Atorvastatin

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, with additional plaque-stabilising and anti-inflammatory effects.

Prescribing in practice

• Advise patients to report unexplained muscle pain, tenderness or weakness promptly, as statins can rarely cause myopathy or rhabdomyolysis; check creatine kinase if symptoms occur and review interacting drugs.
• It is metabolised by CYP3A4, so interactions with macrolides, azole antifungals, certain calcium-channel blockers and grapefruit juice can raise concentrations and myopathy risk.
• Atorvastatin is contraindicated in active liver disease and in pregnancy and breast-feeding.

Monitoring

Check baseline lipids, liver transaminases and a baseline creatine kinase where indicated, with transaminases rechecked within the first months of treatment per current prescribing references.

Counselling the patient

• Can be taken at any time of day, with or without food.
• Report unexplained muscle pain or weakness.
• Continue a healthy diet and lifestyle alongside treatment.

Evidence & guidelines

Large outcome trials and meta-analyses establish that atorvastatin lowers cardiovascular events across the spectrum of vascular risk, underpinning its use in NICE lipid-modification guidance.