Atorvastatin

UK SPC: Atorvastatin 10 mg film-coated tablets. ELDERLY (this page's focus): efficacy and safety in patients older than 70 using recommended doses are similar to those seen in the general population - no separate elderly dose is specified. In elderly patients (age over 70 years) the necessity of measuring creatine kinase before starting statin treatment should be considered (§4.4, pre-disposing factors for rhabdomyolysis). The patient should be placed on a standard cholesterol-lowering diet before and during treatment. Adjust dose at intervals of 4 weeks or more. Primary hypercholesterolaemia and combined (mixed) hyperlipidaemia: majority of patients controlled on 10 mg once a day; therapeutic response evident within 2 weeks and maximum response usually within 4 weeks. Heterozygous familial hypercholesterolaemia: start 10 mg daily, individualise and adjust every 4 weeks to 40 mg daily, thereafter either 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 an adjunct to other lipid-lowering treatments (e.g. LDL apheresis). Prevention of cardiovascular disease: dose in the primary prevention trials was 10 mg/day; higher doses may be necessary to attain LDL-cholesterol levels per current guidelines. Hepatic impairment: use with caution; contraindicated in active liver disease. SPARCL post-hoc analysis: for patients with prior haemorrhagic stroke or lacunar infarct, the balance of risks and benefits of atorvastatin 80 mg is uncertain. Paediatric: in heterozygous familial hypercholesterolaemia aged 10 years and above the recommended starting dose is 10 mg per day, which may be increased to 80 mg daily according to response and tolerability, with adjustments at intervals of 4 weeks or more; not indicated below 10 years of age. Paediatric use should only be carried out by physicians experienced in paediatric hyperlipidaemia.