Statins · Cardiovascular

Atorvastatin

Lipitor®(brand names vary by market)

A high-intensity statin that shrugs at the clock.

Mechanism

HMG-CoA reductase inhibitor: less hepatic cholesterol synthesis, more LDL-receptor expression, lower circulating LDL.

Tablet

Timing

Long half-life means any time of day works. Unlike short-acting simvastatin's evening rule.

Intensity

Statin doses are chosen by intended LDL reduction (moderate vs high intensity), not titrated to a number alone.

Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.

Bioavailability: ~14% (high first-pass)
Half-life: 14 h (active metabolites ~20-30 h)
Elimination: hepatic: CYP3A4 substrate: the source of its famous interactions

MyalgiacommonTrue statin-associated muscle symptoms are less common than reported; rechallenge and dose strategy usually succeed.
Transaminase elevationcommon
RhabdomyolysisseriousRare; risk climbs with CYP3A4 inhibitors and interacting fibrates.
New diabetes (small excess risk)commonOutweighed by vascular benefit in indicated patients.

Contraindications

Precautions

Lipid panel

Confirms the intended intensity was achieved · Baseline and ~8-12 weeks after start

CK only if significant muscle symptoms

Routine CK surveillance is not useful

ALT at baseline

Routine repetition is not required without symptoms

Any time of day, with or without food.
Report unexplained muscle pain or dark urine, especially after starting a new antibiotic or antifungal.
This is long-term prevention; it works while you take it.

Muscle symptoms with normal CK usually tolerate a washout and careful rechallenge; most patients end up back on a statin.

Atorvastatin product monograph (consult the current version for your market) (monograph)
Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)

Last reviewed 2026-08-15 · jurisdiction: global · drug information changes; verify against current references before practice use.

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