The patient should be placed on a standard cholesterol-lowering diet before receiving
Lipitor and should continue on this diet during treatment with Lipitor.
Hypercholesterolemia (Heterozygous Familial and Nonfamilial) and Mixed
Dyslipidemia (Fredrickson Types IIa and IIb)
The recommended starting dose of Lipitor is 10 or 20 mg once daily. Patients who
require a large reduction in LDL-C (more than 45%) may be started at 40 mg once daily.
The dosage range of Lipitor is 10 to 80 mg once daily. Lipitor can be administered as a
single dose at any time of the day, with or without food. The starting dose and
maintenance doses of Lipitor should be individualized according to patient characteristics
such as goal of therapy and response (see NCEP Guidelines, summarized in Table 5).
After initiation and/or upon titration of Lipitor, lipid levels should be analyzed within 2 to
4 weeks and dosage adjusted accordingly.
Since the goal of treatment is to lower LDL-C, the NCEP recommends that LDL-C levels
be used to initiate and assess treatment response. Only if LDL-C levels are not available,
should total-C be used to monitor therapy.
Heterozygous Familial Hypercholesterolemia in Pediatric Patients (10-17 years of
age)
The recommended starting dose of Lipitor is 10 mg/day; the maximum recommended
dose is 20 mg/day (doses greater than 20 mg have not been studied in this patient
population). Doses should be individualized according to the recommended goal of
therapy (see NCEP Pediatric Panel Guidelines 1
, CLINICAL PHARMACOLOGY, and
INDICATIONS AND USAGE). Adjustments should be made at intervals of 4 weeks or
more.
Homozygous Familial Hypercholesterolemia
The dosage of Lipitor in patients with homozygous FH is 10 to 80 mg daily. Lipitor
should be used as an adjunct to other lipid-lowering treatments (eg, LDL apheresis) in
National Cholesterol Education Program (NCEP): Highlights of the Report of the Expert Panel on Blood
Cholesterol Levels in Children Adolescents, Pediatrics. 89(3):495-501. 1992.
these patients or if such treatments are unavailable.
Concomitant Therapy
Atorvastatin may be used in combination with a bile acid binding resin for additive
effect. The combination of HMG-CoA reductase inhibitors and fibrates should generally
be avoided (see WARNINGS, Skeletal Muscle, and PRECAUTIONS, Drug Interactions
for other drug-drug interactions).
Dosage in Patients With Renal Insufficiency
Renal disease does not affect the plasma concentrations nor LDL-C reduction of
atorvastatin; thus, dosage adjustment in patients with renal dysfunction is not necessary
(see CLINICAL PHARMACOLOGY, Pharmacokinetics).