Management of Atorvastatin Overdose (100 mg Total Ingestion)
This ingestion of 100 mg atorvastatin (10 tablets × 10 mg) does not require hospitalization or specific antidotal treatment, as this dose is within the therapeutic range and no specific antidotes exist. 1
Immediate Assessment and Triage
Patients with suspected self-harm should be referred to an emergency department immediately regardless of the amount ingested. 2 If this was an unintentional ingestion without suicidal intent, the patient can be managed with observation at home or brief emergency department evaluation.
The ingested dose of 100 mg is actually a standard therapeutic dose—atorvastatin is FDA-approved for daily dosing from 10-80 mg, with 80 mg being the maximum therapeutic dose used in clinical trials. 3 This ingestion represents only 1.25 times the maximum daily therapeutic dose, making significant toxicity extremely unlikely.
Expected Clinical Course
Patients are unlikely to develop symptoms from this ingestion. 4 In pooled clinical trials of 14,236 patients, atorvastatin 80 mg daily (which is lower than this acute ingestion) showed adverse event rates similar to placebo, with treatment-related myalgia occurring in only 1.5% of patients. 4
The most common adverse effects if any symptoms develop would be:
Monitoring Parameters
No specific laboratory monitoring is required for this acute ingestion. 1 However, if the patient is evaluated in an emergency department, baseline assessment could include:
- Creatine kinase (CK): Baseline measurement only if muscle symptoms develop 6
- Liver transaminases (ALT/AST): Not urgently needed for acute ingestion, as hepatotoxicity occurs with chronic high-dose therapy 6
- Renal function: Not specifically indicated for acute overdose 1
Rhabdomyolysis risk is negligible with this single ingestion. 4 In clinical trials, no cases of rhabdomyolysis were reported even with chronic atorvastatin 80 mg daily use. 4
Treatment Approach
No specific antidotes for atorvastatin exist. 1 Management is supportive only:
- Gastrointestinal decontamination: Not recommended unless presentation is within 1-2 hours of ingestion and only if local protocols support it 2
- Activated charcoal: Could be considered only if <2 hours post-ingestion, though benefit is questionable for this dose 2
- Hemodialysis: Not effective due to extensive plasma protein binding (>98%) 1
Hospitalization Duration
Hospitalization is not required. 1, 4 If the patient presents to an emergency department:
- Observation period: 4-6 hours maximum if asymptomatic 2
- Discharge criteria: Patient remains asymptomatic without muscle pain, weakness, or gastrointestinal symptoms
- Follow-up: Contact poison control or return if symptoms develop within 24-48 hours
For unintentional poisonings, asymptomatic patients are unlikely to develop symptoms if >6 hours have elapsed since ingestion. 7 These patients do not need emergency department referral.
Critical Pitfalls to Avoid
Do not confuse this with high-risk statin overdoses. The concern with statins is chronic high-dose therapy in high-risk populations (elderly, frail, multiple medications, renal disease), not acute single ingestions. 6
Do not routinely check CK levels unless muscle symptoms develop. 6 Asymptomatic CK elevations without clinical myopathy do not require intervention.
Do not delay discharge waiting for laboratory results in asymptomatic patients. 1 The extensive protein binding means atorvastatin effects are delayed and chronic, not acute.
Special Considerations
Contact Poison Control (1-800-222-1222) for latest recommendations and to report the case. 1 This allows for appropriate follow-up and surveillance.
If co-ingestions are suspected (especially other cardiovascular medications, cyclosporine, gemfibrozil, macrolide antibiotics, or azole antifungals), emergency department evaluation is warranted due to increased risk of drug interactions. 3, 6