Adjunct to diet for the reduction of elevated total cholesterol, LDL-cholesterol, apo-B & triglycerides in patients w/ primary hypercholesterolemia, combined (mixed) hyperlipidemia & heterozygous & homozygous familial hypercholesterolemia when response to diet & other nonpharmacological measures are inadequate. Prevention of CV complications, in hypertensive patient (≥40 yr) & dyslipidemia w/ at least 3 risk factor for future CV events eg, LVH, ECG abnormalities, NIDDM, peripheral vascular disease, post-history of cerebrovascular events including TIA ≥3 mth previously, microalbuminaria/proteinuria, smoking (regular smoker w/in the last year of 20 cigarettes or cigards/weel), TC/HDL-C ratio ≥6 & history of CAD event in a 1st degree relative before age 55 (male) or 60 (women). Reduce the risk of fatal CHD & non-fatal MI, stroke & revascularization procedures & angina pectoris. Childn 10-17 yr: Adjunct to diet to reduce total-cholesterol, LDL-cholesterol, apo-B levels in boys & postmenarchal girls, 10-17 yr of age, w/ heterozygous familial hypercholesterolemia if after an adequate trial of diet therapy the following findings are present: LDL-C remains ≥190 mg/dL or ≥160 mg/dL & there is a positive family history of premature CV disease or ≥2 other CVD risk factors.
Recommended starting dose: 10 mg once daily. Usual dosage range: 10-80 mg once daily. Doses may be given any time of the day. Starting & maintenance dosage should be individualized. Primary hypercholesterolemia & combined (mixed) hyperlipidemia 10 mg once daily. Homozygous familial hypercholesterolemia 80 mg. Heterozygous familial hypercholesterolemia in childn 10-17 yr Initially 10 mg daily. Max dose: 20 mg daily. Adjustments should be made at intervals ≥4 wk. Combination w/ cyclosporin, telaprevir, or the combination tipranavir/ritonavir: Dose should not exceed 10 mg.
Hepatic effects: LFTs should be performed prior to initiation of treatment, 12 wk following both the initiation therapy & any evaluation of dose & periodically thereafter. Monitor for creatine phosphokinase & transaminase elevations. Avoid alcohol consumption. Skeletal muscle effects: Myalgia. Increased risk of myopathy in concurrent administration w/ cyclosporine, fibric acid derivatives, erythromycin, niacin or azole antifungals. Not recommended in patients taking letermovir co-administered w/ cyclosporine. Temporary suspension of atorvastatin may be appropriate during fusidic acid therapy. Hemorrhagic stroke. Ensure appropriate diet, exercise & wt reduction in obese patients & treat underlying medical problems before atorvastatin therapy.
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