Lipid-Lowering Pregnancy: Contraindicated during pregnancy and breast-feeding. Women of child-bearing potential should use appropriate contraceptive measures; suspend treatment for the duration of pregnancy.

Atorvastatin

Brand names: Lipitor

Used in: Acute Coronary Syndrome & Chest Pain Stroke & TIA

Atorvastatin is a statin used to lower LDL-cholesterol for the primary and secondary prevention of cardiovascular disease.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 10 mg once daily (usual starting dose); range 10 mg to 80 mg once daily

Route: Oral

Frequency: Once daily

Max: 80 mg once daily

Dose individualised according to baseline LDL-C, goal of therapy and patient response; adjust at intervals of 4 weeks or more. Primary hypercholesterolaemia and combined (mixed) hyperlipidaemia: majority controlled with 10 mg once daily. Heterozygous familial hypercholesterolaemia: start 10 mg daily, adjust every 4 weeks to 40 mg daily, then increase to a maximum of 80 mg daily or combine a bile acid sequestrant with 40 mg once daily. Homozygous familial hypercholesterolaemia: 10 to 80 mg daily as adjunct to other lipid-lowering treatments. Prevention of cardiovascular disease: 10 mg/day in primary prevention trials; higher doses may be needed to attain cholesterol targets. May be taken at any time of day with or without food. Do not exceed 20 mg/day with elbasvir/grazoprevir or letermovir.

Dose adjustments

Renal

No adjustment of dose is required.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Take orally once daily with or without food ( 2.1 ). Assess LDL-C when clinically appropriate, as early as 4 weeks after initiating atorvastatin calcium tablets, and adjust dosage if necessary ( 2.1 ). Adults ( 2.2 ): Recommended starting dosage is 10 or 20 mg once daily; dosage range is 10 mg to 80 mg once daily. Patients requiring LDL-C reduction >45% may start at 40 mg once daily. Pediatric Patients Aged 10 Years of Age and Older with HeFH: Recommended starting dosage is 10 mg once daily; dosage range is 10 to 20 mg once daily ( 2.3 ). Pediatric Patients Aged 10 Years of Age and Older with HoFH: Recommended starting dosage is 10 to 20 mg once daily; dosage range is 10 to 80 mg once daily …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-08-28. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Active liver disease or unexplained persistent elevations of serum transaminases exceeding 3 times the upper limit of normal
Pregnancy, breast-feeding, and women of child-bearing potential not using appropriate contraceptive measures
Treatment with the hepatitis C antivirals glecaprevir/pibrentasvir

Side effects

Nasopharyngitis
Headache
Constipation, flatulence, dyspepsia, nausea, diarrhoea
Myalgia, arthralgia, pain in extremity, muscle spasms, back pain
Hyperglycaemia

Interactions

Elbasvir/grazoprevir or letermovir: do not exceed atorvastatin 20 mg/day
Letermovir co-administered with ciclosporin: use of atorvastatin not recommended
Glecaprevir/pibrentasvir: contraindicated
CYP3A4 and transporter (OATP1B1/1B3, P-gp, BCRP) inhibitors: increased atorvastatin exposure and risk of myopathy/rhabdomyolysis

Clinical monograph

How it works

It competitively inhibits HMG-CoA reductase, the rate-limiting enzyme of hepatic cholesterol synthesis, upregulating LDL receptors and lowering circulating LDL-cholesterol; it also has plaque-stabilising effects.

Prescribing in practice

Owing to its long half-life it can be taken at any time of day.
Check baseline liver enzymes and a lipid profile, and reassess lipids to gauge response.
Ask about muscle symptoms; measure creatine kinase if significant myalgia occurs and review interacting drugs.
Avoid in pregnancy; several drugs (e.g. some macrolides and azole antifungals) raise the risk of myopathy.

Monitoring

Check LFTs at baseline and as clinically indicated; assess the lipid response (e.g. non-HDL cholesterol reduction) after starting.

Counselling the patient

Can be taken at any time of day, with or without food.
Report unexplained muscle pain, tenderness or weakness.
Continue lifestyle measures, mention new medicines, and avoid if you become pregnant.

Evidence & guidelines

High-intensity statins are recommended for secondary prevention and for primary prevention above a risk threshold (e.g. QRISK ≥10%) per NICE NG238.

Reference: NICE NG238 Lipid Modification; HPS Trial Lancet 2002; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways