Atorvastatin Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Prevention of Cardiovascular Disease

Initial dose: 10 mg to 80 mg orally once a day.

The initial dosage of atorvastatin recommended for this patient in the prevention of cardiovascular disease is 10 mg to 80 mg orally once a day. Atorvastatin may be administered at any time of the day without regard for meals.

Dose adjustments should be made at intervals of 2 to 4 weeks.

Studies have demonstrated that treatment with atorvastatin is associated with significant reductions in the risk of cardiovascular endpoints and stroke in various patient populations for both primary and secondary prevention.

For primary prevention, atorvastatin treatment was effective in hypertensive patients with normal or mildly elevated cholesterol levels as well as in patients with type II diabetes. Patients had relatively low cholesterol levels at baseline in both trials; however, treatment with atorvastatin still resulted in significant reductions in cardiovascular outcomes and stroke.

For secondary prevention, intensive lipid lowering therapy with atorvastatin 80 mg/day was associated with significant incremental clinical benefit beyond therapy with 10 mg/day in patients with stable coronary heart disease. It was also shown to significantly reduce the risk of clinical outcomes in coronary heart disease patients versus usual medical care.

Usual Adult Dose for Hyperlipidemia

Initial dose: 10, 20 or 40 mg orally once a day. The 40 mg starting dose is recommended for patients who require a reduction in LDL-cholesterol of more than 45%.

Dose adjustments should be made at intervals of 2 to 4 weeks.

Maintenance dose: 10 to 80 mg orally once a day.

Usual Pediatric Dose for Heterozygous Familial Hypercholesterolemia

10 to 17 years:
10 mg per day (max dose is 20 mg per day). Adjustments should be made at intervals of 4 weeks or more.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

Atorvastatin is contraindicated in patients with active liver disease or with unexplained elevation of liver function enzyme levels.

Dose Adjustments

Adjustments in dosage should be made in intervals of 2 to 4 weeks.

In patients taking the HIV protease inhibitor nelfinavir or the hepatitis C protease inhibitor boceprevir, the dose of atorvastatin should not exceed 40 mg and monitoring is recommended.

Dialysis

Hemodialysis is not expected to significantly enhance clearance of atorvastatin
since the drug is extensively bound to plasma proteins.

Other Comments

Cholesterol levels should be monitored periodically with consideration given to reducing the dosage if cholesterol levels fall significantly below the targeted range.

Atorvastatin may be taken without regard to meals.

It has been suggested that prior to initiating statin therapy, all patients should have a baseline serum creatine kinase (CK) enzyme level measured and if at any time after initiating therapy a patient complains of muscle soreness, tenderness, or pain another CK level should be drawn for comparison. If elevated, the drug should be discontinued.

The results of one study indicate that withdrawal of HMG-CoA reductase inhibitors (statins; atorvastatin, fluvastatin, pravastatin, simvastatin) during the perioperative period in patients with acute coronary syndromes is associated with an increased risk for perioperative adverse cardiac events (i.e., increase postoperative troponin release and the combination of myocardial infarction and cardiovascular death). Patients receiving statins with extended-release formulations (i.e., fluvastatin) appeared to be associated with more favorable outcomes. Other studies appear to confirm these findings.

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