What is the dosing regimen for Lipitor (Atorvastatin)?

Atorvastatin (Lipitor) Dosing Guidelines

The recommended starting dose of atorvastatin (Lipitor) is 10-20 mg once daily, with a dosage range of 10-80 mg once daily, taken at any time of day with or without food. 1

Standard Dosing Recommendations

Atorvastatin dosing should be based on the required LDL-cholesterol reduction and cardiovascular risk:

• Initial dosing:

  • 10-20 mg once daily for most patients 1
  • 40 mg once daily for patients requiring >45% LDL-C reduction 1

• Dosage range: 10-80 mg once daily 1

• Dosing by intensity:

  • Low-intensity: Not typically used with atorvastatin
  • Moderate-intensity: 10-20 mg daily (30-50% LDL-C reduction) 2, 3
  • High-intensity: 40-80 mg daily (≥50% LDL-C reduction) 2, 3

Dosing Based on Patient Population

Adults with Cardiovascular Risk

• Primary prevention: 10-20 mg daily for moderate-intensity therapy in adults >40 years with diabetes or elevated ASCVD risk 2
• Secondary prevention: 40-80 mg daily (high-intensity) for patients with established ASCVD 2

Special Populations

• Pediatric patients (10 years and older) with heterozygous familial hypercholesterolemia: 10-20 mg once daily 1
• Pediatric patients (10 years and older) with homozygous familial hypercholesterolemia: 10-80 mg once daily 1
• Elderly patients (>75 years): Consider starting with moderate-intensity therapy (10-20 mg) 3
• Asian patients: May achieve similar LDL-C reductions at lower doses 3

Monitoring and Dose Adjustments

• Assess LDL-C levels 4-12 weeks after initiating therapy to evaluate response 3, 1
• Adjust dosage if necessary based on LDL-C response and tolerability 1
• For patients not achieving target LDL-C levels:
  • Consider uptitration to next dose level if tolerated
  • For very high-risk patients with LDL-C ≥70 mg/dL despite maximum tolerated statin therapy, consider adding ezetimibe 3

Drug Interactions Requiring Dose Adjustments

• Anti-viral medications:

  • With saquinavir plus ritonavir, darunavir plus ritonavir, fosamprenavir, fosamprenavir plus ritonavir, elbasvir plus grazoprevir, or letermovir: Do not exceed 20 mg daily 1
  • With nelfinavir: Do not exceed 40 mg daily 1

• Azole antifungals or macrolide antibiotics:

  • With clarithromycin or itraconazole: Do not exceed 20 mg daily 1

Contraindications

• Acute liver failure or decompensated cirrhosis 1
• Hypersensitivity to atorvastatin or any excipients 1

Important Considerations

• If a dose is missed, patients should not take the missed dose and should resume with the next scheduled dose 1
• Monitor for signs of myopathy and rhabdomyolysis, particularly when using high-intensity dosing 1
• Risk of new-onset diabetes is increased with high-intensity statin therapy (36% relative increase compared to placebo), particularly in patients with risk factors for diabetes 2

By following these evidence-based dosing recommendations, clinicians can optimize the cardiovascular benefits of atorvastatin while minimizing potential adverse effects.