HMG-CoA reductase inhibitor (statin)
Atorvastatin
Inhibits HMG-CoA reductase, reducing hepatic cholesterol synthesis, upregulating LDL receptors and lowering LDL cholesterol; also stabilises plaque through pleiotropic anti-inflammatory effects.
Brands
Lipitor · Atorva · Storvas
Adult dosing
Maximum 80 mg/day| Indication | Dose | Route | Frequency |
|---|---|---|---|
| Secondary prevention / ACS (high intensity) | 80 mg | Oral | Once daily |
| Primary prevention | 20 mgMax 80 mg once daily | Oral | Once daily |
| With a CYP3A4 inhibitor | 10-20 mgCap the dose or choose pravastatin | Oral | Once daily |
Older adults: No dose change, but review interacting drugs and muscle symptoms.
Paediatric dosing
Always confirm the weight and the local paediatric formulary| Indication | Dose | Route | Frequency |
|---|---|---|---|
| Heterozygous familial hypercholesterolaemia, 10 years and older | 10 mgMax 20 mg once daily (higher only in specialist care) | Oral | Once daily |
Renal adjustment
Move the slider to the patient's eGFRNo adjustment — biliary elimination
Prefer atorvastatin over rosuvastatin in advanced CKD
- Any eGFRNo adjustment — biliary elimination
Hepatic adjustment
- Active liver disease or ALT above 3× upper limitDo not use
- Stable fatty liverUsual dose; statins are not contraindicated
Practical notes
The things that go wrong at the bedside- Any time of day is acceptable — the half-life is long, unlike simvastatin.
- Check lipids 8-12 weeks after starting or changing dose, aiming for a ≥ 50% LDL reduction.
DrZep structured dosing table (demo dataset, formulary-aligned) · DrZep. Confirm every dose against your local formulary and the patient's weight, renal function and comorbidities.
Indications
- Secondary prevention after ACS, stroke or peripheral arterial disease
- Primary prevention with elevated cardiovascular risk
- Familial hypercholesterolaemia
- Diabetes with additional risk factors
Dosing summary
- High intensity (secondary prevention)
- 40-80 mg once daily
- Moderate intensity
- 10-20 mg once daily
- Target
- LDL reduction ≥ 50% and LDL < 1.4 mmol/L in very high risk
Organ adjustment
Renal
- All stages including dialysis
- No dose adjustment (hepatic elimination); benefit is limited in dialysis patients
Hepatic
- Transaminases < 3× ULN
- May continue with monitoring
- Active liver disease or unexplained persistent transaminases > 3× ULN
- Contraindicated
Monitoring
- 1Lipid profile 8-12 weeks after starting or changing dose
- 2Baseline liver enzymes; recheck if symptomatic
- 3Creatine kinase only if muscle symptoms occur
- 4HbA1c in those at diabetes risk
Contraindications & cautions
Do not use / use with care
- Active liver disease
- Pregnancy and breastfeeding
- Previous statin-related rhabdomyolysis
Pregnancy & lactation
- Pregnancy
- Avoid; stop before conception. Recent regulatory reviews are less absolute, but discontinue unless a specialist advises otherwise.
- Lactation
- Avoid.
Interactions
- Clarithromycin, itraconazole, ritonavir (CYP3A4 inhibitors)Raised statin levels and myopathy riskmajor
- CiclosporinMarkedly raised atorvastatin exposuremajor
- GemfibrozilRhabdomyolysis risk — avoid the combinationmajor
- Grapefruit juice (large quantities)Increased exposuremoderate
- Amiodarone, diltiazem, verapamilIncreased statin levels — consider a lower dosemoderate
Adverse effects
Common
- Myalgia
- Headache
- Dyspepsia
- Mild transaminase elevation
Serious
- Rhabdomyolysis
- Immune-mediated necrotising myopathy
- Hepatotoxicity
- Small increase in new-onset diabetes
Toxicity & overdose
Recognise and treat
- Rhabdomyolysis: proximal myalgia, weakness, dark urine, CK > 10× ULN — stop the statin, hydrate and monitor renal function and potassium
Alternatives
- Rosuvastatin
- Ezetimibe (add-on or intolerance)
- PCSK9 inhibitor or inclisiran
- Bempedoic acid
Linked diseases & guidelines
ESC Guidelines for the management of acute coronary syndromes
Single unified ACS guideline covering STEMI and NSTE-ACS: reperfusion timing, antithrombotic strategy and secondary prevention.
European Society of CardiologyEurope2023
AHA/ASA Guidelines for the Early Management of Acute Ischemic Stroke
Time-critical thrombolysis and thrombectomy windows, imaging selection and early secondary prevention.
American Heart Association / American Stroke AssociationUSA2019
ADA Standards of Care in Diabetes
Annual standards for diagnosis, glycaemic targets, pharmacologic sequencing and complication screening.
American Diabetes AssociationUSA2025
Demo monograph for educational use. Always confirm dose, route and interactions against your national formulary and the product label before prescribing.
Demo content. Educational decision support only. Verify every dose, citation and recommendation against your national formulary and the primary source before clinical use.