Atorvastatin
Brand names: Lipitor
Class: 🧪 Statins
What examiners watch for is whether you can pick atorvastatin 40–80 mg as a high-intensity option for the four ACC/AHA benefit groups: clinical ASCVD, LDL ≥190, diabetes age 40–75, and 10-year ASCVD risk ≥7.5%. Atorvastatin inhibits HMG-CoA reductase, lowers LDL ~50% at high intensity, and reduces cardiovascular events. Unlike simvastatin and lovastatin, atorvastatin is metabolized through CYP3A4 with fewer dangerous interactions and no fixed dose ceiling with amlodipine or diltiazem. The signature side effect is myalgias, occasionally rhabdomyolysis. Statins are contraindicated in pregnancy and active liver disease. Counsel patients to report unexplained muscle pain or dark urine — do not check baseline LFTs and CK routinely.
✅ Indications
Primary + secondary ASCVD prevention, dyslipidemia, familial hypercholesterolemia.
⚙️ Mechanism of Action
HMG-CoA reductase inhibitor.
📏 Dosing
10–80 mg PO QHS (or any time; long t½).
🚫 Contraindications
Active liver disease, pregnancy, lactation, history of rhabdomyolysis with statins.
⚠️ Adverse Effects
Myalgia, ↑ LFTs, rhabdomyolysis (rare), ↑ BG (small), cognitive complaints (controversial).
🔬 Monitoring
Baseline LFTs + lipid panel. Lipid recheck at 4–12 weeks. LFTs only if symptomatic.
💎 Board Pearls
- 🏆 #1 prescribed statin; HIGH-INTENSITY at 40–80 mg (≥50% LDL reduction).
- 🍊 Less grapefruit interaction than simvastatin, but still present at high doses.
- 🌙 Can be taken any time of day (long half-life) — unlike simvastatin (bedtime only).
Practice Questions
Which of the following regimens qualifies as high-intensity statin therapy, defined as lowering LDL-C by at least 50%?
Related Drugs in This Class
- Rosuvastatin — Crestor
- Simvastatin — Zocor
Sources
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