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Atorvastatin Dosage

Applies to the following strength(s): 10 mg ; 20 mg ; 40 mg ; 80 mg

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for Prevention of Cardiovascular Disease

-Initial dose: 10 mg or 20 mg orally once a day; an initial dose of 40 mg may be used in patients who require a reduction in low density lipoprotein (LDL-C) of more than 45%
-Maintenance dose: 10 mg to 80 mg orally once a day

Comments:
-Following initiation and/or upon titration, lipid levels should be evaluated within 2 to 4 weeks and dosages adjusted accordingly.

Uses:
-In patients without clinically evident coronary heart disease (CHD), but with multiple risk factors for CHD such as age, smoking, hypertension, low HDL-C, or a family history of early CHD, to reduce the risk of myocardial infarction and stroke, and to reduce the risk for revascularization procedures and angina

-In patients with type 2 diabetes, and without clinically evident CHD, but with multiple risk factors for CHD such as retinopathy, albuminuria, smoking, or hypertension, to reduce the risk for myocardial infarction and stroke

-In patients with clinically evident CHD, to reduce the risk of nonfatal myocardial infarction and fatal and nonfatal stroke; to reduce the risk for revascularization procedures; to reduce the risk of hospitalization for CHF; and to reduce the risk of angina

Usual Adult Dose for Homozygous Familial Hypercholesterolemia

10 mg to 80 mg orally once a day

Uses: To reduce total-C and LDL-C in patients with homozygous familial hypercholesterolemia, as an adjunct to other lipid lowering treatment (e.g., LDL apheresis) or if such treatments are unavailable

Usual Adult Dose for Hyperlipidemia

-Initial dose: 10 mg or 20 mg orally once a day; an initial dose of 40 mg may be used in patients who require a reduction in low density lipoprotein (LDL-C) of more than 45%
-Maintenance dose: 10 mg to 80 mg orally once a day

Comments:
-Following initiation and/or upon titration, lipid levels should be evaluated within 2 to 4 weeks and dosages adjusted accordingly.

Uses: As an adjunct to diet in the following conditions: to reduced total cholesterol (total-C), LDL-C, apolipoprotein B (apo B), and triglyceride (TG) levels, and to increase high density lipoprotein (HDL-C) in patients with primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Fredrickson Types IIa and IIb); for the treatment of elevated TG levels (Fredrickson Type IV); and for the treatment of primary dysbetalipoproteinemia (Fredrickson Type III) in patients who do not respond adequately to diet

Usual Adult Dose for Hyperlipoproteinemia Type IIa (Elevated LDL)

-Initial dose: 10 mg or 20 mg orally once a day; an initial dose of 40 mg may be used in patients who require a reduction in low density lipoprotein (LDL-C) of more than 45%
-Maintenance dose: 10 mg to 80 mg orally once a day

Comments:
-Following initiation and/or upon titration, lipid levels should be evaluated within 2 to 4 weeks and dosages adjusted accordingly.

Uses: As an adjunct to diet in the following conditions: to reduced total cholesterol (total-C), LDL-C, apolipoprotein B (apo B), and triglyceride (TG) levels, and to increase high density lipoprotein (HDL-C) in patients with primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Fredrickson Types IIa and IIb); for the treatment of elevated TG levels (Fredrickson Type IV); and for the treatment of primary dysbetalipoproteinemia (Fredrickson Type III) in patients who do not respond adequately to diet

Usual Adult Dose for Hyperlipoproteinemia Type IIb (Elevated LDL + VLDL)

-Initial dose: 10 mg or 20 mg orally once a day; an initial dose of 40 mg may be used in patients who require a reduction in low density lipoprotein (LDL-C) of more than 45%
-Maintenance dose: 10 mg to 80 mg orally once a day

Comments:
-Following initiation and/or upon titration, lipid levels should be evaluated within 2 to 4 weeks and dosages adjusted accordingly.

Uses: As an adjunct to diet in the following conditions: to reduced total cholesterol (total-C), LDL-C, apolipoprotein B (apo B), and triglyceride (TG) levels, and to increase high density lipoprotein (HDL-C) in patients with primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Fredrickson Types IIa and IIb); for the treatment of elevated TG levels (Fredrickson Type IV); and for the treatment of primary dysbetalipoproteinemia (Fredrickson Type III) in patients who do not respond adequately to diet

Usual Adult Dose for Hyperlipoproteinemia Type III (Elevated beta-VLDL + IDL)

-Initial dose: 10 mg or 20 mg orally once a day; an initial dose of 40 mg may be used in patients who require a reduction in low density lipoprotein (LDL-C) of more than 45%
-Maintenance dose: 10 mg to 80 mg orally once a day

Comments:
-Following initiation and/or upon titration, lipid levels should be evaluated within 2 to 4 weeks and dosages adjusted accordingly.

Uses: As an adjunct to diet in the following conditions: to reduced total cholesterol (total-C), LDL-C, apolipoprotein B (apo B), and triglyceride (TG) levels, and to increase high density lipoprotein (HDL-C) in patients with primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Fredrickson Types IIa and IIb); for the treatment of elevated TG levels (Fredrickson Type IV); and for the treatment of primary dysbetalipoproteinemia (Fredrickson Type III) in patients who do not respond adequately to diet

Usual Adult Dose for Hyperlipoproteinemia Type IV (Elevated VLDL)

-Initial dose: 10 mg or 20 mg orally once a day; an initial dose of 40 mg may be used in patients who require a reduction in low density lipoprotein (LDL-C) of more than 45%
-Maintenance dose: 10 mg to 80 mg orally once a day

Comments:
-Following initiation and/or upon titration, lipid levels should be evaluated within 2 to 4 weeks and dosages adjusted accordingly.

Uses: As an adjunct to diet in the following conditions: to reduced total cholesterol (total-C), LDL-C, apolipoprotein B (apo B), and triglyceride (TG) levels, and to increase high density lipoprotein (HDL-C) in patients with primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Fredrickson Types IIa and IIb); for the treatment of elevated TG levels (Fredrickson Type IV); and for the treatment of primary dysbetalipoproteinemia (Fredrickson Type III) in patients who do not respond adequately to diet

Usual Adult Dose for Hypertriglyceridemia

-Initial dose: 10 mg or 20 mg orally once a day; an initial dose of 40 mg may be used in patients who require a reduction in low density lipoprotein (LDL-C) of more than 45%
-Maintenance dose: 10 mg to 80 mg orally once a day

Comments:
-Following initiation and/or upon titration, lipid levels should be evaluated within 2 to 4 weeks and dosages adjusted accordingly.

Uses: As an adjunct to diet in the following conditions: to reduced total cholesterol (total-C), LDL-C, apolipoprotein B (apo B), and triglyceride (TG) levels, and to increase high density lipoprotein (HDL-C) in patients with primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Fredrickson Types IIa and IIb); for the treatment of elevated TG levels (Fredrickson Type IV); and for the treatment of primary dysbetalipoproteinemia (Fredrickson Type III) in patients who do not respond adequately to diet

Usual Adult Dose for Heterozygous Familial Hypercholesterolemia

-Initial dose: 10 mg or 20 mg orally once a day; an initial dose of 40 mg may be used in patients who require a reduction in low density lipoprotein (LDL-C) of more than 45%
-Maintenance dose: 10 mg to 80 mg orally once a day

Comments:
-Following initiation and/or upon titration, lipid levels should be evaluated within 2 to 4 weeks and dosages adjusted accordingly.

Uses: As an adjunct to diet in the following conditions: to reduced total cholesterol (total-C), LDL-C, apolipoprotein B (apo B), and triglyceride (TG) levels, and to increase high density lipoprotein (HDL-C) in patients with primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Fredrickson Types IIa and IIb); for the treatment of elevated TG levels (Fredrickson Type IV); and for the treatment of primary dysbetalipoproteinemia (Fredrickson Type III) in patients who do not respond adequately to diet

Usual Pediatric Dose for Heterozygous Familial Hypercholesterolemia

10 to 17 years: 10 mg orally once a day
-Maximum dose: 20 mg/day

Comments:
-Doses greater than 20 mg/day have not been studied in this patient population.
-Dose adjustments should be made at intervals of 4 weeks or more.

Use: As an adjunct to diet to reduce total-C, LDL-C, and apo B levels in boys and postmenarchal girls, 10 to 17 years of age, with heterozygous familial hypercholesterolemia if after an adequate trial of diet therapy the following findings are present: LDL-C remains 190 mg/dL or greater, or LDL-C remains 160 mg/dL or greater and there is a positive family history of premature cardiovascular disease (CVD) or 2 or more other CVD risk factors are present in the pediatric patient

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Active liver disease (including unexplained persistent elevations in hepatic transaminase levels): Contraindicated

Dose Adjustments

Concomitant lipid lowering therapy:
-This drug may be used with bile acid resins; the combination of HMG-CoA reductase inhibitors (statins) and fibrates should be used with caution.

In patients taking cyclosporine or HIV protease inhibitors (tipranavir plus ritonavir) or the hepatitis C protease inhibitor (telaprevir):
-Avoid use with atorvastatin

In patients with HIV taking lopinavir plus ritonavir:
-Use with caution; lowest effective dose of atorvastatin should be used

Concomitant therapy with clarithromycin, itraconazole, or in patients with HIV taking a combination of saquinavir plus ritonavir, darunavir plus ritonavir, fosamprenavir, or fosamprenavir plus ritonavir:
-Maximum dose: 20 mg/day; appropriate clinical assessment is recommended to ensure the lowest effective dose is employed

Concomitant therapy with the HIV protease inhibitor nelfinavir or the hepatitis C protease inhibitor boceprevir:
-Maximum dose: 40 mg/day; appropriate clinical assessment is recommended to ensure the lowest effective dose is employed

Precautions

Safety and efficacy have not been established in pre-pubertal patients or patients younger than 10 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-May be taken orally once a day at any time, with or without food

General:
-This drug has not been studied in conditions where the major lipoprotein abnormality is elevation of chylomicrons (Fredrickson Types I and V).
-Dosages should be individualized according to patient characteristics, including goals of therapy and response to therapy.
-Drug therapy should only be one component of multiple risk factor intervention in individuals at significantly increased risk for atherosclerotic vascular disease due to hypercholesterolemia; patients should be placed on this drug only when a diet restricted in saturated fat and cholesterol and other nonpharmacologic measures have proven inadequate.
-Patients with CHD or multiple risk factors for CHD may start this drug simultaneously with diet.

Monitoring:
-Hepatic: Measure liver enzyme tests prior to initiating therapy, if signs/symptoms of liver injury occur, and as clinically indicated throughout therapy
-Metabolic: Following initiation or upon titration if this drug, lipid levels should be analyzed within 2 to 4 weeks and the dosage adjusted accordingly; periodic testing of lipid levels should be performed to determine goal attainment

Patient advice:
-Advise patients to report immediately any unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever, or if muscle signs/symptoms persist after discontinuing therapy.
-Patients should talk to their health care provider if they are pregnant, planning to become pregnant, or breastfeeding; this drug is not recommended for use during pregnancy or lactation.
-Counsel patients on the importance of contraceptive methods while taking this drug.
-Patients should be aware that there are a number of potential drug interactions with this drug and they should speak with a healthcare professional before starting any new medications including over the counter medications.

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