Atorvastatin

CLINICAL USE

Hyperlipidaemia and hypercholesterolaemia

DOSE IN NORMAL RENAL FUNCTION

10–80 mg daily

PHARMACOKINETICS

  • Molecular weight                           :558.6 (1209.4 as calcium salt)
  • %Protein binding                           :>98
  • %Excreted unchanged in urine     : Negligible
  • Volume of distribution (L/kg)       :381 litres
  • half-life – normal/ESRD (hrs)      :14 (active metabolite 20–30)/Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function
  • <10           : Dose as in normal renal function

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Not dialysed. Dose as in normal renal function
  • HD                     :Not dialysed. Dose as in normal renal function
  • HDF/high flux   :Unknown dialysability. Dose as in normal renal function
  • CAV/VVHD      :Not dialysed. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Antibacterials: erythromycin, clarithromycin or fusidic acid possibly increased risk of myopathy; concentration increased by clarithromycin – do not exceed 20 mg of atorvastatin;1 avoid concomitant use with telithromycin; increased risk of myopathy with daptomycin.
  • Anticoagulants: may transiently reduce anticoagulant effect of warfarin
  • Antifungals: increased risk of myopathy with itraconazole – do not exceed 40 mg of atorvastatin,1 posaconazole and possibly other imidazoles and triazoles – avoid concomitant useAntivirals: increased risk of myopathy with amprenavir, atazanavir, indinavir, lopinavir, nelfinavir, ritonavir or saquinavir; concentration reduced by efavirenz
  • Ciclosporin: increased risk of myopathy – do not exceed 10 mg of atorvastatin.
  • Lipid lowering agents: increased risk of myopathy with fibrates, gemfibrozil (avoid) and nicotinic acid

    ADMINISTRATION

    Reconstition

    Route

    Oral

    Rate of Administration

    Comments

    OTHER INFORMATION

    Rhabdomyolysis with renal dysfunction secondary to myoglobinaemia has been reported with other statins

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