What is the recommended dose of Storvas (Atorvastatin)?

Recommended Dosage of Storvas (Atorvastatin)

The recommended starting dose of Storvas (Atorvastatin) is 10 to 20 mg once daily, with a dosage range of 10 mg to 80 mg once daily depending on the required LDL-C reduction and cardiovascular risk factors. 1

Dosing Guidelines

• Atorvastatin can be taken at any time of day, with or without food 1
• For patients requiring LDL-C reduction greater than 45%, a starting dose of 40 mg daily may be considered 1
• High-intensity statin therapy (atorvastatin 40-80 mg) typically lowers LDL-C levels by ≥50% 2
• Moderate-intensity statin therapy (atorvastatin 10-20 mg) typically lowers LDL-C levels by 30-49% 2

Dose Selection Based on Clinical Scenario

Primary Prevention

• For patients with multiple cardiovascular risk factors but without clinically evident coronary heart disease:
  • Start with 10-20 mg daily 1, 3
  • Titrate based on LDL-C response and treatment goals 2

Secondary Prevention

• For patients with established atherosclerotic cardiovascular disease (ASCVD):
  • High-intensity statin therapy is recommended (atorvastatin 40-80 mg daily) 2
  • Specifically, atorvastatin 80 mg daily is recommended for patients with recent acute coronary syndrome or high cardiovascular risk 2

Special Populations

• Pediatric patients (10 years and older) with heterozygous familial hypercholesterolemia:

  • Starting dose: 10 mg once daily
  • Dosage range: 10-20 mg once daily 1

• Pediatric patients (10 years and older) with homozygous familial hypercholesterolemia:

  • Starting dose: 10-20 mg once daily
  • Dosage range: 10-80 mg once daily 1

Dose Modifications for Drug Interactions

• When used with saquinavir plus ritonavir, darunavir plus ritonavir, fosamprenavir, fosamprenavir plus ritonavir, elbasvir plus grazoprevir, or letermovir:

  • Do not exceed 20 mg once daily 1

• When used with nelfinavir:

  • Do not exceed 40 mg once daily 1

• When used with clarithromycin or itraconazole:

  • Do not exceed 20 mg once daily 1, 2

• When used with cyclosporine:

  • Avoid combination if possible; if used, limit atorvastatin dose 2

Monitoring and Safety

• Assess LDL-C when clinically appropriate, as early as 4 weeks after initiating therapy 1
• Monitor liver function tests initially, approximately 12 weeks after starting therapy, then annually or more frequently if indicated 2
• Evaluate muscle symptoms and creatine kinase (CK) before starting therapy and at follow-up visits 2
• Obtain CK measurement when patients report muscle soreness, tenderness, or pain 2

Common Pitfalls and Considerations

• Atorvastatin is subject to extensive first-pass metabolism, with oral bioavailability of only 14% 4
• The half-life of atorvastatin is approximately 7 hours, allowing for once-daily dosing 4
• Some studies suggest that alternate-day dosing may be effective in selected patients, potentially reducing costs while maintaining efficacy 5, 6
• Caution is needed with drugs metabolized via CYP3A4, fibrates, and in patients at risk for myopathy 2
• Statin therapy should be employed more cautiously in older persons, particularly older thin or frail women 2
• Consider withholding statins during periods of major surgery 2

Remember that the dose should be adjusted based on LDL-C response and treatment goals, with the primary objective of reducing morbidity and mortality from cardiovascular disease.