolimus
- sirolimus albumin-bound
- sodium zirconium cyclosilicate
- sorafenib
- sotagliflozin
- sotalol
- sotorasib
- sparsentan
- stiripentol
- sufentanil
- suvorexant
- tacrolimus
- tadalafil
- tafamidis
- tedizolid phosphate
- telmisartan
- temsirolimus
- tepotinib
- teriflunomide
- tezacaftor/ivacaftor
- ticagrelor
- tolvaptan
- trazodone
- triazolam
- trimethoprim
- trofinetide
- tucatinib
- turmeric
- ubrogepant
- uridine triacetate
- vadadustat
- valbenazine
- vandetanib
- vanzacaftor/tezacaftor/deutivacaftor
- vardenafil
- velpatasvir
- vemurafenib
- venetoclax
- verapamil
- vimseltinib
- vinblastine
- vincristine
- vinorelbine
- voclosporin
- voriconazole
- voxilaprevir
- warfarin
- xanomeline
- zanubrutinib
- zonisamide
Caution Advised
- apalutamide
- armodafinil
- artemether/lumefantrine
- belzutifan
- bexarotene
- bosentan
- butalbital
- cariprazine
- cenobamate
- clobazam
- cobimetinib
- cyclophosphamide
- dabrafenib
- danshen
- dexamethasone
- dicloxacillin
- dihydroergotamine
- echinacea
- efavirenz
- eplerenone
- ergotamine
- eslicarbazepine acetate
- etravirine
- felbamate
- fexinidazole
- fosphenytoin
- garlic
- ginseng, Asian
- glycerol phenylbutyrate
- green tea
- griseofulvin
- lorlatinib
- maralixibat
- meropenem
- methylergonovine
- mitotane
- modafinil
- nafcillin
- nevirapine
- odevixibat
- olutasidenib
- omaveloxolone
- oxcarbazepine
- palovarotene
- pentobarbital
- perampanel
- pexidartinib
- phenobarbital
- phenytoin
- prednisone
- primidone
- repotrectinib
- rifabutin
- rifapentine
- roflumilast
- roflumilast topical
- rufinamide
- sarilumab
- sirolimus topical
- somatropin
- St. John's wort
- suzetrigine
- tazemetostat
- tecovirimat
- telotristat ethyl
- tocilizumab
- topiramate
- tovorafenib
- vaborbactam
- vamorolone
- vorasidenib
Adverse Reactions .
Serious Reactions
- myopathy
- immune-mediated necrotizing myopathy
- tendon rupture
- rhabdomyolysis
- acute renal failure
- hepatotoxicity
- pancreatitis
- hypersensitivity rxn
- anaphylaxis
- photosensitivity
- toxic epidermal necrolysis
- erythema multiforme
- Stevens-Johnson syndrome
- thrombocytopenia
- leukopenia
- hemolytic anemia
- diabetes mellitus
- interstitial lung dz
- hemorrhagic stroke (high-dose use)
- myasthenia gravis
Common Reactions
- URI
- headache
- arthralgia
- diarrhea
- UTI
- extremity pain
- dyspepsia
- nausea
- musculoskeletal pain
- muscle spasms
- myalgia
- insomnia
- pharyngolaryngeal pain
- diabetes mellitus
- CK elevated
- ALT or AST elevated
- cognitive impairment
- gynecomastia
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; LFTs at baseline, then as clinically indicated; CK at baseline if myopathy risk, then as clinically indicated; glucose if diabetes risk
Look/Sound-Alike Drug Names
Lipitor confused with: labetalol; lisinopril; Lopid; Lortab; Mevacor; Zocor
atorvastatin confused with: atomoxetine; lovastatin; pravastatin; rosuvastatin; simvastatin
Pregnancy/Lactation .
Pregnancy
Clinical Summary
avoid use during pregnancy in non-high risk pts, otherwise weigh risk/benefit in high risk pts; possible risk of teratogenicity based on limited or conflicting human data; no known risk of teratogenicity based on animal data at 20x and 30x recommended human dose, though risk of low birth wt and neonatal developmental delays based on animal data at 6x and 22x recommended human dose; possible risk of delayed fetal development based on drug's mechanism of action
Lactation
Clinical Summary
avoid breastfeeding in high risk pts, otherwise weigh risk/benefit in non-high risk pts; no human data available to assess risk of infant harm, though possible risk of drug excretion into milk; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver; CYP450: 3A4 substrate; Info: active metabolites
Excretion: bile primarily, urine <2%; Half-life: 14h (parent drug), 20-30h (metabolites)
Subclass: Dyslipidemia: HMG-CoA Reductase Inhibitors (Statins)
Mechanism of Action
inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, inhibiting cholesterol synthesis
Formulary .
No Formulary Selected
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