Lipitor (Atorvastatin) Indications and Dosage
- hypercholesterolemia
- hyperlipoproteinemia
- hypertriglyceridemia
- myocardial infarction prophylaxis
Lipitor (Atorvastatin) Indications and Dosage
NOTE: Patients receiving atorvastatin therapy should also be placed on a standard cholesterol-lowering diet, and this diet should be continued throughout therapy. Serum lipoprotein concentrations should be determined periodically and dosage adjusted according to individual response and established NCEP treatment guidelines.
For use as an adjunct to diet for the treatment of hypercholesterolemia or hyperlipoproteinemia; for secondary prevention † (myocardial infarction prophylaxis) of ischemic cardiac events in patients with coronary artery disease (CHD); for primary prevention of stroke and myocardial infarction in patients with type 2 diabetes and at least one other CHD risk factor; or for primary prevention to reduce cardiac events in adult patients with multiple risk factors for CHD, but without clinical evidence of CHD:
- To reduce LDL cholesterol, apolipoprotein B, and triglycerides, and/or to increase HDL in patients with primary hypercholesterolemia (heterozygous familial and nonfamilial), mixed dyslipidemia (Types IIa or IIb), Type IV hypertriglyceridemia, or primary dysbetalipoproteinemia (Type III); or to reduce LDL cholesterol in patients with homozygous familial hypercholesterolemia as an adjunct to other lipid-lowering treatments (e.g., LDL apheresis) or when such treatments are unavailable:
NOTE: Clinical outcome trials showing benefits of atorvastatin have been demonstrated in various patient populations including the patients treated for the first several months following acute coronary syndromes (MIRACLE), high-risk hypertensives (ASCOT-LLA), and type 2 diabetics (CARDS trial).
Oral dosage:
Adults: Initially, 10-20 mg PO once daily; may start at 40 mg PO once daily in patients requiring > 45% LDL-reduction. The dosage range is 10-80 mg PO once daily (mean LDL reduction range: 43-60% LDL). Atorvastatin may be administered as a single dose at any time during the day and without regard to meals. After dosage initiation or titration, lipid concentrations should be analyzed within 2-4 weeks. Adjust dosage to attain the target LDL and lipid goals based on the NCEP guidelines.
Elderly: See adult dosage. In general, elderly patients may have an increased cholesterol-lowering response to HMG-CoA reductase inhibitors. The degree of LDL-cholesterol reduction at a given atorvastatin dosage is greater than that seen in younger patient populations.
Adolescents and children >= 10 years, including postmenarchal females: Initially, 10 mg PO once daily. Maximum dosage is 20 mg/day. Atorvastatin is FDA-approved for heterozygous familial hypercholesterolemia in adolescent boys and postmenarchal females. Adjust dosage at intervals >= 4 weeks to attain the target LDL and lipid goals.
Children < 10 years: Safe and effective use has not been established.
Maximum Dosage Limits:
- Adults: 80 mg/day PO.
- Elderly: 80 mg/day PO.
- Adolescents and children >= 10 years: 20 mg/day PO.
- Children < 10 years: Safe and effective use has not been established.
Patients with hepatic impairment:
Not recommended in patients with hepatic disease (see Contraindications).
Patients with renal impairment:
Renal impairment has no influence on atorvastatin plasma concentrations or LDL cholesterol reductions. No dosage adjustments are needed.
Intermittent hemodialysis:
Atorvastatin is highly protein bound and is not likely to be significantly removed by hemodialysis.
† non-FDA-approved indication
[ Last revised: 10/6/2005 8:58:00 PM ]
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