Statin initiation
Common statin starting doses with intensity targets and monitoring reminders.
Last reviewed January 5, 2026
Contraindications
- Avoid in active liver disease or unexplained persistent severe transaminase elevation.
- Avoid with contraindicated interacting medications that markedly increase statin toxicity risk.
- Avoid initiation during pregnancy.
Dosing
Atorvastatin
- Starting dose
- 10-20 mg once daily
- Typical titration / target
- 40-80 mg daily for high-intensity
- Monitoring / notes
- Check baseline ALT; repeat if symptomatic.
Rosuvastatin
- Starting dose
- 5-10 mg once daily
- Typical titration / target
- 20-40 mg daily for high-intensity
- Monitoring / notes
- Use lower start in Asian ancestry or renal impairment.
Simvastatin
- Starting dose
- 10-20 mg once daily
- Typical titration / target
- Max 40 mg daily
- Monitoring / notes
- Avoid strong CYP3A4 inhibitors and grapefruit.
| Medication (generic) | Starting dose | Typical titration / target | Monitoring / notes |
|---|---|---|---|
| Atorvastatin | 10-20 mg once daily | 40-80 mg daily for high-intensity | Check baseline ALT; repeat if symptomatic. |
| Rosuvastatin | 5-10 mg once daily | 20-40 mg daily for high-intensity | Use lower start in Asian ancestry or renal impairment. |
| Simvastatin | 10-20 mg once daily | Max 40 mg daily | Avoid strong CYP3A4 inhibitors and grapefruit. |
Renal and hepatic considerations
- Check baseline ALT and review hepatic history before initiation.
- Use conservative starts when renal impairment is present for dose-sensitive agents.
- Review interaction burden (including CYP-mediated interactions) before up-titration.
Pregnancy and lactation cautions
- Statins are generally not used during pregnancy; discontinue and reassess plan if pregnancy is planned or confirmed.
- Provide preconception counseling before long-term therapy in reproductive-age patients.
- Avoid routine statin use during lactation unless specialist-led risk-benefit justification exists.
Monitoring checkpoints
- Recheck lipids 6-12 weeks after initiation or titration.
- Review muscle symptoms and consider CK if severe.
- Reinforce lifestyle interventions alongside medication.
Stop or escalate criteria
- Stop and escalate for suspected rhabdomyolysis, severe myopathy, or significant hepatic injury signals.
- Escalate when LDL targets are not met despite adherence and tolerated dose optimization.
- Escalate early when adverse effects limit evidence-based intensity in high-risk patients.
References
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