Top 300 Pharmacy Drug Cards

ATORVASTATIN: Lipitor, Various

Class: HMG-CoA Reductase Inhibitor

Dosage Forms. Tablet: 10 mg, 20 mg, 40 mg, and 80 mg

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Common FDA Label Indication, Dosing, and Titration.

1. Familial hypercholesterolemia: 10-80 mg po daily with other lipid-lowering therapy

2. Hypercholesterolemia, primary and mixed dyslipidemia: Adults, 10-20 mg po daily, may titrate to 80 mg po daily; Children (boys and postmenarchal girls aged 10-17 y), 10 mg po daily, may titrate to 20 mg po daily

3. Diabetes mellitus type 2, disorder of cardiovascular system, or multiple risk factors for coronary heart disease: 10-20 mg po daily, may titrate to 80 mg po daily

Off-Label Uses.

1. Acute coronary syndrome: 80 mg po daily

MOA. HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. A compensatory increase in LDL receptors, which bind and remove circulating LDL-cholesterol, results. Production of LDL-cholesterol also can decrease because of decreased production of VLDL-cholesterol or increased VLDL; removal by LDL receptors.

Drug Characteristics: Atorvastatin

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Medication Safety Issues: Atorvastatin

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Drug Interactions: Atorvastatin

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Adverse Reactions: Atorvastatin

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Efficacy Monitoring Parameters. Total cholesterol, LDL-cholesterol, and triglycerides levels; HDL-cholesterol levels.

Toxicity Monitoring Parameters. Signs/symptoms of rhabdomyolysis (myalgias, dark urine, arthralgias, fatigue) or hepatotoxicity; LFTs should be performed at baseline, 12 wk after initiation of therapy, and every 6 mo thereafter; serum creatine kinase should be measured in patients experiencing muscle pain and in those receiving other drugs associated with myopathy.

Key Patient Counseling Points. Contact prescriber immediately if pregnancy occurs while taking atorvastatin. Avoid alcohol, grapefruit, and grapefruit juice while taking drug. Atorvastatin does not take the place of lifestyle changes (diet, exercise) to lower cholesterol levels.

Clinical Pearls. Lipid level assessment should be done within 6-8 wk following dose initiation or titration. Statins have been shown to increase risk of diabetes.