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HMG-CoA Reductase Inhibitor (Statin) Pregnancy: X

Atorvastatin

Brand names: Lipitor

Adult dose

Dose: 10–80 mg once daily (usually 20–80 mg for high CV risk); 10–20 mg for primary prevention
Route: oral
Frequency: once daily
Max: 80 mg/day
Can be taken at any time (unlike some other statins); high-intensity statin therapy: 40–80 mg; no need to avoid grapefruit if moderate amounts

Paediatric dose

Route: oral
Frequency: once daily
Max: 20 mg/day (age 10–17)
Familial hypercholesterolaemia: ≥10 years: 10 mg once daily, titrate to max 20 mg; specialist initiation

Dose adjustments

Renal

No dose adjustment required

Hepatic

Contraindicated in active liver disease or unexplained persistent elevated LFTs

Clinical pearls

  • ASCOT-LLA trial: 36% reduction in MI in hypertensive patients with total cholesterol <6.5 mmol/L
  • High-intensity statin: ≥40% LDL reduction; 80 mg atorvastatin — most potent available in UK
  • CK should be checked before starting if high myopathy risk (elderly, renal impairment, high-dose, drug interactions)

Contraindications

  • Active liver disease
  • Pregnancy
  • Breastfeeding
  • Concurrent potent CYP3A4 inhibitors (ciclosporin — use pravastatin instead)

Side effects

  • Myalgia
  • CK elevation
  • Rhabdomyolysis (rare)
  • Elevated LFTs
  • Headache
  • GI upset
  • Diabetes mellitus (modest risk)

Interactions

  • Ciclosporin (CI — markedly increases levels)
  • Fibrates (especially gemfibrozil — myopathy)
  • Macrolides/azoles (increase levels)
  • Amiodarone (max 20 mg atorvastatin)

Monitoring

  • LFTs (baseline, 3 months, and 12 months)
  • CK (if myopathy symptoms)
  • Lipid profile (3 months after initiation)

Reference: BNFc; BNF 86; NICE NG238; ASCOT-LLA trial. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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