The LDL goal is to achieve a concentration between 70 and 130 mg/dL. Individual patients may need lower levels of atorvastatin based on their risk factors, such as age and other comorbid conditions. Most patients with heart disease will not be able to attain this level without additional cholesterol-lowering therapies. Often, many medications are used in combination to improve the effectiveness of atorvastatin in lowering total cholesterol (TC) or raising HDL cholesterol (HDLc).
* * *
Plasma concentrations should rarely exceed 300 mg/dL in any situation because it can cause serious side effects including myopathy, peripheral neuropathy, hepatic steatosis, hyponatremia, fluid retention leading to hypertension or congestive heart failure. The average dose ranges from 20–80 mg daily depending on the underlying atherosclerotic cardiovascular disease present in the patient being treated for hypercholesterolemia. Lower doses are generally used for younger people (<55 years), while higher doses are typically needed in older individuals (>55 years). Larger amounts may be required when drugs containing an excess of HMGCoA reductase inhibitors increase plasma levels by inhibiting CYP3A4 enzyme activity—a common occurrence with phenytoin overdose or cyclosporine use—and thus elevating plasma TGs indirectly via inhibition of CYP3A4 enzyme activity. Patients who have had prior episodes that resulted in hospital