Indications

As an adjunct to diet to reduce elevated total cholesterol, LDL cholesterol, Apolipoprotein B (Apo‑B), and triglycerides when response to diet and other non‑pharmacological measures is inadequate.
To reduce total cholesterol and LDL cholesterol in patients with heterozygous and homozygous familial hypercholesterolemia.
To reduce elevated cholesterol and triglycerides in patients with mixed dyslipidemia (Fredrickson Type IIa and IIb).
For treatment of patients with elevated serum triglycerides in hypertriglyceridemia (Fredrickson Type IV).
For treatment of patients with diabetic dyslipoproteinemia (Fredrickson Type III).
To reduce cardiac ischemic events in patients with asymptomatic or mild to moderate coronary artery disease with elevated LDL cholesterol.
To reduce total and LDL cholesterol in patients with hypercholesterolemia associated with diabetes mellitus or renal transplantation.

Pharmacology Atorvastatin is a selective inhibitor of HMG‑CoA reductase, the rate‑limiting enzyme in cholesterol biosynthesis. It lowers plasma cholesterol and lipoprotein levels by inhibiting hepatic cholesterol synthesis and increasing LDL receptor activity.

Absorption: Rapid after oral administration; peak plasma concentration within 1–2 hours. Bioavailability ~14%.
Distribution: Volume of distribution ~38 L; 90% bound to plasma proteins.
Metabolism: Extensively metabolized by CYP3A4 to active metabolites.
Excretion: Primarily via bile; half‑life ~14 hours, inhibitory activity 20–30 hours. Less than 2% excreted in urine.

Dosage & Administration

Primary hypercholesterolemia/mixed hyperlipidemia: Adults: 10 mg once daily, titrated up to 80 mg. Children (10–17 years): 10 mg once daily, max 20 mg.
Familial hypercholesterolemia: Adults: 10 mg daily, titrated up to 80 mg. Children (10–17 years): 10 mg daily, max 20 mg.
Prevention of cardiovascular events: Adults: 10–20 mg daily, adjusted as needed.

Interactions

Increased risk of myopathy with cyclosporine, fibrates, niacin, erythromycin, antifungals.
Antacids reduce plasma concentration (~35%) but not LDL‑C reduction.
Colestipol reduces plasma concentration (~25%) but enhances LDL‑C reduction.
Digoxin plasma concentration increases ~20%.
Oral contraceptives increase norethindrone and ethinyl estradiol levels.
Warfarin: No significant effect on prothrombin time.

Contraindications

Hypersensitivity to any component.
Active liver disease or unexplained persistent elevation of transaminases.
History of serious adverse reaction to HMG‑CoA reductase inhibitors.

Side Effects Common: Constipation, flatulence, dyspepsia, abdominal pain. Others: Infection, headache, back pain, rash, asthenia, arthralgia, myalgia.

Pregnancy & Lactation Contraindicated during pregnancy and breastfeeding. May cause fetal toxicity; discontinue if pregnancy occurs.