HMG-CoA reductase inhibitor
Atorvastatin
Lipitor · Atorvastatin Krka
High-intensity statin with a long half-life, allowing it to be taken at any time of day unlike simvastatin. Muscle complaints are frequently reported but rarely confirmed in blinded re-challenge.
BOXED WARNING
Rhabdomyolysis is rare but serious. Risk increases at high doses in combination with CYP3A4 inhibitors, fibrates, or impaired renal function.
Dosing in adults
By indicationuppdaterad 2026-08-19
| Indication | Regimen | Comment |
|---|---|---|
| Secondary prevention, very high risk | 40–80 mg orally daily | LDL target < 1,4 mmol/l |
| Primary prevention, high risk | 20–40 mg orally daily | LDL target < 1,8 mmol/l |
| After acute coronary syndrome | 80 mg orally daily from the start | initiate during hospitalisation |
| Statin intolerance | 10 mg every other day, titrate up | evaluate with blinded re-challenge |
Renal impairment
No adjustment; not renally excreted.
Hepatic impairment
Contraindicated in active liver disease and unexplained transaminase elevation.
Children
From 10 years of age in familial hypercholesterolaemia, under paediatric specialist care.
Pitfall
Do not discontinue permanently for myalgia without a re-challenge — most patients who report statin-induced myalgia tolerate the same drug on blinded re-challenge.
Pharmacokinetics
- BIOAVAIL.
- 12 % (high first-pass)
- Vd
- 381 l
- t½
- 14 h (active metabolites 20–30 h)
- PROTEIN BINDING
- > 98 %
- METABOLISM
- CYP3A4
- EXCRETION
- Biliary
- SUBSTRATE
- OATP1B1
- ONSET
- Full lipid effect after 2–4 weeks
Adverse effects by frequency
≥ 10 %
Myalgia, headache, gastrointestinal complaints
1–10 %
Transaminase elevation, sleep disturbance, hyperglycaemia
< 1 %
Rhabdomyolysis, immune-mediated necrotising myopathy, hepatic injury