Section 13 · Monograph
Atorvastatin
Reviewed Nov 2026FDA label
LipitorHMG-CoA reductase inhibitor
- Forms
- Tab: 10, 20, 40, 80mg
- Dose
- Stroke/TIA secondary prevention: 80mg once daily (LDL goal below 70mg/dL)
- MOA
- ↓Hepatic cholesterol synthesis, ↑LDL receptors
Indications
- Reduce risk of stroke, MI and revascularization in adults with multiple CHD risk factorsFDA-labeled
- Hyperlipidemia (reduce LDL-C)FDA-labeled
- Secondary stroke prevention: 80mg daily supported by SPARCL (stroke/TIA without known CHD)FDA-labeled
Mechanism of Action
- HMG-CoA reductase inhibitor decreasing hepatic cholesterol synthesis and increasing LDL receptor uptake
- Pleiotropic anti-inflammatory and endothelial effects
Full Dosing
Adult / usual
- Usual 10-80mg once daily at any time of day
- Stroke/TIA secondary prevention (SPARCL): 80mg daily
- High-intensity: 40-80mg daily
Contraindications
- Acute liver failure or decompensated cirrhosis
- Known hypersensitivity to atorvastatin
Drug Interactions
- Strong CYP3A4 inhibitors (clarithromycin, itraconazole) increase myopathy risk — limit dose
- Cyclosporine and gemfibrozil: avoid
- CYP3A4 inducers (carbamazepine, phenytoin) lower levels
Adverse Effects
- Myalgias
- Rhabdomyolysis (rare)
- Elevated transaminases
- Small increase in new-onset diabetes
- Higher rate of hemorrhagic stroke observed with high-dose therapy in SPARCL
Monitoring Parameters
- Lipid panel 4-12 weeks after starting, then every 3-12 months
- Baseline liver tests and as clinically indicated
- Muscle symptoms (CK if symptomatic)
- Glucose/HbA1c
Pregnancy & Lactation
- FDA removed the blanket pregnancy contraindication in 2021; most patients should stop when pregnancy is recognized, but benefit may outweigh risk in select high-risk patients
- Breastfeeding not recommended