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Statin — HMG-CoA Reductase Inhibitor Pregnancy: Contraindicated in pregnancy

Atorvastatin

Brand names: Lipitor

Adult dose

Dose: 10-80 mg once daily
Route: Oral
Frequency: Once daily (evening preferred)
Max: 80 mg/day
NICE NG238: 20 mg atorvastatin for primary prevention; 80 mg for secondary prevention in cardiovascular disease

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: Oral
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion

Dose adjustments

Renal

No dose adjustment required

Hepatic

Contraindicated in active liver disease or unexplained persistent elevated transaminases

Paediatric weight-based calculator

Seek specialist opinion

Clinical pearls

  • In frail elderly patients over 85 or those with limited life expectancy, consider deprescribing statins — absolute risk reduction is small and polypharmacy burden is significant (STOPP criteria v3)
  • Myopathy risk increases with age, renal impairment, hypothyroidism, and high doses — check CK if unexplained muscle pain
  • Atorvastatin is the preferred statin in elderly due to lower interaction potential compared to simvastatin (no CYP3A4 dose ceiling issue with amiodarone)
  • NICE NG238 2023: 20 mg for primary prevention; do not withhold purely on grounds of age

Contraindications

  • Active liver disease
  • Pregnancy and breastfeeding
  • Concomitant use of strong CYP3A4 inhibitors (e.g. clarithromycin, itraconazole)

Side effects

  • Myalgia (most common)
  • Rhabdomyolysis (rare, serious)
  • Elevated transaminases
  • Headache
  • Gastrointestinal upset
  • New-onset diabetes (class effect)

Interactions

  • Ciclosporin (significant increase in atorvastatin levels)
  • Clarithromycin / erythromycin (CYP3A4 inhibitors)
  • Amiodarone (myopathy risk)
  • Colchicine (myopathy risk)
  • Warfarin (modest increase in INR)

Monitoring

  • Lipid profile (3 months after initiation, then annually)
  • LFTs (before starting, at 3 months)
  • CK (if muscle symptoms)

Reference: BNFc; BNF 90; NICE NG238 (Cardiovascular Disease); AGS Beers Criteria 2023; STOPP/START v3. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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