Atorvastatin: what's the right dosage for me?

Heart disease is the leading cause of death in the United States (CDC, 2020). Atorvastatin (brand name Lipitor) is one of the most popular medicines for treating it. 

Atorvastatin (or atorvastatin calcium) is a statin medication (HMG-COA reductase inhibitor) commonly prescribed to manage high cholesterol and prevent cardiovascular disease. Along with lifestyle modifications (changes in diet and exercise habits), atorvastatin is prescribed to help reduce "bad" cholesterol and fats, such as low-density lipoprotein (LDL) and triglycerides. It can also raise your high-density lipoprotein cholesterol (HDL-C) or "good" cholesterol levels in the blood (DailyMed, 2019). 

Other available statins include fluvastatin (brand name Lescol), rosuvastatin (brand name Crestor), lovastatin (brand name Mevacor), pitavastatin (brand name Livalo), pravastatin (brand name Pravachol), and simvastatin (brand name Zocor).

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Generic atorvastatin and brand name Lipitor are both available as an oral tablet taken once per day. Healthcare providers encourage people to embed the medication in their routine: take it at the same time every day (with or without food), take the tablet whole instead of crushed or chewed, and take as prescribed—even if you're feeling healthy (MedlinePlus, 2015).

The effectiveness of the medication depends on the dosage and your response to the drug. The higher the dose of atorvastatin, the more your cholesterol levels go down, but it comes with a higher potential risk of side effects. A standard daily starting dose for adults is usually 10 mg to 20 mg and then progresses to higher doses like 10 mg, 20 mg, 40 mg, or 80 mg daily (FDA, 2017).

Usually, your provider will not increase your dose of atorvastatin more than once every two to four weeks (MedlinePlus, 2015). A higher starting dose may be needed for people who require a larger reduction in low-density lipoprotein (FDA, 2017). 

The pediatric starting dose (children 10-17 years of age) for atorvastatin is usually around 10 mg orally per day, then increases as needed, depending on the individual's goals for therapy and their response to the medication (FDA, 2017).  

Like many medications, doubling a dose to make up for a missed one is not advised. If it's less than 12 hours until the next scheduled dose, skip the missed dose and continue your regular dosing schedule (MedlinePlus, 2015). 

Atorvastatin is commonly used to treat hyperlipidemia, high levels of fats, such as cholesterol and triglycerides, in the blood. Cholesterol is essential because your body uses it to create substances like hormones, bile acids, and vitamin D. 

Triglycerides provide the body with energy (HHS, 2005). High cholesterol can lead to a buildup of plaques in the blood vessel walls, restricting blood flow and increasing the risk of coronary heart disease, myocardial infarction (heart attack), and stroke (Hill, 2020).

Hyperlipidemia is a progressive, life-long disease that cannot be cured; unfortunately, it may not cause any symptoms initially. Healthcare providers sometimes need to rely on routine blood tests and patient history to diagnose or determine the risk of high cholesterol. If hyperlipidemia is left untreated, people can develop heart disease, leading to many problems like heart attacks, strokes, and death. Fortunately, the condition can usually be managed with medication, diet, and lifestyle modifications. 

The American Heart Association says that one of the best ways to lower your cholesterol from a dietary perspective is to decrease the amount of saturated fat and trans fat in your diet. Cutting back on red meat, fried foods, and whole dairy products while emphasizing fruits, vegetables, low-fat dairy, and whole grains can improve your cholesterol (and your overall health) (AHA, 2017).

Exercise is another piece to solving the hyperlipidemia puzzle. Just 2.5 hours, or 150 minutes, per week of walking, running, swimming, or cycling, can lower cholesterol and high blood pressure (AHA, 2017). Smoking cessation can also help you improve your heart health (AHA, 2017). 

Despite all of these lifestyle changes, some people still need a prescription medication like atorvastatin to lower their cholesterol and risk of heart disease. 

Atorvastatin (brand name Lipitor) is FDA-approved for the following uses (DailyMed, 2019):

• Reduce total cholesterol and low-density lipoprotein (LDL) levels when used with dietary modifications

• Reduce triglyceride levels when used with dietary modifications

• Raise "good" (HDL) cholesterol levels when used with dietary modifications

• Lower the risk of heart attacks and strokes in people with cardiovascular risk factors, like age, smoking, high blood pressure, diabetes, low HDL ("good" cholesterol), or a family history of early heart disease

• Lower the likelihood of needing revascularization procedures, as well as decreasing the risk of heart attacks and strokes in people with heart disease

• Treat adults with homozygous familial hypercholesterolemia and primary dysbetalipoproteinemia, genetic disorders that cause abnormal cholesterol levels

• Treat pediatric patients (aged 10-17 years) with heterozygous familial hypercholesterolemia (a genetic condition where cholesterol cannot be removed from the body normally) 

In clinical trials, the most common side effects of atorvastatin were nasopharyngitis (cold symptoms), joint pain (arthralgia), diarrhea, pain in the arms or legs, and urinary tract infections (FDA, 2017).

Some people will notice muscle pain or weakness shortly after starting atorvastatin, which often goes away within two to three weeks. If you feel that the muscle pain worsens or is accompanied by extreme tiredness, dark-colored urine, or a fever, you may have a serious condition called rhabdomyolysis. Rhabdomyolysis is a rare adverse effect of muscle breakdown that can lead to kidney disease and, in the worst case, death (Tomaszewski, 2011).

Atorvastatin can cause abnormalities with liver function blood tests (elevated serum transaminases). Your provider may run baseline liver blood tests before starting atorvastatin (McIver, 2020). 

In rare cases, atorvastatin can lead to liver toxicity, liver damage, and liver failure. If you develop fatigue or weakness, dark urine, loss of appetite, stomach pain, or yellowing of your skin or the whites of your eyes, you may have liver problems—seek medical attention right away. 

Atorvastatin (brand name Lipitor) is contraindicated for use in pregnant or nursing women (FDA, 2017). Stop taking atorvastatin if you are trying to become pregnant or become pregnant while on the medication. Atorvastatin should not be given to people with active liver disease. Lastly, people with hypersensitivity or severe allergic reactions to atorvastatin should not take this drug.

Before starting atorvastatin, let your healthcare professional know about any other drugs you are taking, including prescription drugs and over-the-counter medicines, to avoid potential drug interactions. Certain medications, when taken along with atorvastatin, may increase the risk of side effects. Examples include (DailyMed, 2019)

• Antibiotic medicines like clarithromycin 

• Antifungal medications like itraconazole or ketoconazole

• Cyclosporine

• ​Niacin

• Birth control pills

• Fibrates like gemfibrozil 

• Heart medications like digoxin

• Protease inhibitor drugs to treat HIV/AIDS like ritonavir, fosamprenavir, tipranavir, lopinavir, or saquinavir

• Colchicine

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Current version

October 08, 2020

Written by

Alexandria Bachert

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.