Atorvastatin (Lipitor)

What it's used for

Lowering LDL ("bad") cholesterol and reducing the risk of heart attack, stroke, and other cardiovascular events — both in people with established heart disease and those at elevated risk.

Typical dosing (adults)

• Starting: 10-20mg once daily (any time of day, with or without food).
• Range: 10-80mg daily based on LDL goals and cardiovascular risk.
• High-intensity: 40-80mg for very high risk or after heart attack.

Key interactions

• Grapefruit juice: moderate — increases drug levels; less dramatic than simvastatin but still worth limiting.
• Certain antifungals (itraconazole, ketoconazole): major — raises statin levels significantly.
• Certain antibiotics (clarithromycin, erythromycin): moderate-major — similar CYP3A4 issue.
• Cyclosporine, HIV protease inhibitors: major — markedly raises levels.
• Gemfibrozil, fenofibrate: moderate — increased muscle toxicity risk.
• Warfarin: moderate — may raise INR.

Common side effects

Muscle aches (most common — affects 5-10% of patients), headache, GI upset, small increase in blood sugar. Rare but serious: rhabdomyolysis (severe muscle breakdown), liver enzyme elevation.

Who should be cautious

• Active liver disease.
• Pregnancy (avoid).
• Heavy alcohol use.
• Existing muscle disease.

What to do if you get muscle aches

Don't stop abruptly without talking to your prescriber. Options include: trying a different statin (rosuvastatin, pravastatin), adjusting dose, alternate-day dosing, or ruling out other causes. Most muscle aches resolve with a change.

What to ask your pharmacist

• Can I drink grapefruit juice at all?
• Should I take CoQ10?
• When will I need my next liver function and cholesterol labs?