Active substanceAtorvastatinAtorvastatin
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  • Dosage form: & nbspfilm coated tablets
    Composition:

    1 tablet, film-coated, contains:

    dosage of 10 mg

    active substance: atorvastatin calcium in terms of atorvastatin - 10 mg

    auxiliary substances (core): lactose monohydrate (sugar milk) - 62.0 mg; calcium carbonate 33.0 mg; Povidone K 30 (medium-molecular weight polyvinylpyrrolidone) 6.0 mg; croscarmellose sodium(impellosis) - 6.75 mg; sodium stearyl fumarate - 1.5 mg; silicon dioxide colloid (aerosil) - 0.75 mg; microcrystalline cellulose - 30.0 mg;

    auxiliary substances (shell):

    Opadrai II (polyvinyl alcohol, partially hydrolyzed 2.2 mg, macrogol 3350 0.6175 mg, talc 1.0 mg, titanium dioxide E 171 0.9585 mg, soy lecithin E 322 0.175 mg, aluminum lacquer based on indigo carmine dye - 0,003 mg, aluminum varnish based on dye azorubin - 0.0255 mg, aluminum varnish based on dye crimson [Ponso 4R] 0.0205 mg).

    dosage of 20 mg

    active substance: atorvastatin calcium in terms of atorvastatin - 20 mg

    auxiliary substances (core): lactose monohydrate (milk sugar) - 124,0 mg; calcium carbonate - 66.0 mg; povidone K 30 (medium-molecular weight polyvinylpyrrolidone) - 12.0 mg; Croscarmellose sodium (optional) - 13,5 mg; sodium stearyl fumarate 3.0 mg; silicon dioxide colloid (aerosil) - 1.5 mg; microcrystalline cellulose - 60.0 mg;

    auxiliary substances (shell):

    Opadrai II (polyvinyl alcohol, partially hydrolyzed - 3.96 mg, macrogol (polyethylene glycol) 3350 - 1.1115 mg, talc 1.8 mg, titanium dioxide E 171 1.7253 mg, soy lecithin E 322 0.315 mg; aluminum paint based on dyeindigo carmine - 0.0054 mg; Aluminum lacquer based on dye azorubin - 0.0459 mg; Aluminum lacquer based on dye crimson [Ponso 4R] 0.0369 mg).

    dosage of 40 mg

    active substance: atorvastatin calcium in terms of atorvastatin - 40 mg;

    auxiliary substances (core): lactose monohydrate (milk sugar) - 177,5 mg; calcium carbonate - 77.0 mg; povidone K 30 (medium-molecular weight polyvinylpyrrolidone) - 16.0 mg; Croscarmellose sodium (optional) - 124,0 mg; sodium stearyl fumarate 4.0 mg; silicon dioxide colloid (aerosil) - 1.5 mg; cellulose microcrystalline - 70.0 mg;

    auxiliary veins (shell):

    Opadrai II (polyvinyl alcohol, partially hydrolyzed - 5.28 mg, macrogol (polyethylene glycol) 3350 - 1.482 mg, talc - 2.4 mg, titanium dioxide E 171 - 2,3004 mg, soy lecithin E 322 - 0.42 mg; aluminum lacquer based on indigo carmine dye - 0.0072 mg, aluminum varnish based on dye azorubin - 0.0612 mg, aluminum varnish based on dye crimson [Ponso 4R] - 0.0492 mg).

    dosage: 80 mg

    of the active substance: atorvastatin calcium in terms of atorvastatin - 80 mg;

    auxiliary substances (core): lactose monohydrate (sugar milk) - 13.5 mg; calcium carbonate - 115.0 mg; Povidone K 30 (medium-molecular weight polyvinylpyrrolidone) - 24.0 mg; Croscarmellose sodium (optional) - 21,0 mg; sodium stearyl fumarate 6.0 mg; silicon dioxide colloid (aerosil) - 2.5 mg; cellulose microcrystalline - 105.0 mg; auxiliary substances (shell):

    Opadrai II (polyvinyl alcohol, partially hydrolyzed - 7.92 mg, macrogol (polyethylene glycol) 3350 - 2.223 mg, talc - 3.6 mg, titanium dioxide E 171 - 3.4506 mg, soy lecithin E 322 - 0.63 mg; aluminum lacquer based on indigo carmine dye 0.0108 mg, aluminum varnish based on dye azorubin 0.0918 mg, aluminum lacquer based on dye crimson [Ponso 4R] - 0.0738 mg).

    Description:

    The tablets covered with a film cover of pink color, round, biconcave. On the cross section, the core of the tablet is white or almost white in color.

    Pharmacotherapeutic group:Hypolipidemic agent - inhibitor of HMG-CoA reductase
    ATX: & nbsp

    C.10.A.A   Inhibitors of HMG-CoA reductase

    C.10.A.A.05   Atorvastatin

    Pharmacodynamics:

    Atorvastatin is a selective competitive inhibitor of HMG-CoA reductase, a key enzyme that converts 3-hydroxy-3-methylglutaryl-CoA into a mevalonate precursor of steroids, including cholesterol; synthetic hypolipidemic agent.

    In patients with homozygous and heterozygous familial hypercholesterolemia, non-family forms of hypercholesterolemia and mixed dyslipidemia atorvastatin lowers the concentration in the blood plasma of cholesterol (cholesterol), low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apo-B), and very low density lipoprotein cholesterol (CHL-VLDL) and triglycerides (TG), causes an unstable increase in concentration high-density lipoprotein cholesterol (HDL-C).

    Atorvastatin reduces the concentration of cholesterol and lipoproteins in the blood plasma, inhibiting HMG-CoA reductase and the synthesis of cholesterol in the liver and increasing the number of "liver" LDL receptors on the cell surface, which leads to increased cholesterol-lowering and catabolism.

    Atorvastatin reduces the formation of LDL-C and the number of LDL particles, causes a marked and persistent increase in the activity of LDL receptors in combination with favorable qualitative changes in LDL-particles, and also reduces the concentration of LDL-C in patients with homozygous hereditary familial hypercholesterolemia, resistant to therapy with other lipid-lowering means.

    Atorvastatin at doses of 10 mg to 80 mg reduces the concentration of cholesterol by 30% -46%, LDL-cholesterol by 41% -61%, apolipoprotein-B by 34% -50% and TG by 14% -33%. The results of therapy are similar in patients with heterozygous familial hypercholesterolemia,non-family forms of hypercholesterolemia and mixed hyperlipidemia, including in patients with type 2 diabetes mellitus.

    In patients with isolated hypertriglyceridemia atorvastatin reduces the concentration of cholesterol, LDL-C, HDL-VLD, apo-B and TG and increases the concentration of HDL-C. In patients with disbetalipoproteinemia atorvastatin reduces the concentration of intermediate-density lipoprotein cholesterol.

    In patients with hyperlipoproteinemia of the type IIa and IIb according to Fredrickson classification, the average value of increasing the concentration of cholesterol-HDL in the treatment with atorvastatin (10-80 mg) compared with the initial index is 5.1 % - 8,7% and does not depend on the dose. There is a significant dose-dependent reduction in the ratio: total cholesterol / HDL-C and LDL-C-HDL-C at 29% -44% and 37% -55 %, respectively. The antisclerotic effect of atorvastatin is a consequence of its effect on the walls of blood vessels and blood components. Atorvastatin Suppresses the synthesis of isoprenoids, which are the growth factors of the cells of the inner shell of the vessels. Under the influence of atorvastatin, the endothelium-dependent dilatation of blood vessels improves, the concentration of LDL-C, LDL-C, apolipoprotein B, TG decreases, and cholesterol levels of HDL-C and HDL-apolipoprotein increase.

    Atorvastatin reduces the viscosity of the blood plasma and the activity of certain clotting factors and platelet aggregation. Due to this, it improves hemodynamics and normalizes the state of the coagulation system. Inhibitors of HMG-CoA reductase also have an effect on the metabolism of macrophages, block their activation and prevent the rupture of atherosclerotic plaque.

    Atorvastatin-SZ in a dose of 80 mg significantly reduces the risk of developing ischemic complications and a death rate of 16 % after a 16-week course, and the risk of re-hospitalization for angina, accompanied by signs of myocardial ischemia, at 26 %. In patients with different baseline concentrations of LDL cholesterol, atorvastatin-C3 causes a reduction in the risk of ischemic complications and mortality (in patients with myocardial infarction without a tooth Q and unstable angina, as well as in men and women, and in patients younger than 65 years of age).

    Reducing the concentration in the blood plasma of LDL-C is better correlated with the dose of the drug than with its concentration in the blood plasma. The dose is selected taking into account the therapeutic effect (see section "Method of administration and dose").The therapeutic effect is achieved 2 weeks after the initiation of therapy, reaches a maximum after 4 weeks, and persists throughout the period of therapy.

    Pharmacokinetics:

    Suction

    Atorvastatin is rapidly absorbed after oral administration: the time to reach its maximum concentration (TCmOh) in blood plasma is 1-2 hours. In women, the maximum concentration (CmOh) atorvastatin by 20 % above, and the area under the curve "concentration-time" (AUC) - 10% lower than that of men. The degree of absorption and concentration in the blood plasma increase in proportion to the dose.

    Absolute bioavailability - about 14 %, and the systemic bioavailability of inhibitory activity against HMG-CoA reductase is about 30%. Low systemic bioavailability is due to presystemic metabolism in the mucosa of the gastrointestinal tract and / or during the "primary passage" through the liver. Eating reduces the speed and degree of absorption of the drug (by 25% and 9%, respectively), as evidenced by the results of the determination Cmax and AUC, however, a decrease in LDL cholesterol is similar to that of fasting atorvastatin. Despite the fact that after taking atorvastatin in the evening, its concentration in the blood plasma is lower (CmOh and AUC, approximately 30%) than after taking in the morning, the decrease in the concentration of LDL-C is not dependent on the time of day in which the drug is taken.

    Distribution

    The average volume of atorvastatin distribution is about 381 liters. The connection with plasma proteins is not less than 98%. The ratio of the erythrocyte / plasma content is about 0.25, i.e., atorvastatin poorly penetrates into red blood cells.

    Metabolism

    Atorvastatin is largely metabolized with the formation of ortho- and para-hydroxylated derivatives and various β-oxidation products. In vitro ortho- and para-hydroxylated metabolites have an inhibitory effect on HMG-CoA reductase, comparable to that of atorvastatin. Approximately 70% decrease in the activity of HMG-CoA reductase occurs due to the action of active circulating metabolites. Research results in vitro suggest that isoenzyme CYP3A4 The liver plays an important role in the metabolism of atorvastatin. In favor of this fact is an increase in the concentration of the drug in the blood plasma with the simultaneous administration of erythromycin, which is an inhibitor of this isoenzyme. Research in vitro They also showed that atorvastatin is a weak isoenzyme inhibitor CYP3A4. Atorvastatin does not have a clinically significant effect on the concentration in the blood plasma of terfenadine, which is metabolized mainly by isoenzyme CYP3A4, therefore, its significant effect on the pharmacokinetics of other isoenzyme substrates CYP3A4 is unlikely (see the section "Interaction with other drugs").

    Excretion

    Atorvastatin and its metabolites are excreted mainly with bile after hepatic and / or extrahepatic metabolism (atorvastatin not subject to severe intestinal hepatic recirculation). The half-life (T1/2) Atorvastatin is about 14 hours, while the inhibitory effect of the drug against HMG-CoA reductase is approximately 70% determined by the activity of circulating metabolites and lasts about 20 to 30 hours due to their presence. After ingestion, less than 2% of the accepted dose of the drug is found in the urine.

    Special patient groups

    Elderly patients

    The concentrations of atorvastatin in the blood plasma of patients older than 65 years are higher (Cmax by about 40%, AUC approximately 30 %), than in adult patients of a young age. Differences in the efficacy and safety of the drug, or the achievement of the goals of lipid-lowering therapy in elderly patients, as compared with the general population, have not been revealed.

    Children

    Studies of the pharmacokinetics of the drug in children have not been conducted.

    Lack of kidney function

    Impaired renal function does not affect the concentration of atorvastatin in the blood plasma or its effect on lipid metabolism, therefore, a dose change in patients with impaired renal function is not required.

    Atorvastatin is not excreted during hemodialysis due to intensive binding to blood plasma proteins.

    Studies of the use of atorvastatin in patients with terminal stage of renal failure have not been conducted.

    Lack of liver function

    The concentration of the drug is significantly increased (CmOh about 16 times, AUC approximately 11 times) in patients with alcoholic cirrhosis of the liver (stage B on the Child-Pugh scale) (see section "Contraindications").

    Indications:

    - Primary hypercholesterolemia (heterozygous familial and non-family hypercholesterolemia (IIbut a Frederickson type);

    - Combined (mixed) hyperlipidemia (IIa and IIb types according to Fredrickson's classification);

    - Disbetalipoproteinemia (type III according to Fredrickson classification) (as a supplement to the diet);

    - Family endogenous hypertriglyceridemia (type IV according to Fredrickson classification), resistant to diet;

    - Homozygous familial hypercholesterolemia with insufficient effectiveness of diet therapy and other non-pharmacological methods of treatment;

    - Prevention of cardiovascular diseases:

    - Primary prophylaxis of cardiovascular complications in patients without clinical signs of coronary heart disease (CHD), but having several risk factors for its development: age over 55, nicotine dependence, arterial hypertension, diabetes, genetic predisposition, including dyslipidemia ;

    - Secondary prophylaxis of cardiovascular complications in patients with ischemic heart disease in order to reduce the total death rate, myocardial infarction, stroke, re-hospitalization for angina pectoris and the need for revascularization.

    Contraindications:

    Hypersensitivity to any component of the drug.

    Active liver disease or increased activity "liver" enzymes in the blood plasma of unclear origin by more than 3-fold compared with the upper limit of normal.

    Age to 18 years (not enough clinical data on the efficacy and safety of the drug in this age group).

    Lactose intolerance, lactase deficiency, glucose-galactose malabsorption.

    Hypersensitivity to soy and peanuts.

    Pregnancy and the period of breastfeeding.

    Use in women planning pregnancy and not using reliable methods of contraception.

    Carefully:

    Alcohol abuse, history of liver disease, musculoskeletal system diseases (a history of use of other representatives of HMG-CoA reductase inhibitors group), severe vodnoelektrolitnogo balance, endocrine (hyperthyroidism), and metabolic disorders, severe acute infection (sepsis), hypotension, diabetes mellitus, uncontrolled epilepsy, extensive surgical interventions, trauma.

    Pregnancy and lactation:

    The drug Atorvastatin-SZ is contraindicated in pregnancy.

    Women of reproductive age during treatment should use adequate methods of contraception. The drug Atorvastatin-SZ can be prescribed to women of reproductive age only if the probability of pregnancy is very low and the patient is informed of the possible risk of treatment for the fetus.

    The drug Atorvastatin-SZ is contraindicated during breastfeeding. It is not known whether atorvastatin with breast milk. If it is necessary to prescribe the drug during lactation, breastfeeding should be stopped in order to avoid the risk of adverse events in infants.

    Dosing and Administration:

    Inside. Take at any time of the day, regardless of food intake.

    Before starting treatment with the drug Atorvastatin-SZ should try to achieve control of hypercholesterolemia with diet, exercise and weight loss in obese patients, as well as therapy for the underlying disease.

    When appointing the drug, the patient should recommend a standard hypocholesterolemic diet, which he must adhere to throughout the period of therapy.

    The dose of the drug varies from 10 mg to 80 mg once a day and is titrated taking into account the initial concentration of LDL-C, the purpose of therapy and the individual effect on the therapy.

    The maximum daily dose of the drug for a single dose is 80 mg.

    At the beginning of treatment and / or during an increase in the dose of Atorvastatin-C3, it is necessary to monitor the concentration of lipids in the blood plasma every 2-4 weeks and adjust the dose accordingly.

    Primary hypercholesterolemia and combined (mixed) hyperlipidemia

    For the majority of patients - 10 mg once a day; The therapeutic effect manifests itself within 2 weeks and usually reaches a maximum within 4 weeks. With prolonged treatment, the effect persists.

    Homozygous familial hypercholesterolemia

    The initial dose is selected individually depending on the severity of the disease. In most cases, the optimal effect is observed when the drug is administered at a dose of 80 mg 1 time per day (a decrease in the concentration of LDL-C in 18-45%).

    Lack of liver function

    If liver function is inadequate, care must be taken (in connection with the delay in removing the drug from the body).Clinical and laboratory indicators should be closely monitored (regular monitoring of the activity of "liver" transaminases: aspartate aminotransferase (ACT) and alanine aminotransferase (ALT)). With a significant increase in "hepatic" transaminases, the dose of Atorvastatin-C3 should be reduced or treatment should be discontinued.

    Lack of kidney function

    Violation of the kidney function does not affect the concentration of atorvastatin in the blood plasma or the degree of decrease in the concentration of LDL-C during the therapy with the drug Atorvastatin-SZ, so no correction of the dose is required.

    Elderly patients

    Differences in the efficacy, safety or therapeutic effect of Atorvastatin-SZ in elderly patients are not found in comparison with the general population and no dose adjustment is required (see the section "Pharmacokinetics").

    Use in combination with other medicines

    If a simultaneous use with cyclosporine, telaprevir or a combination of tipranavir / ritonavir is required, the dose of atorvastatin-SZ should not exceed 10 mg / day. Care should be taken and the lowest effective dose of atorvastatin useduse with HIV protease inhibitors, hepatitis C inhibitors, clarithromycin and itraconazole. (see section "Special instructions").

    Side effects:

    Classification of frequency of development of side effects of the World

    Health Organization (WHO):

    Often 1/10

    often from ≥ 1/100 to <1/10

    infrequently from ≥ 1/1000 to <1/100

    rarely from ≥ 1/10000 to <1/1000

    very rarely from <1/10000, including individual messages

    frequency is unknown - unwanted reactions with unknown frequency (not can be calculated from available data)

    From the nervous system:

    often: headache, insomnia, dizziness, paresthesia, asthenic syndrome;

    infrequently: peripheral neuropathy, amnesia, hypoesthesia, "nightmarish" dreams;

    From the sense organs:

    infrequently: noise in the ears;

    rarely: nasopharyngitis, epistaxis;

    From the cardiovascular system:

    palpitation, symptoms of vasodilation, migraine, postural hypotension, increased blood pressure, phlebitis, arrhythmia;

    On the part of the hematopoiesis system:

    infrequently: thrombocytopenia;

    From the respiratory system:

    often: chest pain;

    From the digestive system:

    often: constipation, indigestion, nausea, diarrhea, flatulence (bloating), abdominal pain;

    infrequently: a violation of taste perception, vomiting, pancreatitis, belching;

    rarely: hepatitis, cholestatic jaundice;

    very rarely: liver failure.

    From the musculoskeletal system:

    often: myalgia, arthralgia, back pain, swelling of the joints;

    infrequently: myopathy, muscle cramps;

    rarely: myositis, rhabdomyolysis, tendopathy (in some cases with a rupture of tendons);

    From the genitourinary system:

    often: urinary tract infections;

    infrequently: decreased potency, secondary renal failure;

    From the skin:

    often: skin rash, itchy skin;

    infrequently: urticaria, alopecia;

    rarely: angioedema, alopecia, bullous rash, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis;

    Allergic reactions:

    often: allergic reactions;

    very rarely: anaphylaxis;

    Laboratory indicators:

    infrequently: increased activity of aminotransferases (ACT, AJIT), increased serum creatine phosphokinase (CK), leukocyturia;

    Very rarely: hyperglycemia, hypoglycemia;

    Other:

    often: peripheral edema;

    infrequently: weakness, fatigue, fever, anorexia,

    an increase in body weight, the appearance of "shroud" in front of the eyes.

    In the postmarketing use of statins, the following adverse effects were reported: loss or loss of memory, depression, sexual dysfunction, gynecomastia, increased concentration of glycosylated hemoglobin, single cases of interstitial lung disease (especially with prolonged use), cases of immunocompromised necrotic myopathy.

    The causal relationship of some unwanted effects with the use of the drug Atorvastatin-SZ, which are regarded as "very rare", is not established.

    If severe undesirable effects occur, use of Atorvastatin-C3 should be discontinued.

    Overdose:

    In case of an overdose, the following general measures are necessary: ​​monitoring and maintaining the vital functions of the body, as well as preventing further absorption of the drug (gastric lavage, intake of activated charcoal or laxatives).

    With the development of myopathy with subsequent rhabdomyolysis and acute renal failure (rare,but a severe side effect) the drug must be immediately discontinued and the infusion of a diuretic and sodium bicarbonate started. If necessary, hemodialysis should be performed. Rhabdomyolysis can lead to hyperkalemia, which requires the intravenous administration of calcium chloride solution or calcium gluconate solution, the infusion of 5% dextrose (glucose) solution with insulin, the use of potassium-exchange resins. Since the drug actively binds to blood plasma proteins, hemodialysis is ineffective.

    Interaction:

    Risk of myopathy during treatment with HMG-CoA reductase inhibitors increases with simultaneous use of cyclosporine, fibrates, antibiotics (erythromycin, clarithromycin, quinupristin / delfopristin), nefazodone, HIV protease inhibitors (indinavir, ritonavir), colchicine, antifungal agents - azole derivatives, - and nicotinic acid in lipid-lowering doses (more than 1 g / day) (see section "Special instructions").

    Inhibitor inhibitors CYP3A4

    Because the atorvastatin is metabolized by isoenzyme CYP3A4, combined use of atorvastatin with isozyme inhibitors CYP3A4 can lead to an increase in the concentration of atorvastatin in the blood plasma. The degree of interaction and the effect of potentiation is determined by the variability of the effect on the isoenzyme CYP3A4.

    Inhibitors of transport protein OATP1B1

    Atorvastatin and its metabolites are substrates of the transport protein OATP1B1. Inhibitors of OATP1B1 (for example, cyclosporine) may increase the bioavailability of atorvastatin. Thus, the combined use of atorvastatin 10 mg and cyclosporine at a dose of 5.2 mg / kg / day leads to an increase in the concentration of atorvastatin in blood plasma by 7.7 times. If the simultaneous use with cyclosporine dose of the drug Atorvastatin-SZ should not exceed 10 mg / day (see the section "Method of administration and dose").

    Erythromycin / clarithromycin

    With simultaneous use of atorvastatin and erythromycin (500 mg 4 times a day) or clarithromycin (500 mg twice a day), which inhibit the isoenzyme CYP3A4, an increase in the concentration of atorvastatin in the blood plasma was observed (see section "Special instructions"). Caution should be exercised and the lowest effective dose of atorvastatin should be used when combined with clarithromycin.

    Inhibitors of proteases

    The simultaneous use of atorvastatin with protease inhibitors, known as isoenzyme inhibitors CYP3A4, is accompanied by an increase in the concentration of atorvastatin in the blood plasma (with simultaneous use with erythromycin Cmax atorvastatin is increased by 40%).

    Combination of protease inhibitors

    Patients taking HIV protease inhibitors and hepatitis C inhibitors should be careful and use the lowest effective dose of atorvastatin.

    In patients receiving telaprevir or a combination of tipranavir / ritonavir drugs, the dose of Atorvastatin-SZ should not exceed 10 mg / day.

    Patients taking an HIV protease inhibitor tipranavir a plus ritonavir or a hepatitis C protease inhibitor telaprevirshould be avoided simultaneous administration of the drug Atorvastatin-SZ. Patients taking HIV protease inhibitors lopinavir plus ritonavir, caution should be exercised when prescribing Atorvastatin-C3 and the lowest necessary dose should be given. In patients taking HIV protease inhibitors saquinavir a plus ritonavir, darunavir a plus ritonavir, fosamprenavir or fosamprenavir a plus ritonavir, the dose of Atorvastatin-SZ should not exceed 20 mg and the drug should be used with caution. In patients taking an HIV protease inhibitor nelfinavir or a hepatitis C protease inhibitor boceprevir, the dose of Atorvastatin-SZ should not exceed 40 mg and careful clinical monitoring is recommended.

    Diltiazem

    Joint use of atorvastatin in a dose of 40 mg with diltiazem at a dose of 240 mg, leads to an increase in the concentration of atorvastatin in blood plasma.

    Ketoconazole, spironolactone and cimetidine.

    Caution should be exercised with the simultaneous use of atorvastatin with drugs that reduce the concentration of endogenous steroid hormones, such as ketoconazole, spironolactone and cimetidine.

    Itraconazole

    The simultaneous use of atorvastatin in doses of 20 mg to 40 mg and itraconazole at a dose of 200 mg resulted in an increase in the value AUC atorvastatin. Caution should be used and the lowest effective dose of atorvastatin should be used when combined with itraconazole.

    Grapefruit juice

    Because grapefruit juice contains one or more components that inhibit the isoenzyme CYP3A4, its excessive consumption (more than 1.2 liters per day) can cause an increase in the concentration of atorvastatin in the blood plasma.

    Inductors of isoenzyme CYP3A4

    Combined use of atorvastatin with isoenzyme inducers CYP3A4 (eg, efavirenz, phenytoin, or rifampicin) may lead to a decrease in the concentration of atorvastatin in the blood plasma. Due to the dual mechanism of interaction with rifampicin (isoenzyme inducer CYP3A4 and inhibitor of hepatocyte transport protein OATP1B1), simultaneous use of atorvastatin and rifampicin is recommended, since delayed administration of atorvastatin after taking rifampicin results in a significant decrease in the concentration of atorvastatin in blood plasma.

    Antacids

    Simultaneous ingestion of a suspension containing magnesium hydroxide and aluminum hydroxide reduced the concentration of atorvastatin in the blood plasma by approximately 35%, but the degree of decrease in the concentration of LDL-C was not changed.

    Fenazone

    Atorvastatin does not affect the pharmacokinetics of phenazone, therefore interaction with other drugs metabolized by the same isoenzymes of cytochrome is not expected.

    Kolestypol

    With the simultaneous use of colestipol, the concentration of atorvastatin in the blood plasma decreased by about 25%; However, the hypolipidemic effect of the combination of atorvastatin and colestipol was superior to that of each drug alone.

    Digoxin

    With repeated administration of digoxin and atorvastatin at a dose of 10 mg, the equilibrium concentrations of digoxin in the blood plasma did not change. However, when using digoxin in combination with atorvastatin in a dose of 80 mg / day. the digoxin concentration increased by about 20%. Patients receiving digoxin in combination with atorvastatin, require appropriate monitoring.

    Azithromycin

    With the simultaneous use of atorvastatin 10 mg once a day and azithromycin 500 mg once a day, the concentration of atorvastatin in the blood plasma did not change.

    Oral contraceptives

    With simultaneous use of atorvastatin and oral contraceptive containing norethisterone and ethinyl estradiol, there was a significant increase AUC norethisterone and ethinyl estradiol by about 30% and 20%, respectively. This effect should be considered when choosing an oral contraceptive for a woman receiving atorvastatin.

    Terfenadine

    With the simultaneous use of atorvastatin and terfenadine, clinically significant changes in the pharmacokinetics of terfenadine have not been identified.

    Warfarin

    The simultaneous use of atorvastatin with warfarin may, in the first days, increase the effect of warfarin on blood clotting parameters (reduction of prothrombin time). This effect disappears after 15 days of simultaneous application of these drugs.

    Amlodipine

    With simultaneous use of atorvastatin in a dose of 80 mg and amlodipine at a dose of 10 mg, the pharmacokinetics of atorvastatin did not change in the equilibrium state.

    Other concomitant therapy

    In clinical trials atorvastatin used in combination with antihypertensive agents and estrogens within the framework of substitution therapy; Signs of clinically significant undesirable interaction were not observed; studies of interaction with specific drugs have not been conducted.

    Special instructions:

    Before starting therapy with the drug Atorvastatin-SZ, the patient should be prescribed a standard hypocholesterolemic diet, which he must observe during the entire treatment period.

    Action on the liver

    As with the use of other lipid-lowering drugs of this class, after treatment with the drug Atorvastatin-SZ, moderate (more than 3 times as compared with the upper limit of the norm) increased activity of "liver" transaminases ACT and ALT. A steady increase in the activity of "liver" transaminases (more than 3 times compared with the upper limit of the norm) was observed in 0.7% of patients who received the drug Atorvastatin-SZ. The frequency of such changes in the use of the drug in doses of 10 mg, 20 mg, 40 mg and 80 mg was 0.2%, 0.2%, 0.6% and 2.3%, respectively. Increased activity of "liver" transaminases usually was not accompanied by jaundice or other clinical manifestations. With a decrease in the dose of the drug Atorvastatin-SZ, the temporary or complete withdrawal of the drug, the activity of "hepatic" transaminases returned to its original level. Most patients continued to take Atorvastatin-C3 at a reduced dose without any clinical consequences.

    Before the start of therapy, 6 weeks and 12 weeks after the start of the use of the drug Atorvastatin-SZ or after increasing its dose, and during the entire course of treatment, it is necessary to monitor the liver function parameters. The liver function should also be investigated when there are clinical signs of liver damage.In the case of increased activity of "hepatic" transaminases, their activity should be monitored until it is normalized. If the increase in activity ACT or ALT more than 3 times compared with the upper limit of the norm is maintained, it is recommended to reduce the dose or cancel the drug Atorvastatin-SZ (see the section "Contraindications"),

    The drug Atorvastatin-SZ should be used with caution in patients who consume significant amounts of alcohol and / or have a history of liver disease. Active liver disease or permanently increased activity of "hepatic" transaminases of blood plasma of unknown origin is a contraindication to the use of the drug Atorvastatin-SZ (see section "Contraindications").

    Action on skeletal muscles

    In patients who received the drug Atorvastatin-SZ, myalgia was noted (see section "Side effect"). The diagnosis of myopathy (muscle pain or muscle weakness combined with an increase in creatine phosphokinase activity (CK) by more than 10 times compared with the upper limit of normal) should be assumed in patients with diffuse myalgia, muscle soreness or weakness, and / or a marked increase in CKK activity.Therapy with Atorvastatin-S3 should be discontinued in the event of a marked increase in CK activity, with confirmed myopathy or suspected. The risk of myopathy in treatment with other drugs of this class increased with simultaneous use of cyclosporine, fibrates, certain antibiotics, nefazodone, HIV protease inhibitors (indinavir, ritonavir), colchicine, antifungal agents - azole derivatives, - and nicotinic acid in lipid-lowering doses (more than 1 g / day). Many of these drugs inhibit isoenzyme mediated metabolism CYP3A4, and / or the transport of drugs. It is known that isoenzyme CYP3A4 - the main isoenzyme of the liver involved in the biotransformation of atorvastatin. When prescribing Atorvastatin-SZ in combination with fibrates, immunosuppressants, colchicine, nefazodone, erythromycin, clarithromycin, quinupristin / delfopristine, azole antifungal agents, HIV protease inhibitors or lipid-lowering doses of nicotinic acid, the physician should carefully weigh the expected benefit of treatment and the possible risk.Patients should be observed regularly to identify pain or weakness in the muscles, especially during the first months of therapy and during the period of increasing the dose of any of these agents. If combination therapy is required, consideration should be given to the possibility of using lower initial and maintenance doses of the above. In such situations, periodic monitoring of the activity of CK can be recommended, although such monitoring does not prevent the development of severe myopathy (see section "Interaction with other drugs").

    When using the drug Atorvastatin-SZ as well as other statins, rare cases of rhabdomyolysis with acute renal failure due to myoglobinuria are described. When symptoms of possible myopathy or the presence of a risk factor for renal failure against rhabdomyolysis (for example, severe acute infection, arterial hypotension, extensive surgical intervention, trauma, metabolic, endocrine and water-electrolyte disorders and uncontrolled convulsions), therapy with atorvastatin-SZ should be temporarily stop or completely cancel.

    Attention! Patients should be warned that they should seek medical attention immediately if unexplained pain or muscle weakness occurs, especially if they are accompanied by a malaise or fever.

    Effect on the ability to drive transp. cf. and fur:

    Given the possibility of developing dizziness, care should be taken when driving vehicles and other technical devices that require increased concentration and speed of psychomotor reactions.

    Form release / dosage:

    Film-coated tablets, 10 mg, 20 mg, 40 mg and 80 mg.

    Packaging:For 10 or 14 tablets in a contour mesh package.

    For 20 or 90 tablets in a can of polymer or in a bottle of polymer.

    Each jar or bottle, 3, 6, 9 contour packs of 10 tablets or 2, 4 contour packs of 14 tablets together with the instruction for use are placed in a pack of cardboard.

    Storage conditions:

    In a dry, the dark place at a temperature of no higher than 25 ° C. Keep out of the reach of children.

    Shelf life:

    3 years.

    Do not use after the expiry date printed on the package.

    Terms of leave from pharmacies:On prescription
    Registration number:LP-002600
    Date of registration:22.08.2014 / 13.08.2015
    Expiration Date:22.08.2019
    The owner of the registration certificate:NORTH STAR, CJSC NORTH STAR, CJSC Russia
    Manufacturer: & nbsp
    Information update date: & nbsp08.10.2017
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