Atorvastatin: Uses, Dosage & Side Effects
A potent HMG-CoA reductase inhibitor (statin) used to lower cholesterol levels, reduce triglycerides, and decrease the risk of cardiovascular events including heart attack and stroke
Atorvastatin is a potent HMG-CoA reductase inhibitor (statin) widely prescribed to lower elevated levels of LDL cholesterol (“bad” cholesterol), total cholesterol, apolipoprotein B, and triglycerides, while modestly increasing HDL cholesterol (“good” cholesterol). It is also used to reduce the risk of heart attack, stroke, and cardiovascular death in patients with or at high risk for atherosclerotic cardiovascular disease. Listed on the WHO Model List of Essential Medicines, atorvastatin is one of the most widely prescribed medications worldwide. It requires a prescription and should be used alongside a cholesterol-lowering diet and lifestyle modifications.
Quick Facts: Atorvastatin
Key Takeaways
- Atorvastatin is one of the most potent statins available, capable of reducing LDL cholesterol by up to 50–60% at higher doses, and is used to treat elevated blood lipids and prevent cardiovascular events.
- Unlike some other statins, atorvastatin has a long-acting effect due to active metabolites, so it can be taken at any time of day—not just at bedtime—with or without food.
- The most commonly reported side effect is muscle pain (myalgia); however, in rare cases, serious muscle breakdown (rhabdomyolysis) can occur—seek immediate medical attention for unexplained muscle pain, especially with fever or dark urine.
- Atorvastatin must not be used during pregnancy or breastfeeding, as cholesterol is essential for normal fetal development and statins may cause harm to the unborn baby.
- Several medications can increase atorvastatin levels and the risk of side effects, including ciclosporin, certain antibiotics (erythromycin, clarithromycin), antifungals (ketoconazole, itraconazole), HIV protease inhibitors, and fusidic acid. Always inform your doctor about all medications you are taking.
What Is Atorvastatin and What Is It Used For?
Atorvastatin belongs to a class of medications known as HMG-CoA reductase inhibitors, commonly called statins. These drugs work by selectively and competitively inhibiting 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, the rate-limiting enzyme in the mevalonate pathway responsible for hepatic cholesterol biosynthesis. By reducing cholesterol production in the liver, atorvastatin triggers an upregulation of LDL receptors on the surface of hepatocytes (liver cells), which in turn increases the clearance of LDL cholesterol from the bloodstream.
First approved in the late 1990s, atorvastatin quickly became one of the most prescribed medications in the world. The landmark CARDS (Collaborative Atorvastatin Diabetes Study), ASCOT-LLA (Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm), and TNT (Treating to New Targets) trials demonstrated its ability to significantly reduce cardiovascular events, establishing it as a cornerstone of cardiovascular prevention. It is included on the World Health Organization (WHO) Model List of Essential Medicines and is now widely available as a generic medication in most countries, making it an affordable and accessible treatment option.
Atorvastatin produces clinically meaningful reductions across multiple lipid parameters. At standard doses, it can reduce LDL cholesterol by approximately 35–50%, total cholesterol by 25–45%, triglycerides by 15–33%, and apolipoprotein B by 30–50%. At the maximum dose of 80 mg, LDL reductions of up to 60% have been observed. Additionally, atorvastatin produces modest increases in HDL cholesterol (“good” cholesterol) of approximately 5–10%. These lipid-modifying effects are typically evident within two weeks of starting therapy and reach their maximum effect after approximately four weeks.
Beyond its lipid-lowering properties, atorvastatin is believed to exert beneficial effects on the cardiovascular system through what are known as “pleiotropic effects.” These include improvement of endothelial (blood vessel lining) function, anti-inflammatory effects as measured by reduction in C-reactive protein (CRP) levels, stabilization of atherosclerotic plaques, and antioxidant properties. While the clinical significance of these pleiotropic effects relative to the lipid-lowering effect remains a subject of ongoing research, they may contribute to the overall cardiovascular benefit observed with statin therapy.
Atorvastatin is indicated for several clinical scenarios. For primary hypercholesterolemia and mixed dyslipidemia, it is prescribed when elevated LDL cholesterol, total cholesterol, or triglyceride levels have not responded adequately to dietary modification and lifestyle changes. For cardiovascular risk reduction, atorvastatin is used in patients with established atherosclerotic cardiovascular disease (such as coronary artery disease, peripheral arterial disease, or previous stroke) or those at high cardiovascular risk due to multiple risk factors (such as diabetes, hypertension, smoking, or family history of premature heart disease), even when cholesterol levels may appear within normal ranges. According to the 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias and the ACC/AHA Cholesterol Guidelines, high-intensity statin therapy (atorvastatin 40–80 mg) is recommended for secondary prevention in patients with established cardiovascular disease.
A key pharmacokinetic advantage of atorvastatin over some other statins (such as simvastatin or lovastatin) is its long duration of action. Although the parent compound has a half-life of approximately 14 hours, its active metabolites extend the effective inhibition of HMG-CoA reductase to approximately 20–30 hours. This means that, unlike simvastatin or lovastatin which are typically taken at bedtime to coincide with the body’s peak cholesterol synthesis overnight, atorvastatin can be taken at any time of day with comparable efficacy. This flexibility may improve patient adherence to long-term therapy.
What Should You Know Before Taking Atorvastatin?
Contraindications
There are specific medical conditions and circumstances where atorvastatin must not be used. Understanding these absolute contraindications is essential for patient safety. Do not take atorvastatin if any of the following apply to you:
- Known hypersensitivity: Allergy to atorvastatin or any of the inactive ingredients in the formulation (such as lactose, calcium carbonate, or magnesium stearate).
- Active liver disease: Current liver disease or unexplained, persistent elevations in serum transaminases (liver enzymes) exceeding three times the upper limit of normal.
- Pregnancy: Atorvastatin is strictly contraindicated during pregnancy. Cholesterol and its biosynthetic products are essential for normal fetal development, including synthesis of cell membranes and steroid hormones. Inhibiting cholesterol synthesis may cause fetal harm.
- Breastfeeding: It is not known whether atorvastatin passes into human breast milk, but due to the potential for serious adverse effects in nursing infants, breastfeeding is contraindicated during treatment.
- Women of childbearing potential not using contraception: Reliable contraceptive methods must be used throughout treatment. If you become pregnant, stop atorvastatin immediately and contact your doctor.
- Concurrent use of glekaprevir/pibrentasvir: This combination, used to treat hepatitis C, significantly increases atorvastatin levels and must not be used together.
Warnings and Precautions
In rare cases, atorvastatin can cause a serious condition called rhabdomyolysis—severe muscle breakdown that can lead to kidney failure and can be life-threatening. Stop taking atorvastatin and contact your doctor immediately if you experience unexplained muscle pain, tenderness, weakness, or cramping, especially if accompanied by fever, dark brown urine, or general malaise. The risk is increased when atorvastatin is combined with certain other medications (see Drug Interactions section).
Atorvastatin requires careful use and medical monitoring in several circumstances. Talk to your doctor, pharmacist, or nurse before taking atorvastatin if any of the following apply:
- Severe respiratory problems: If you have severe breathing difficulties, medical supervision is recommended during atorvastatin therapy.
- Recent or concurrent fusidic acid use: If you are taking or have taken fusidic acid (an antibiotic) by mouth or injection within the last 7 days, the combination with atorvastatin can lead to serious muscle problems including rhabdomyolysis. Do not take atorvastatin during fusidic acid therapy.
- Previous stroke with cerebral hemorrhage: Or if you have small pockets of fluid in the brain from previous strokes, there may be an increased risk of further cerebral hemorrhage.
- Kidney problems: Although atorvastatin is primarily metabolized by the liver and does not require dose adjustment for renal impairment alone, kidney disease may increase the risk of muscle-related adverse effects (myopathy and rhabdomyolysis).
- Hypothyroidism (underactive thyroid): Untreated hypothyroidism increases the risk of myopathy. Thyroid function should be assessed and treated before starting statin therapy.
- Personal or family history of muscle problems: A history of hereditary muscular disorders or previous muscle problems with statins or fibrates increases your risk. Your doctor may recommend baseline and periodic creatine kinase (CK) measurements.
- Heavy alcohol consumption: Regular consumption of large amounts of alcohol increases the risk of liver damage. Your doctor may need to monitor liver function more closely.
- History of liver disease: Liver function tests should be performed before starting atorvastatin and periodically during treatment. If significant elevations in liver enzymes occur, your dose may be reduced or the drug discontinued.
- Age over 70 years: Elderly patients may be at increased risk of muscle-related side effects. Your doctor will assess whether the benefits of treatment outweigh the risks.
- Myasthenia gravis or ocular myasthenia: Statins may occasionally worsen or trigger the onset of myasthenia gravis (a condition causing muscle weakness). Inform your doctor if you experience weakness in your arms or legs that worsens with activity, double vision, drooping eyelids, difficulty swallowing, or shortness of breath.
During treatment with atorvastatin, your doctor will monitor you closely if you have diabetes or are at risk of developing diabetes. You are more likely to be at risk if you have high blood sugar and high blood lipid levels, are overweight, or have high blood pressure. Large meta-analyses (including the CTT Collaboration data) have confirmed that statins are associated with a small increase in the risk of new-onset type 2 diabetes, but the cardiovascular benefits of statin therapy far outweigh this risk in the vast majority of patients.
Pregnancy and Breastfeeding
Do not use atorvastatin during pregnancy or if you are trying to become pregnant. Cholesterol and its derivatives are essential components for normal fetal development, including cell membrane synthesis and the production of steroid hormones. Women of childbearing age must use reliable contraception while on atorvastatin. If you discover you are pregnant, stop taking atorvastatin immediately and contact your doctor.
Atorvastatin is classified as absolutely contraindicated in pregnancy by the European Medicines Agency (EMA) and the U.S. Food and Drug Administration (FDA). Although there are limited human data on atorvastatin exposure during pregnancy, the theoretical risk of disrupting cholesterol biosynthesis in the developing fetus is considered significant. Animal studies have shown adverse developmental effects at high doses, and the drug class as a whole carries a clear contraindication in pregnancy. If a patient on atorvastatin becomes pregnant, the medication should be stopped immediately. The temporary discontinuation of lipid-lowering therapy during pregnancy is not expected to affect long-term cardiovascular outcomes, as elevated cholesterol during pregnancy is a normal physiological response.
Breastfeeding is also contraindicated during atorvastatin treatment. Although it is not definitively established whether atorvastatin is excreted in human breast milk, rat studies have demonstrated that drug concentrations in milk are similar to those in plasma. Given the potential for serious adverse reactions in nursing infants, the decision must be made either to discontinue breastfeeding or to discontinue atorvastatin, taking into account the importance of the drug to the mother. For most patients, statin therapy can be deferred until after breastfeeding is completed.
Driving and Operating Machinery
Atorvastatin is not normally expected to affect your ability to drive or operate machinery. However, some patients may experience dizziness as a side effect, which could potentially impair these abilities. If you notice that your ability to concentrate or react is affected while taking atorvastatin, you should not drive or use tools or machinery until you feel able to do so safely. As with all medications, you are responsible for assessing your own fitness to drive.
Important Information About Some Ingredients
Atorvastatin film-coated tablets contain lactose. If your doctor has told you that you have an intolerance to certain sugars, contact your doctor before taking this medication. The tablets also contain very small amounts of sodium (less than 1 mmol or 23 mg per tablet, essentially “sodium-free”) and trace amounts of benzoic acid. These quantities are not expected to cause any clinical effects.
How Does Atorvastatin Interact with Other Drugs?
Atorvastatin is metabolized primarily by the cytochrome P450 3A4 (CYP3A4) enzyme in the liver. This means that any drug that inhibits or induces CYP3A4 can significantly alter atorvastatin blood levels. Additionally, atorvastatin is a substrate for the drug transporter OATP1B1, and inhibitors of this transporter can also increase atorvastatin plasma concentrations. Increased atorvastatin levels raise the risk of serious muscle side effects, including myopathy and rhabdomyolysis. Always inform your doctor, pharmacist, or nurse about all medications you are taking, including prescription drugs, over-the-counter medications, herbal remedies, and dietary supplements.
Major Interactions
| Interacting Drug | Effect | Clinical Advice |
|---|---|---|
| Ciclosporin | Markedly increases atorvastatin levels (up to 7-fold) via inhibition of CYP3A4 and OATP1B1, greatly increasing risk of rhabdomyolysis | Avoid combination. If necessary, atorvastatin dose should not exceed 10 mg daily with close monitoring of muscle symptoms. |
| Glekaprevir / Pibrentasvir | Significantly increases atorvastatin levels through OATP1B1/1B3 inhibition | Contraindicated. Do not use atorvastatin with this hepatitis C combination. |
| Fusidic acid (oral/IV) | Increased risk of rhabdomyolysis when combined with statins, through an unclear mechanism | Temporarily stop atorvastatin during fusidic acid treatment. Restart atorvastatin 7 days after the last dose of fusidic acid. |
| Erythromycin, Clarithromycin, Telithromycin | CYP3A4 inhibition increases atorvastatin levels, raising the risk of myopathy | Use with caution. Consider lower atorvastatin dose. Temporary statin suspension during short antibiotic courses may be appropriate. |
| Ketoconazole, Itraconazole, Voriconazole, Posaconazole | Potent CYP3A4 inhibitors that can significantly increase atorvastatin exposure and risk of muscle toxicity | Avoid combination where possible. If concomitant use is required, use lowest effective atorvastatin dose with close clinical monitoring. |
| HIV protease inhibitors (Ritonavir, Lopinavir, Atazanavir, Darunavir, Tipranavir) | CYP3A4 and/or OATP1B1 inhibition increases atorvastatin levels substantially (ritonavir can increase exposure 5-fold or more) | Avoid combination where possible. If needed, use the lowest effective atorvastatin dose (max 20 mg) with careful monitoring. |
| Gemfibrozil, Other Fibrates | Fibrates independently increase the risk of myopathy; gemfibrozil also inhibits OATP1B1, increasing statin levels | Avoid gemfibrozil-atorvastatin combination. Other fibrates (fenofibrate) may be combined with caution at the lowest effective statin dose. |
Moderate Interactions
| Interacting Drug | Effect | Clinical Advice |
|---|---|---|
| Diltiazem | Moderate CYP3A4 inhibition increases atorvastatin levels by approximately 40% | Use the lowest effective atorvastatin dose. Monitor for muscle symptoms. |
| Amlodipine | Mild CYP3A4 inhibition; amlodipine 10 mg increases atorvastatin AUC by approximately 18% | Atorvastatin dose should not exceed 40 mg daily when combined with amlodipine. Monitor for side effects. |
| Letermovir | Inhibits OATP1B1/1B3, increasing atorvastatin plasma concentrations | Atorvastatin dose should not exceed 20 mg daily during letermovir co-administration. |
| Elbasvir / Grazoprevir, Ledipasvir / Sofosbuvir | Hepatitis C antivirals that can increase atorvastatin exposure through transporter inhibition | Atorvastatin dose should not exceed 20 mg daily. Monitor for muscle symptoms. |
| Warfarin | Atorvastatin may slightly decrease warfarin clearance, modestly increasing INR at the start of therapy | Monitor INR closely when starting, stopping, or changing atorvastatin dose. Warfarin dose adjustment may be needed. |
| Oral contraceptives | Atorvastatin can increase the plasma concentrations of norethisterone and ethinyl estradiol | Consider this when selecting oral contraceptive doses. No specific dose change usually needed. |
| Colchicine | Both drugs independently carry a risk of myopathy; combination may increase this risk | Use with caution. Monitor closely for signs of muscle problems. |
| Daptomycin | Both drugs can cause myopathy; combination may increase the risk of muscle damage | Consider temporarily suspending atorvastatin during daptomycin treatment. |
| Rifampicin | A potent CYP3A4 inducer that can decrease atorvastatin levels, potentially reducing its efficacy | Simultaneous co-administration is recommended (rather than staggered dosing). Monitor lipid levels. |
| St. John’s Wort (Hypericum) | Herbal CYP3A4 inducer that may reduce atorvastatin effectiveness | Avoid concomitant use. If used, monitor lipid levels and consider dose adjustment. |
Food and Beverage Interactions
Grapefruit juice contains compounds called furanocoumarins that inhibit CYP3A4 in the intestinal wall, which can increase the absorption and blood levels of atorvastatin. Do not consume more than one or two small glasses of grapefruit juice per day while taking atorvastatin, as large quantities may increase the risk of side effects including muscle problems.
Alcohol: Avoid drinking excessive amounts of alcohol while taking atorvastatin. Heavy alcohol consumption increases the risk of liver damage, and your doctor may decide that atorvastatin is not suitable for you if you regularly consume large quantities of alcohol. Your liver function will need closer monitoring.
What Is the Correct Dosage of Atorvastatin?
Before starting atorvastatin, your doctor will place you on a cholesterol-lowering diet, which you should continue throughout treatment. The dosage of atorvastatin is individualized based on your baseline LDL cholesterol level, your cardiovascular risk profile, your treatment goal, and your response to the medication. Your doctor will adjust the dose at intervals of four weeks or more until the optimal dose is determined.
Adults
Standard Adult Dosing
Starting dose: 10 mg once daily. For patients requiring a larger LDL reduction (more than 45%), treatment may be initiated at 20 mg or 40 mg once daily.
Dose range: 10 mg to 80 mg once daily.
Maximum dose: 80 mg once daily.
Administration: Swallow the tablet whole with water. Can be taken at any time of day, with or without food. Take at the same time each day to maintain a consistent routine.
Dose titration: Your doctor will assess your lipid levels after 2–4 weeks and adjust the dose as needed. The majority of the LDL-lowering effect is seen at 10–20 mg; each doubling of the dose produces an additional 6% reduction in LDL cholesterol (the “rule of 6”).
According to the ESC/EAS and ACC/AHA guidelines, high-intensity statin therapy (atorvastatin 40–80 mg) aims for a 50% or greater reduction in LDL cholesterol and is recommended for patients with established cardiovascular disease or very high cardiovascular risk. Moderate-intensity therapy (atorvastatin 10–20 mg) aims for a 30–49% LDL reduction and is appropriate for primary prevention in patients at moderate to high cardiovascular risk.
Children (10 Years and Older)
Pediatric Dosing (Age 10+)
Starting dose: 10 mg once daily.
Maximum dose: 80 mg once daily (dose adjustments based on clinical response).
Indication: Treatment of heterozygous familial hypercholesterolemia in children aged 10 years and older when diet has been inadequate.
Experience in pediatric patients is limited. Atorvastatin has not been studied in children under 10 years of age, and its use in this age group is not recommended.
Elderly Patients
No dose adjustment is required solely based on age. However, elderly patients may be at greater risk of myopathy due to factors such as reduced renal function, polypharmacy (taking multiple medications), and lower body weight. Standard dosing may be used, but close monitoring for muscle-related side effects is advised, and the lowest effective dose should be considered when initiating therapy in very elderly patients.
Patients with Kidney Problems
Renal impairment does not significantly affect the plasma concentrations or lipid-lowering effects of atorvastatin. No dose adjustment is required for patients with kidney disease. However, renal impairment is a recognized risk factor for myopathy and rhabdomyolysis, so careful monitoring is recommended in patients with significant renal disease.
Missed Dose
If you forget to take a dose, take the next dose at the usual time. Do not take a double dose to make up for a missed one. Missing a single dose of atorvastatin will not significantly impact your overall cholesterol management, as the medication works over time and its benefits are cumulative.
Overdose
There is no specific antidote for atorvastatin overdose. If you take more atorvastatin than prescribed, or if a child accidentally swallows the medication, contact your doctor, hospital emergency department, or poison control center immediately for risk assessment and advice. Treatment is supportive and symptomatic. Because atorvastatin is extensively bound to plasma proteins, hemodialysis is not expected to significantly enhance its clearance from the body.
If You Stop Taking Atorvastatin
If you have questions about this medication or wish to discontinue treatment, consult your doctor or pharmacist. Unlike some cardiovascular medications, there is no medical danger in stopping atorvastatin abruptly (there is no “rebound” effect). However, cholesterol levels will typically return to pretreatment levels within a few weeks after stopping, which may increase your long-term cardiovascular risk. Any decision to stop statin therapy should be made in consultation with your doctor.
What Are the Side Effects of Atorvastatin?
Like all medicines, atorvastatin can cause side effects, although not everyone experiences them. Most side effects are mild and temporary. However, some side effects are serious and require immediate medical attention. The frequency categories below are based on clinical trial data and post-marketing surveillance.
Stop taking atorvastatin and seek emergency medical care if you experience: severe allergic reaction with swelling of the face, tongue, or throat causing difficulty breathing; severe skin peeling and blistering (Stevens-Johnson syndrome or toxic epidermal necrolysis); or unexplained muscle pain, tenderness, or weakness with fever or dark urine, which may indicate rhabdomyolysis. These are rare but potentially life-threatening conditions.
Common Side Effects
May affect up to 1 in 10 people
- Nasopharyngitis (inflammation of the nose and throat), sore throat, nosebleeds
- Allergic reactions (general)
- Increased blood sugar levels (hyperglycemia) – particularly relevant for patients with diabetes who should monitor blood glucose carefully
- Elevated blood creatine kinase (a marker of muscle stress)
- Headache
- Nausea, constipation, flatulence (gas), indigestion, diarrhea
- Joint pain (arthralgia), muscle pain (myalgia), back pain
- Blood test results showing abnormal liver function
Uncommon Side Effects
May affect up to 1 in 100 people
- Loss of appetite (anorexia), weight gain, decreased blood sugar levels
- Nightmares, insomnia (difficulty sleeping)
- Dizziness, numbness or tingling in fingers and toes, reduced sensation of pain or touch, changes in taste, memory loss
- Blurred vision
- Tinnitus (ringing in the ears)
- Vomiting, belching, upper and lower abdominal pain, pancreatitis (inflammation of the pancreas causing stomach pain)
- Hepatitis (liver inflammation)
- Skin rash, itching, hives (urticaria), hair loss
- Neck pain, muscle fatigue
- Tiredness, feeling unwell, weakness, chest pain, swelling (especially in the ankles – edema), elevated temperature
- White blood cells in the urine
Rare Side Effects
May affect up to 1 in 1,000 people
- Severe allergic reaction causing swelling of the face, tongue, and throat, potentially leading to serious difficulty breathing
- Serious skin condition with severe peeling and swelling, blisters on skin, mouth, eyes, and genitals, with fever (Stevens-Johnson syndrome / toxic epidermal necrolysis)
- Rhabdomyolysis – serious muscle breakdown causing muscle weakness, tenderness, pain, or dark urine; may lead to kidney failure and can be life-threatening
- Visual disturbances
- Unexpected bleeding or bruising (may indicate liver involvement)
- Cholestasis (yellowing of the skin and whites of the eyes)
- Tendon injury
- Lichenoid drug eruption (skin/mouth lesions)
- Purplish skin lesions (cutaneous vasculitis – inflammation of blood vessels)
Very Rare Side Effects
May affect up to 1 in 10,000 people
- Severe anaphylactic reaction – sudden wheezing, chest pain, shortness of breath, swelling of eyelids, face, lips, mouth, tongue, or throat, breathing difficulties, collapse
- Hearing loss
- Gynecomastia (breast enlargement in men)
- Lupus-like syndrome (including skin rash, joint problems, and effects on blood cells)
Frequency Not Known
Cannot be estimated from available data
- Persistent muscle weakness (immune-mediated necrotizing myopathy – may not resolve after stopping atorvastatin)
- Myasthenia gravis (generalized muscle weakness, including respiratory muscles) or ocular myasthenia (eye muscle weakness). Contact your doctor if you experience weakness in arms or legs worsening with activity, double vision, drooping eyelids, difficulty swallowing, or breathlessness.
Side Effects Reported with Other Statins
The following additional side effects have been reported with some statins as a class, but not necessarily with atorvastatin specifically:
- Sexual difficulties: Including erectile dysfunction and reduced libido
- Depression: Low mood or emotional changes
- Respiratory problems: Including persistent cough and/or shortness of breath or fever
- New-onset diabetes: This is a recognized statin class effect. You are more likely to develop diabetes if you have elevated blood sugar, high blood lipids, are overweight, or have high blood pressure. Your doctor will monitor you during treatment. Large clinical trials have confirmed that the cardiovascular benefits of statins far outweigh the small increase in diabetes risk for the majority of patients.
If you experience any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed here. You can also report side effects directly to your national medicines regulatory authority. By reporting side effects, you help provide more information on the safety of this medicine.
How Should You Store Atorvastatin?
Keep atorvastatin out of the sight and reach of children at all times. This is especially important as an accidental overdose by a child requires immediate medical evaluation.
Do not use atorvastatin after the expiry date stated on the label and outer carton after “EXP.” The expiry date refers to the last day of that month. Most atorvastatin formulations do not require any special storage conditions and can be kept at room temperature. However, always check the package leaflet of your specific brand for any particular storage requirements.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. These measures help to protect the environment and prevent accidental exposure.
What Does Atorvastatin Contain?
Active Ingredient
The active substance in atorvastatin tablets is atorvastatin, present as atorvastatin calcium trihydrate. This is the chemical form of atorvastatin used in pharmaceutical manufacturing, which is converted to the pharmacologically active form upon dissolution in the body.
- Each 10 mg tablet contains 10 mg atorvastatin (as atorvastatin calcium trihydrate)
- Each 20 mg tablet contains 20 mg atorvastatin (as atorvastatin calcium trihydrate)
- Each 40 mg tablet contains 40 mg atorvastatin (as atorvastatin calcium trihydrate)
- Each 80 mg tablet contains 80 mg atorvastatin (as atorvastatin calcium trihydrate)
Inactive Ingredients (Excipients)
The tablet core typically contains: calcium carbonate, microcrystalline cellulose, lactose monohydrate, croscarmellose sodium, polysorbate 80, hydroxypropyl cellulose, and magnesium stearate.
The film coating typically contains: hypromellose, macrogol (polyethylene glycol), titanium dioxide (E 171), talc, and other film-forming agents. The exact composition of the film coating may vary slightly between different manufacturers and generic brands.
Atorvastatin film-coated tablets are typically white, round tablets. Tablet sizes vary by strength, and different brands may have different markings for identification purposes. The tablets are generally available in blister packs (common sizes include 14, 28, 30, 56, 90, and 100 tablets) or in bottles with a child-resistant cap. Not all pack sizes may be marketed in all countries.
Frequently Asked Questions About Atorvastatin
Atorvastatin is a statin medication primarily used to lower elevated levels of LDL (“bad”) cholesterol and triglycerides in the blood when lifestyle changes and diet alone are insufficient. It is also prescribed to reduce the risk of heart attack, stroke, and other cardiovascular events in patients with or at high risk for cardiovascular disease, even if their cholesterol levels are within normal ranges. Atorvastatin works by inhibiting an enzyme called HMG-CoA reductase in the liver, which plays a central role in cholesterol production.
Yes, muscle pain (myalgia) is one of the most commonly reported side effects of atorvastatin, affecting up to 1 in 10 users. Most cases are mild and manageable. However, in rare instances (less than 1 in 1,000), atorvastatin can cause a serious condition called rhabdomyolysis, which involves severe muscle breakdown that can lead to kidney damage. You should contact your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness, especially if accompanied by fever, dark urine, or general malaise.
You should limit grapefruit juice consumption while taking atorvastatin. Grapefruit juice contains compounds that inhibit the CYP3A4 enzyme in the liver, which is responsible for metabolizing atorvastatin. Drinking large quantities of grapefruit juice can increase atorvastatin blood levels, potentially raising the risk of side effects including muscle problems. Small amounts (one or two small glasses per day) are generally considered acceptable, but discuss this with your doctor.
No, atorvastatin must not be used during pregnancy or breastfeeding. Cholesterol and its derivatives are essential for normal fetal development, and inhibiting cholesterol synthesis with statins may cause harm to the developing baby. Women of childbearing age must use reliable contraception while taking atorvastatin. If you become pregnant while taking atorvastatin, stop the medication immediately and contact your doctor. Treatment can usually be safely resumed after pregnancy and breastfeeding are completed.
Unlike some other statins, atorvastatin can be taken at any time of day, with or without food. This is because atorvastatin has a long half-life (approximately 14 hours, extended to 20–30 hours by active metabolites), meaning it remains effective throughout the day regardless of when it is taken. The most important thing is to take it at the same time each day to maintain consistent blood levels and help establish a routine that supports adherence.
Both atorvastatin and rosuvastatin are potent statins used to lower cholesterol, but they have some differences. Rosuvastatin is generally considered slightly more potent per milligram for LDL reduction and may produce greater increases in HDL cholesterol. Atorvastatin is more effective at lowering triglycerides. Atorvastatin is metabolized by the CYP3A4 enzyme, leading to more drug interactions (including with grapefruit juice), while rosuvastatin has fewer CYP-mediated interactions. Both are effective and well-tolerated; your doctor will choose based on your individual lipid profile and other medications.
References & Sources
This article is based on the following peer-reviewed guidelines, official drug information, and clinical evidence. All medical claims follow the GRADE evidence framework at the highest applicable level.
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About the Medical Editorial Team
This article has been written and reviewed by the iMedic Medical Editorial Team, a multidisciplinary group of licensed healthcare professionals with expertise in cardiology, clinical pharmacology, and internal medicine. Our team follows strict editorial standards based on the GRADE evidence framework, and all content is reviewed against current international guidelines from the WHO, EMA, FDA, BNF, and relevant medical specialty societies.
All medical information is sourced from peer-reviewed clinical trials, systematic reviews, and official prescribing information. We use the GRADE framework to assess the quality of evidence for each claim.
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