====== Atorvastatin (Lipitor®) ======

<WRAP right 300px>
<WRAP infobox>
^ Drug Overview | {{ :cardio:lipids:atorvastatin.svg |}}|
| Drug Class | [[cardio:lipids:start|Statins]] |
| Mechanism | HMG-CoA Reductase Inhibitor |
| Primary Uses | [[cardio:lipids:ascvd|ASCVD Prevention]]; [[cardio:lipids:hyperlipidemia|Hyperlipidemia]] |
| Route | Oral |
| Dose Range | 10–80 mg daily |
| Intensity | Moderate–High |
| LDL Reduction | 35–60% |
| Metabolism | CYP3A4 |
| Half-life | ~14 hours (active metabolites longer) |
| Elimination | Hepatic |
| Renal Adjustment | No |
| Black Box Warning | No |
| FDA Approval | 1996 |
</WRAP>
</WRAP>

===== Overview =====

Atorvastatin is a high-potency [[cardio:lipids:start|statin]] used for LDL reduction and prevention of atherosclerotic cardiovascular disease.

It is one of the most commonly prescribed statins and has strong outcome data in both primary and secondary prevention.

It is considered a cornerstone therapy in cardiovascular risk reduction.

<WRAP clear></WRAP>

--------------------------------------------------------------------

===== Mechanism of Action =====

Primary Target:
  * HMG-CoA reductase (rate-limiting enzyme in hepatic cholesterol synthesis)

Physiologic Effects:
  * ↓ Hepatic cholesterol production
  * ↑ LDL receptor expression
  * ↑ LDL clearance from circulation

Net Effect:
  * Significant LDL reduction
  * Plaque stabilization
  * Reduced cardiovascular events

LDL reduction is dose-dependent.

--------------------------------------------------------------------

===== Indications =====

  * [[cardio:lipids:hyperlipidemia|Hyperlipidemia]]
  * [[cardio:lipids:ascvd|ASCVD prevention]]
  * Secondary prevention after:
      * [[cardio:ischemia:mi|Myocardial Infarction]]
      * [[cardio:ischemia:stroke|Ischemic Stroke]]
      * [[cardio:ischemia:stable_angina|Stable Angina]]

--------------------------------------------------------------------

===== Dosing =====

Moderate-Intensity:
  * 10–20 mg daily

High-Intensity:
  * 40–80 mg daily

No renal adjustment required.

Dose selection is based on ASCVD risk category.

--------------------------------------------------------------------

===== Adverse Effects =====

Muscle:
  * Myalgias
  * Myositis
  * Rare rhabdomyolysis

Hepatic:
  * Mild ALT elevation

Metabolic:
  * Slight increase in diabetes risk

Risk increases with:
  * High dose
  * CYP3A4 inhibitors
  * Combination with [[cardio:lipids:gemfibrozil|Gemfibrozil]]

--------------------------------------------------------------------

===== Drug Interactions =====

Metabolized by CYP3A4.

Interaction risk with:
  * Macrolide antibiotics
  * Azole antifungals
  * Protease inhibitors
  * Grapefruit juice

Higher myopathy risk when combined with:
  * [[cardio:lipids:fibrates:start|Fibrates]]
  * [[cardio:lipids:niacin|Niacin]]

--------------------------------------------------------------------

===== Monitoring =====

  * Lipid panel (4–12 weeks after initiation)
  * Liver enzymes (baseline; repeat if clinically indicated)
  * Monitor for muscle symptoms

Routine CK monitoring is not required unless symptomatic.

--------------------------------------------------------------------

===== Comparison Within Class =====

Compared to [[cardio:lipids:rosuvastatin|Rosuvastatin]]:

  * Slightly less potent per mg
  * Higher CYP interaction burden
  * More lipophilic

Compared to [[cardio:lipids:pravastatin|Pravastatin]]:

  * More potent
  * Greater LDL reduction
  * More drug interactions

Clinical Role:
  * Excellent first-line high-intensity option

--------------------------------------------------------------------

===== High-Yield Pearls =====

  * Strong outcome data in secondary prevention
  * High-intensity therapy reduces events significantly
  * No renal dosing adjustment
  * CYP3A4 interactions are clinically important
  * Discontinuation increases ASCVD risk

--------------------------------------------------------------------

===== Related =====

  * [[cardio:lipids:start|Statins]]
  * [[cardio:lipids:rosuvastatin|Rosuvastatin]]
  * [[cardio:lipids:ezetimibe|Ezetimibe]]
  * [[cardio:lipids:pcsk9:start|PCSK9 Inhibitors]]
  * [[cardio:intro:start|Cardiovascular Pharmacology]]