How to use Atorvastatin (Lipitor)

Dosage forms and strengths of Atorvastatin / Lipitor

• Adults and paediatric: The medication (and its generic version) is available in tablet form (oral) at strengths of 10mg, 20mg, 40mg and 80mg.

At what dosages is the medication likely to be prescribed?

The dosage will depend on the patient and the health condition being treated, in general dosage is as follows:

1. Adults

• Hypercholesterolemia / mixed dyslipidaemia (elevated LDL-cholesterol and triglycerides): Dosage may initially be recommended at 10mg to 20mg per day. For patients with higher LDL-cholesterol levels requiring reduction, an initial dosage may be recommended at 40mg per day. A follow-up may be required after 2 to 4 weeks, and necessary dosage adjustments made. 
• Hypertriglyceridemia (elevated triglyceride levels): A recommended initial dosage will likely be at 10mg per day. Lipid level check-ups may be required after 2 to 4 weeks, which may prompt dosage adjustments. Treatment maintenance is recommended at between 10mg and 80mg per day thereafter. 
• Primary dysbetalipoproteinemia (elevated LDL-cholesterol and triglycerides, & low HDL-cholesterol levels): Initial daily dosage recommendations may be low (10mg) and increased as needed following a lipid level check after 2 to 4 weeks. Treatment maintenance dosages can range between 10mg and 80mg per day thereafter, depending on the patient’s needs.
• Homozygous familial hypercholesterolemia (genetic inability to metabolise cholesterol): Dosages (10mg to 80mg per day) will likely depend on the reduction of total cholesterol and LDL-cholesterol levels required. Treatment using Atorvastatin / Lipitor may be recommended in conjunction with LDL apheresis therapy, which separates plasma carrying cholesterol by machine as a means to remove it from the bloodstream.
• Cardiovascular disease (prevention): Patients at high risk of heart attack (myocardial infarction), stroke, angina or who may require revascularisation procedures (such as a coronary artery bypass) can be given dosages as necessary between 10mg and 80mg a day. A doctor will gauge prevention according to primary or secondary risk. Primary prevention is aimed at treating risk at the root cause of a particular condition or disease. Secondary prevention addresses identification of a disease or condition and treatment within its early stages. Lower dosages are more typical of primary prevention treatment, which has been shown to provide significant cholesterol reductions. Secondary prevention may be recommended at higher dosages for effective treatment. Preventative treatment has also been shown to be effective for those with risk factors involving age, smoking habits, high blood pressure (hypertension), a family history of cardiovascular disease, and type 2 diabetes (with signs of eye problems / retinopathy and kidney dysfunction / albuminuria).

A doctor will cautiously approach medication recommendations when it comes to use with other drugs and substances. Co-administration dosages will depend on the type of medication known to be (or have been) in use and its class. The lowest necessary dosage is normally prescribed, should benefits outweigh risks. A doctor will take care to only prescribe a dosage (normally on the lower end – 10mg to 20mg) that is deemed relatively safe when taken in conjunction with another specific substance.

2. Paediatric (10 to 17 years of age)

• Heterozygous familial hypercholesterolemia: Children at high risk of early cardiovascular disease, and who have not been able to achieve safe levels of cholesterol through diet alone may initially be started off on 10mg per day. Testing may be required at 4-week intervals and dosages adjusted as required. The highest recommended dosage is at 20mg per day (higher dosages have not yet been adequately studied). If a patient is between the ages of 6 and 10, a doctor may consider a treatment dose of 5mg per day, even though this has not been sufficiently researched for safety. Should this not show adequate LDL-cholesterol improvement after 4 weeks, the dosage can be increased to 10mg (the maximum allowance), provided no other adverse reactions occur.

*Average dosages may vary according to multiple factors a doctor determines as necessary for a patient’s specific condition and those which best benefit him/her for effective treatment. Dosage recommendations will be prescribed in accordance with individual patient characteristics, determined goals of treatment and therapy responses.

How to take this medication correctly

The tablet form of this medication is normally required to be taken orally (by mouth) once a day, either with or without food. Each tablet should be swallowed whole when taken and not broken.

It is recommended that Atorvastatin / Lipitor be taken at the same time every day in accordance with the prescription label directions. A patient can thus decide on a morning or evening schedule. Only the prescribed dosage must be taken, and no adjustments should be made by a patient on their own. The taking of more or less of the medication is expressly advised against. 

Atorvastatin is likely to begin working in the body within a matter of hours (1 to 2 hours) once treatment has commenced. With regular scheduled dosing, improvements in overall health are expected to be seen within a week or two. It can take up to 2 weeks for cholesterol and triglyceride levels to show signs of marked improvement. A doctor will be aiming to achieve a target level within 4 weeks of treatment.

Once treatment commences, an initial lipid level check will normally take place after 2 to 4 weeks. Dosages can gradually be increased following the initial weeks of treatment as the body becomes accustomed to the medication and begins to show benefits. Regular / periodic lipid level checks are to be expected during treatment as this is often the best indication for a doctor to assess whether the medication is having the intended effect. A person’s symptoms alone are not the best way to gauge effectiveness of the medication.

Liver enzyme testing may be required should periodic check-ups / follow-ups indicate any signs of liver dysfunction or possible damage. A doctor will actively look for possible signs at each check-up and test as is clinically indicated at any point during treatment with this medication.

A doctor is likely to advise that a patient continue to take their daily dosage even if they begin to feel well. Discontinuation of the medication that is not co-ordinated by a treating doctor isn’t recommended. 

If a patient misses a dose, it should be taken as soon as it is remembered if the period between the previous dosage and the missed one is less than 12 hours. If the previous dosage was taken more than 12 hours prior, a patient should wait until their next scheduled dose time in order to get back to their regular treatment plan. Double dosages (i.e. two which are taken within a 12-hour period) are not recommended should one be missed. 

Atorvastatin / Lipitor is best used in conjunction with healthy adjustments to exercise activity, diet and if necessary, weight control. Medication is also best stored in its original packaging at room temperature, and not exposed to light, heat or moisture.

Treatment dosages may be interrupted (i.e. temporarily stopped) for any of the following reasons:

• It is noted during treatment that a patient has been experiencing uncontrolled seizures.
• A patient develops severely low blood pressure or electrolyte imbalances.
• A patient contracts another illness or infection.
• A patient is admitted to hospital, requires a surgical procedure (including dental procedures) or medical treatment in an emergency. Use of this medication must be disclosed to the relevant treating medical professional/s as soon as possible in these instances. This is important as treatment measures and medications used during a hospitalisation or surgical procedure can potentially interact adversely with Atorvastatin / Lipitor in the body.