Liquid Suspension Statin Options for Patients Requiring This Formulation
Atorvastatin oral suspension (0.4% w/v) can be compounded extemporaneously using either commercial tablets or pure atorvastatin calcium powder for patients who require a liquid formulation. 1
Compounding Options for Liquid Statin Formulations
Atorvastatin Suspension
- Can be prepared as a 0.4% w/v suspension using either:
- Commercial atorvastatin tablets (preferred option due to better dissolution profile)
- Pure atorvastatin calcium powder 1
- The compounded suspension shows good stability and remains free from microbial contamination during the period of use
- pH remains stable around 9.9 throughout the storage period
Clinical Considerations for Liquid Statin Use
Indications
- Patients with dysphagia or swallowing difficulties
- Patients with feeding tubes
- Patients unable to take solid oral dosage forms 1
Dosing Recommendations
- Initial dosing should follow standard atorvastatin recommendations:
- 10-20 mg daily for most patients requiring statin therapy
- 5-10 mg daily (moderate-intensity) for patients over 40 years without ASCVD
- 20 mg daily (high-intensity) for patients with established ASCVD or high risk 2
- For ischemic stroke and TIA patients without cardioembolic mechanism and LDL-C >2.5 mmol/L (>100 mg/dL), atorvastatin 80 mg is recommended 3
Target LDL-C Goals
- For very high-risk patients: <1.4 mmol/L (55 mg/dL) and ≥50% reduction from baseline 3
- For patients with recurrent atherothrombotic events: <1.0 mmol/L (40 mg/dL) may be considered 3
- For ischemic stroke and TIA patients: <1.8 mmol/L (70 mg/dL) 3
Practical Considerations
Preparation and Storage
- The compounded suspension should be stored properly according to stability data
- Pharmacists can prepare the suspension using commercially available tablets as the source of active ingredient 1
- Complete dissolution of atorvastatin occurs within 30 minutes in the properly compounded suspension
Monitoring
- Check lipid panel 4-12 weeks after initiating therapy to assess response
- For patients with ischemic stroke or TIA on lipid-lowering medications, monitor lipid levels 1-3 months after treatment initiation, followed by assessments every 3-12 months 3
Important Caveats
- Compounded formulations may have different bioavailability compared to commercial tablets
- Stability data should be consulted for appropriate beyond-use dating
- Atorvastatin is insoluble in aqueous solutions of pH 4 and below, which may affect formulation considerations 4
- Patients should be counseled about proper storage and administration of the compounded suspension
- Atorvastatin should not be given when pregnancy is planned, during pregnancy, or during breastfeeding 3
For patients requiring a liquid statin formulation, an extemporaneously compounded atorvastatin suspension represents a viable option that can be prepared by pharmacists using commercially available tablets or pure powder.