Prior to the use of the drug Atoris®, the patient should be transferred to a diet.providing a decrease in the concentration of lipids in the blood, which must be observed during the whole therapy with the drug. Before starting therapy, you should try to achieve control of hypercholesterolemia with exercise and weight loss in obese patients, as well as therapy for the underlying disease.
The drug is taken orally, regardless of food intake. The dose of the drug varies from 10 mg to 80 mg once a day and is selected taking into account the initial concentration of LDL-C, the purpose of therapy and individual therapeutic effect.
The drug Atoris ® can be taken once at any time of the day, but at the same time every day.
Therapeutic effect is observed after two weeks of treatment, and the maximum effect develops in four weeks.
Therefore, dosage should not be changed earlier than four weeks after the start of the drug in the previous dose.
At the beginning of therapy and / or during a dose increase, it is necessary to monitor the concentration of lipids in the blood plasma every 2-4 weeks and adjust the dose accordingly.
Primary (heterozygous hereditary and polygenic) hypercholesterolemia (type IIa) and mixed hyperlipidemia (type IIb)
Treatment begins with a recommended initial dose of 10 mg, which is increased after four weeks, depending on the patient's response. The maximum daily dose is 80 mg.
Homozygous hereditary hypercholesterolemia
The range of doses is the same as for other types of hyperlipidemia.
The initial dose is selected individually depending on the severity of the disease. In most patients with homozygous hereditary hypercholesterolemia, the optimal effect is observed when the drug is used in a daily dose of 80 mg (once). Atoris® is used as adjunctive therapy for other treatments (plasmapheresis) or as a primary treatment if therapy with other methods is not possible.
At patients of advanced age and at patients with diseases of kidneys the dose of preparation Atoris® should not be changed. The renal dysfunction does not affect the concentration of atorvastatin in the blood plasma or the degree of decrease in the concentration of LDL-C in the use of atorvastatin, so a dose change is not required.
Care should be taken in patients with violations of the liver function (due to the delay in the removal of the drug from the body).In such a situation, clinical and laboratory indicators should be closely monitored (regular monitoring of activity of aspartate aminotransferase (ACT) and alanine aminotransferase (ALT)). With a significant increase in the activity of "hepatic" transaminases, the dose of Atoris® should be reduced or treatment should be discontinued.
Use in combination with other medicines
If a simultaneous application with cyclosporine is necessary, the daily dose of Atoris® should not exceed 10 mg.
Recommendations for determining the purpose of treatment.
A. Recommendations of the National Cholesterol Education Program NCEP, USA
Category risk | Target concentration Xc-LDL (mg / dL) | Concentration Xc-LDL, at which recommended change image life (mg / dL) | Concentration of LDL-C, at which it is recommended pharmacotherapy (mg / dL) |
CHD |
|
|
|
or |
|
|
|
risk |
|
| >130 (100- |
development of |
|
| 129 |
CHD | <100 | >100 | is possible |
(10- |
|
| pharmacotherapy * |
summer |
|
|
|
risk> 2 |
|
|
|
0 %) |
|
|
|
more than 2 |
|
| 10-year-old |
factors |
|
| risk of 10- |
|
|
| 20%;>130 |
risk |
|
|
|
| <130 | >130 |
|
(10- |
|
| 10-year-old |
summer |
|
| risk |
risk < |
|
| <10%:>160 |
20 %) |
|
|
|
0-1 |
|
| >190 (160- |
factor | <160 | >160 | 189: |
risk ** |
|
| appoint a drug, decreasing concentration Xs-LDL) |
|
|
* Some experts recommend the use of lipid-lowering drugs,which reduce the concentration of LDL-C, if a change in lifestyle does not lead to a decrease in its concentration to <100 mg / dl. Others prefer drugs that have a predominant effect on Tg and HDL-C, such as a nicotinic acid in lipid-lowering doses and fibrates. The doctor may also postpone the pharmacotherapy in this subgroup.
** In the absence of risk factors or the presence of only 1 risk factor, almost all patients have a 10-year risk of <1%, so its evaluation is not required.
If the target concentration of LDL-C is reached, and the TG concentration is> 200 mg / dL, the secondary goal of the therapy is to lower the cholesterol concentration (excluding HDL-C) to a concentration of 30 mg / dL higher than the target in each risk category.
B. Recommendations of the European Society of Atherosclerosis:
In patients with confirmed diagnosis of IHD and other patients with very high risk ischemic complications treatment is a decrease in concentration Xc-LDL <1,8 mmol / l (or <70 mg / dl) or a decrease in LDL-C level by> 50%.
B. Recommendations of the Russian cardiological society, The National Society for the Study of Atherosclerosis (NOA) and the Russian Society of Cardiosomal rehabilitation and secondary prevention (RosOKR) (V revision 2012):
The optimal values for the levels of Xc-LPS and total cholesterol (OXc) for high-risk patients are: <2.5 mmol / L (or <100 mg / dl) and <4.5 mmol / L (or <175 mg / dL) , respectively, and for patients with a very high risk: <1.8 mmol / L (or <70 mg / dl) and <4 mmol / l (or <150 mg / dl), respectively.