Lipitor dosage, forms, and strengths

Lipitor (generic: atorvastatin) s a commonly used prescription drug used to treat dyslipidemia, a group of diseases involving high levels of cholesterol or triglycerides in the blood. It is most often used to treat high cholesterol. Due to its ability to reduce “bad” cholesterol which contributes to plaques in the arteries, Lipitor is also used to prevent atherosclerotic cardiovascular disease (ASCVD) and cardiovascular events such as a stroke. Lipitor belongs to a class of drugs called HMG-CoA reductase inhibitors, also known as “statins.” Examples of other medications in this drug class include simvastatin, pravastatin, lovastatin, rosuvastatin, pitavastatin, and fluvastatin.

Lipitor was approved by the U.S. Food and Drug Administration (FDA) in 2001. It is a brand-name drug that is also available as a generic drug called atorvastatin. Both are available in tablet form, and dosages will vary based on the medical condition being treated.

Lipitor forms and strengths

• Tablet: 10 mg, 20 mg, 40 mg, 80 mg

Lipitor dosage for hyperlipidemia

The major concern for patients with hyperlipidemia (high cholesterol) is the increased risk for ASCVD brought about by high LDL-C (“bad” cholesterol). Lowering cholesterol is the primary method of lowering ASCVD risk. The specific dose of Lipitor is based on a patient’s calculated risk of developing ASCVD. Risk is calculated based on multiple factors, but cholesterol levels play a major role in determining risk. Very high cholesterol warrants initiation of statin therapy even when no other risk factors for ASCVD are present, and moderately high cholesterol warrants statin therapy if additional risk factors are present. Patients of any age with LDL-C levels greater than or equal to 190 mg/dL should be initiated on a “high intensity” statin regimen. Doses of Lipitor that are 40 mg per day or higher are considered high intensity. Patients with moderately elevated low-density lipoprotein cholesterol (LDL cholesterol) and additional risk factors may only require “moderate intensity,” which corresponds to 10-20 mg of Lipitor per day.

RELATED: Why you should monitor your cholesterol levels

Lipitor dosage for homozygous familial hypercholesterolemia

Homozygous familial hypercholesterolemia, or homozygous FH for short, is a genetic disorder characterized by high levels of LDL cholesterol (“bad” cholesterol). It can result in the early development of ASCVD. There are two types—heterozygous and homozygous—with the latter being more rare and severe. Statin therapies such as Lipitor are the first-line treatment options for patients with this disease, with current guidelines recommending the highest tolerated dose possible for adults. Lower doses such as 10-20 mg may be initiated to ensure patients tolerate Lipitor without experiencing significant joint pain or muscle pain (if not, they may try a different statin drug). The goal is to increase Lipitor to the highest dose possible, with a max dose of 80 mg per day. In most cases, medications in addition to a statin must be used to control cholesterol levels. Examples include ezetimibe, evolocumab, alirocumab, mipomersen, and lomitapide.

Lipitor dosage for hypertriglyceridemia

In adults forty to seventy-five years or older with moderate or severe hypertriglyceridemia and risk for ASCVD of 7.5% or higher, Lipitor may be prescribed, starting at the lower end of the dosage spectrum. The initial starting dose would be the same as the low-intensity dose for high cholesterol: 10-20 mg per day. In patients with high ASCVD risk (20% or higher) or with triglyceride levels of 500 mg/dL or more, additional medications would likely be added to Lipitor to help lower triglyceride levels. Examples include icosapent (Vascepa), niacin, and fenofibrate.

Lipitor dosage for prevention of cardiovascular events

Patients who do not yet have ASCVD, but have risk factors for developing the disease, may require statins for “primary prevention” of ASCVD. Primary prevention is medical intervention taken before a disease ever develops. As mentioned previously, statin treatment is based on patient-specific risk factors such as high cholesterol. However, even with normal cholesterol levels, certain risk factors may necessitate statin treatment. For example, patients aged 40 to 75 with Type 1 or Type 2 diabetes should be placed on moderate-intensity statin therapy, which corresponds to 10-20 mg of Lipitor. If additional risk factors are present, such as high cholesterol, age, and race-based risk factors, or family history of ASCVD, patients may require 40-80 mg of Lipitor. The American Heart Association and American College of Cardiology published a summary of their guidelines for the primary prevention of cardiovascular disease.

Lipitor dosage for atherosclerotic cardiovascular disease

Secondary prevention refers to medical intervention which prevents an established disease from getting worse. Dosing recommendations for secondary prevention in patients with established atherosclerotic cardiovascular disease are found in the American Heart Association/American College of Cardiology 2018 guidelines on the management of blood cholesterol. All patients with ASCVD should be on high-intensity statin therapy. This means patients with ASCVD taking Lipitor should be on 40 – 80 mg per day.

Lipitor dosage for children

• Standard Lipitor dosage for children ages 10 and above: 10-20 mg per day

• Maximum Lipitor dosage for children ages 10 and above: 20 mg per day

The recommended max dose of 80 mg per day for homozygous familial hypercholesterolemia is based on medical literature and is not approved by the FDA or on the Lipitor package label; it is considered an “off-label” indication.

Lipitor dosage for familial hypercholesterolemia

Familial hypercholesterolemia, FH for short, is a genetic disorder characterized by high levels of LDL cholesterol (“bad” cholesterol). It can result in the early development of ASCVD, necessitating cholesterol-lowering medication in children as young as ten years. There are two types—heterozygous and homozygous—with the latter being more rare and severe. 

Lipitor is only approved by the FDA to treat heterozygous FH although it is still used “off-label” to treat homozygous FH. Treatment first consists of lifestyle changes such as exercise and a low-fat, high-fiber diet. The American Heart Association guidelines for treating heterozygous FH recommend that pediatric patients eight years or older with an LDL-C greater than or equal to 160 mg/dL after three months of lifestyle modification should receive statin therapy. 

While some statins, such as pravastatin and pitavastatin, are FDA-approved for children as young as eight years, Lipitor is only approved in patients 10 years or older. Treatment should be initiated at the lowest recommended dose and increased every four weeks according to the LDL-C lowering response and tolerability to side effects.

RELATED: Lipitor side effects and how to avoid them

Lipitor dosage restrictions

Patients who have liver disease, including unexplained elevation in liver enzymes, should not take Lipitor.

You should not take Lipitor (or the generic version, atorvastatin) if you have had an allergic reaction (rash, hives, swelling of the face or throat) to the active ingredient or any component of Lipitor or atorvastatin tablets in the past.

Lipitor should not be used in pregnant women. There is a known potential for fetal harm based on human data, specifically for congenital heart defects and spontaneous abortion. Risk is highest during the first trimester, but the potential for fetal harm exists when taking Lipitor at any stage of pregnancy.

In patients taking cyclosporine, therapy should be limited to 10 mg once daily. In patients taking clarithromycin, itraconazole, or patients with HIV taking a combination of ritonavir plus saquinavir or lopinavir plus ritonavir, clinical assessment is recommended if the dose exceeds 20 mg of Lipitor, to ensure the lowest dose necessary is being used.

How to take Lipitor

• Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.

• Take this medicine at the same time each day. Take with or without food.

• Swallow the tablet whole. Do not break, crush, or chew it.

• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Lipitor dosage FAQs

How long does it take Lipitor to work?

Lipitor is absorbed within one to two hours after a dose. Eating food during this time can decrease the absorption of Lipitor, but this does not have any clinical impact. The amount of time it takes to absorb Lipitor does not impact how long it takes to have its clinical effects. In fact, according to Pfizer, the manufacturer of Lipitor, a patient should not expect cholesterol and triglyceride levels to begin decreasing until two weeks after starting treatment.

How long does Lipitor stay in your system?

Healthcare professionals measure the time it takes to eliminate a drug from the body using a metric called a half-life. This is the time it takes the body to get rid of half the amount of drug currently in your system. The half-life of Lipitor is roughly fourteen hours, and it takes five half-lives to completely eliminate Lipitor. As the liver breaks Lipitor down, it continues to have its effect for 20-30 hours. The levels of Lipitor may remain high enough to lower cholesterol for a day or so, and small levels of Lipitor can remain in your system for nearly three days after a dose. However, to maintain levels that are high enough to effectively lower cholesterol and triglycerides, Lipitor generally needs to be taken every day.

Some statins need to be taken at night because they do not remain in the body as long as Lipitor. The enzymes responsible for producing cholesterol in the body are most active at night when dietary intake is low. These shorter-acting statins should be taken at night to ensure they are reducing the amount of cholesterol being produced at night. But since Lipitor has longer effects, it can be taken any time of the day and it will still lower the amount of cholesterol produced during the night.

The liver eliminates Lipitor, so any liver damage or dysfunction can greatly increase the time it takes to eliminate Lipitor. For this reason, patients with severe liver disease should not take Lipitor. Patients with more mild disease may still be able to take lower doses of Lipitor. Other medications may affect the time it takes to eliminate Lipitor, so patients might need to lower their Lipitor dose if they are taking certain medications. Always provide a doctor or pharmacist with a complete list of current medications before starting Lipitor.

What happens if I miss a dose of Lipitor?

Take a dose as soon as you remember. If it is less than 12 hours until your next dose, skip the missed dose and take the next dose at the regular time. Do not make up for a missed dose by taking more than the dose your healthcare provider prescribed.

How long can you take Lipitor?

Lipitor is intended for long-term use. It is normal for patients to take Lipitor for many years. Lipitor is a statin. Many of the cardiovascular health benefits of statins require regular use of the drug for a long period of time. For example, the American College of Cardiology and American Heart Association recommends that all adults over 40 years of age consider starting therapy with Lipitor or another statin if their risk for atherosclerotic cardiovascular disease (ASCVD) is 5% or greater. You can calculate your risk for ASCVD here. Patients who already have atherosclerotic cardiovascular disease should remain on treatment indefinitely.

What is the maximum dosage for Lipitor?

The maximum dosage for Lipitor is 80 mg per day. However, patients taking cyclosporine should not take more than 10 mg per day, according to the manufacturer’s product label. Patients taking clarithromycin, cobicistat, itraconazole, darunavir plus ritonavir, fosamprenavir, or saquinavir plus ritonavir should not take Lipitor doses greater than 20 mg per day. Patients taking the HIV medication nelfinavir should not take doses of Lipitor greater than 40 mg per day. Generally, pediatric patients (10-17 years old) should not take more than 20 mg per day.

Can you overdose on Lipitor?

Taking too much Lipitor increases the risk for statin toxicity, which includes liver damage, increased potassium levels, diarrhea, peripheral neuropathy, Type 2 diabetes mellitus, and muscle damage. In cases of significant overdoses, muscle damage (rhabdomyolysis) can cause muscle pain (myopathy), fever, liver damage, kidney failure, and even death. Signs of kidney damage include dark urine. Liver damage may manifest as a yellow tint to the whites of the eyes or skin (jaundice). If you suspect an acute Lipitor overdose call Poison Control at 1-800-222-1222.

What interacts with Lipitor?

The liver clears Lipitor cleared from the body. CYP3A4 is a liver enzyme that helps break down the drug so it can be removed. However, other medications can lower the activity of this enzyme, which means that Lipitor levels will be higher in patients taking these medications. This must be accounted for by your doctor when determining an appropriate dose of Lipitor. Medications likely to have this interaction with Lipitor include HIV medications, certain antibiotics, antifungals, and cyclosporine. Specific examples include:

• Cobicistat

• Clarithromycin

• Cyclosporine

• Erythromycin

• Grapefruit juice

• HIV antivirals (protease inhibitors)

• Itraconazole

• Ketoconazole

• Posaconazole

• Voriconazole

P-glycoprotein, or “PGP'', is another protein that helps the liver and kidneys remove drugs from the body. Because Lipitor is a drug that relies on the removal of this protein from the body, certain drugs that affect this protein can also affect the levels of Lipitor. Examples of these medications that may necessitate a change in Lipitor dosages include:

• Colchicine

• Cyclosporine

• Erythromycin

• Glecaprevir

• Mifepristone

• Pibrentasvir

• Posaconazole

• Propafenone

• Quinine

• Ritonavir

• Tipranavir

• Venetoclax

Conversely, some medications such as rifampin can interact by reducing the levels of Lipitor in the blood, thereby lowering its efficacy.

Finally, Lipitor may increase the levels of other drugs or have additive side effects. Examples of drugs that may require discontinuation or changes in dose when taken with atorvastatin include:

• Alprazolam

• Cisapride

• Codeine

• Colchicine

• Cyclosporine

• Eliglustat

• Erythromycin

• Contraceptives containing ethinyl estradiol

• Fedratinib

• Fenofibrate

• Gemfibrozil

• Glecaprevir

• Hydrocodone

• Lonafarnib

• Meperidine

• Methadone

• Niacin

• Contraceptives containing norethindrone

• Oxycodone

• Pibrentasvir

• Propafenone

• Red yeast rice

This is not an exhaustive list of all Lipitor drug interactions. It is best to consult with a doctor or pharmacist about potential interactions with other medications you are taking.

What happens when you mix Lipitor and alcohol?

For many people, it is okay to drink alcohol in moderation while using statins. For men, this means two drinks a day, and for women, one drink.

However, certain patients may have a much greater risk of serious side effects when mixing alcohol and Lipitor. Those who drink more excessively, or have a history of heavy drinking, are at risk of experiencing liver problems such as cirrhosis or fatty liver disease. Lipitor may also contribute to liver inflammation in these patients, but more importantly, underlying liver impairment can affect how Lipitor is metabolized in the body. Moderate liver disease can prevent the proper elimination of Lipitor, making it unsafe to use.

Patients without a history of heavy drinking might need to avoid mixing statins with alcohol if they have known liver disease, such as nonalcoholic fatty liver disease. Anyone with known chronic liver disease should avoid alcohol while taking Lipitor.

At the very least, your doctor will probably want to monitor your liver function if you are taking Lipitor and have a history of heavy drinking or known liver disease.

Is it safe to take Lipitor during pregnancy?

It is not safe to use Lipitor during pregnancy, particularly during the first trimester. The U.S. Food and Drug Administration (FDA) categorizes the risk of fetal harm from Lipitor when taken during pregnancy as “category X.” Lipitor increases the risk of heart defects and spontaneous abortions. Use effective birth control to avoid pregnancy while taking Lipitor, and for at least one week after discontinuing therapy. If you do become pregnant while taking Lipitor, stop taking Lipitor immediately and call your doctor.

It is not known whether taking Lipitor during breastfeeding can cause harm to an infant. Limited evidence exists that indicates there is no obvious risk to infants exposed to Lipitor through breast milk. Possible minor adverse reactions such as GI upset and diarrhea may be experienced by the infant. However, because of the lack of safety data, do not use Lipitor while breastfeeding.

Related resources for Lipitor dosages:

• Atorvastatin

• Diagnosis and treatment of heterozygous familial hypercholesterolemia

• Frequently asked questions about Lipitor and cholesterol

• Lipid-lowering and anti-inflammatory benefits of statin therapy: more than meets the plaque

• 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease

• Guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines

• Management of hypertriglyceridemia: common questions and answers