Atorvastatin RVN 20 RVSel medicine reduces total cholesterol (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Atorvastatin
Ingredient High blood fat, high blood cholesterol

Ingredient

Composition information	Content
Atorvastatin	20mg

Uses

Indications

Atorvastatin RVN 20 drugs are indicated in the following cases:

Additional treatment for eating therapy to reduce total cholesterol, LDL - Cholesterol, Apolipoprotein B and Triglycerides. Increasing HDL-Cholesterol in patients with primary blood cholesterol (type IIA and LIB) triglycerides less. Diet and other non-drug methods do not bring adequate results. The conversion of HMG-CoA to Mevalonate is the first step in cholesterol biosynthesis.

Atorvastatin reduces lipoprotein and plasma cholesterol by inhibiting HMG-COA reducing enzymes, inhibiting the synthesis of cholesterol in the liver and by increasing the number of LDL receptors in the liver on the cell surface. Since then increase the removal and divestment of LDL.

Atorvastatin reduces LDL production and reduces the number of LDL particles. Atorvastatin significantly increases the activity of the LDL receptor along with the beneficial change on the nature of the circulating LDL particles. Atorvastatin is effective on reducing LDL in patients with homozygous family hypertension, a rarely response to lipid remedy.

Pharmacokinetics

absorption

Atorvastatin is quickly absorbed after oral, the maximum plasma drug concentration is achieved within 1-2 hours. The level of absorption and concentration of Atorvastatin increases proportional to the dose. The absolute bioavailability of Atonvastatin is about 14% and the system of systemic use of HMG-CAA reducing enzymes is about 30%. The low body usability is due to the purification in the gastrointestinal mucosa and/or first metabolism in the liver.

Although the food reduces the rate and absorption of Atorvastatin about 25% when rated by CMAX and about 9% when assessed by AUC, the effect reduces LDL-C, unchanged when Atorvastatin is taken with or not with food. The concentration of plasma Atorvastatin after taking the evening in the evening is lower in the morning when taking the drug in the morning (about 30% for CMAX and AUC). However, the effectiveness of LDL-C reduction is the same regardless of the time when taking the drug during the day.

Distribution

The average distribution of Atorvastatin is about 381 liters. Over 98% of Atorvastatin is connected to plasma proteins, the ratio of plasma red blood cells is approximately 0.25, showing the permeability into low red blood cells.

Metabolism

Atorvastatin is converted mainly into hydroxy derivatives at Ortho and Para positions and oxidized products at beta. In vitro, the inhibition of HMG-CoA reducing enzymes of metabolic substances through the hydroxylation pathway in the Ortho and Para position is equivalent to the inhibition of Atorvastatin. About 70% of the HMG-CoA reducing enzyme inhibitors in plasma is due to active metabolites.

In vitro, studies show the importance of Atorvastatin metabolism by cytochrome P450 3A4 in the liver, suitable for the level of Atorvastatin in humans after using it simultaneously with erythromycin, a known inhibitor of this Isozyme.

Elimination

Atorvastatin and its metabolites are excreted mainly through bile after the metabolism in the liver and/or outside the liver. However, the drug does not go through the intestinal cycle. Atorvastatin's average semi -cancellation time in humans is about 14 hours, but the half -life of HMG -CAA reducing enzymes is 10-20 hours due to the contribution of active metabolites. Under 2% of Atovastatin oral intake is found in the urine.

Atorvastatin and some of its metabolites have pharmacological activity in humans. The first place of Atorvastatin is the liver, this is the main place to synthesize cholesterol and clear the LDL. The decrease in LDL-C corresponds to the dose of the drug than the body concentration.

Before taking Atorvastatin RVN 20 RVSel medicine reduces total cholesterol (3 blisters x 10 tablets)

How to use

Take oral use. The drug can be used anytime of the day, no need to pay attention to the meal.

Dosage

Hyper cholesterol (heterozygous and non -family family) and mixed blood lipid disorders

The recommended starting dose is 10 - 20 mg, 1 time/day. Patients who need to reduce cholesterol LDL (over 45%) may start at a dose of 40 mg, 1 time/day. Maintenance dose of 10 - 40 mg/day. If necessary, the dose can be increased, but not more than 80 mg/day.

After starting treatment and/or after increasing the dose of Atorvastatin, it is necessary to evaluate the lipid indicators within 2 to 4 weeks and to adjust the dose appropriately.

Hyper cholesterol hyperliper has a homozygous family.

The starting dose of 10 mg, 1 time/day. Adjust the dose every 4 weeks. Maintenance dose of 10 - 40 mg/day. If necessary, the dose can be increased, but not more than 80 mg/day. Need to be coordinated with other lipid measures.

Coordination treatment

Atorvastatin can be treated in combination with resin to increase the effectiveness of treatment.

Coordinate with the following drugs and combinations: Fosamprenavir, Darunavir and Ritonavir combination, combination of fosamprenavir and ritonavir, coordinated Saminavir and Ritonavir: Do not use more than 20 mg atorvastatin/day.

Coordinate with nelfinavir: Do not use more than 40 mg atorvastatin/day.

Dosage in kidney: No dose adjustment.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What to do when overdose? When using overdose, symptomatic treatment and total status support measures. Due to the strong drug associated with plasma proteins, there is no hope of increasing the clearance of Atorvastatin by blood separation.

What to do when you forget 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.

Side Effects

When using Atorvastatin RVN 20, you may experience unwanted effects (ADR).

Common, ADR> 1/100

Digestive: diarrhea, constipation, flatulence, indigestion, abdominal pain, nausea.

central nervous system: headache, dizziness, blurred vision, insomnia, weakness.

Neurological - muscle and bone: muscle pain, joint pain.

Liver: The test results of liver function increases more than 3 times the upper limit of normal, but mostly have no symptoms and recover when stopping the drug.

Uncommon, 1/1000

Neurological - muscle and bone: muscle disease (combining muscle weakness and increased creatin phosphokinase plasma).

Skin: Ban Da.

Respiratory: rhinitis, sinusitis, sore throat, cough.

Rare, 1/10000

Bone muscles: muscle inflammation, muscle pilot, leading to secondary acute renal failure due to myoglobinuria.

Instructions on how to handle ADR

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

Atorvastatin RVN 20 drugs are contraindicated in the following cases:

Hypersensitivity to HMG inhibitors - Coa Reductase or any ingredient of the drug.

Patients with liver disease progresses or increases serum transaminase continuously without the cause.

Pregnant and lactating women.

Be cautious when using

Patients need a reasonable diet before treatment with the drug. This regime should be maintained during the treatment process with the drug.

Before treatment with Atorvastatin, pay attention to eliminate the causes of secondary lipid disorders and quantify lipid indicators. Should conduct periodic quantification of lipids, with a distance of no less than 4 weeks.

Use cautiously in patients with liver dysfunction, patients drink a lot.

In clinical trials, a small number of adult patients drink statin see significantly increasing serum transaminase (> 3 normal limits). When stopping the drug in these people, the transaminase concentration often lowered the level before treatment. Some of these patients before treatment with statins have abnormal liver function test results and/or drink a lot of alcohol. Therefore, it is necessary to conduct liver function tests before starting treatment and periodically later in all patients.

Consider monitoring Creatin Kinase (CK) in the case:

Before treatment, CK tests should be conducted in the following cases: impaired renal function, hypothyroidism, self -history or family history of genetic muscle disease, a history of muscle disease due to the use of statin or fibrat before, a history of liver disease and/or drinking lots of alcohol, elderly patients (> 70 years old) with risk factors for muscle pattern, special possibility of drug interactions and some special patients. In these cases, the benefits/risks should be considered and monitor patients clinically when treated with statin. If the results of CK test> 5 times the upper limit of normal levels, do not start treatment with statin.

During statin treatment, patients need to notify when there are muscle manifestations such as muscle pain, stiffness, muscle weakness ... When these manifestations, patients need to do CK test to take appropriate interventions.

The ability to drive and operate machinery

does not affect the capabilities of the car and operating machinery.

Pregnancy

Atorvastatin is contraindicated for pregnant women. There is no safe data on pregnant women. Rarely the birth defect reports due to uterus exposed to statins. Using Atorvastatin on mothers can reduce the level of meevalonate in fetus, this is a sign of cholesterol biosynthesis.

The period of breastfeeding

unknown Atorvastatin and its metabolites are eliminated through breast milk. In mice, Atorvastatin levels and metabolites are also active in the same blood in the milk. Due to serious unwanted effects, Atorvastatin is contraindicated during breastfeeding.

Drug interaction

Increased risk of muscle lesions when used simultaneously with the following drugs: Gemfibrozil, other fibrat blood cholesterol medications, high doses (> 1 g/day), Colchicin, erythromycin, clarithromycin, cyclosporin, and antifungal drugs Azol.

Simultaneously used with protease inhibitors of HIV and hepatitis C (HCV) may increase the risk of muscle damage. The most serious is the pattern, kidney damage leads to renal failure and can be fatal:

With Telaprevir, or with Tipranavir and Ritonavir combination: avoid simultaneous use of Atorvastatin.

With Lopinavir and Ritonavir combination: Use carefully and if necessary, the lowest atorvastatin dose should be used.

With the following drugs and combinations: Fosamprenavir, Darunavir and Ritonavir combination, combined Fosamprenavir and Ritonavir, Saminavir and Ritonavir: Do not use more than 20 mg atorvastatin/day.

With Nelfinavir: Do not use more than 40 mg atorvastatin/day.

Antacid: Concentrated with Atorvastatin with oral epidemic Antacid contains magnesium and aluminum hydroxide, which will reduce the level of Atorvastatin in plasma by about 35%. However, the effect of the drug on the effective reduction of LDL-C is not changed.

Antyrine: Atorvastatin does not affect the pharmacokinetics of antipipyrine. Therefore, the interaction of drugs metabolized with cytochrome iszymes is not thought of.

cholestyramine: Atorvastatin concentration in plasma decreases (about 25%) when using cholestyramine along with Atorvastatin. However, the effectiveness of treatment on blood lipids when using 2 drugs is higher when only 1 of 2 drugs.

Digoxin: Used in combination with Atorvastatin and Digoxin, increasing plasma digoxin levels are in a stable state of nearly 20%. Need to monitor appropriately in patients using digoxin.

Oral contraceptive pills: Concomitance with oral contraceptive pills containing norethindrone and ethinyl estradiol increases the AUC of Norethindrone and of Ethinyl estradiol nearly 20%. When selecting a contraceptive pill for women, it is necessary to consider this.

Studies on the interaction of Atorvastatin with cimetidin have been done and there is no clinical interaction.

Statin may increase the effects of warfarin. Prothrombin must be determined before starting to use statin and regular monitoring in the first stage of treatment to ensure no change in prothrombin time.

Other drugs: In clinical studies, when concurrent Atorvastatin with antihypertensive drugs and estrogen alternative therapy, there is no clinical adverse adverse drug interaction.

Storage

Store in a dry, cool place (below 30 ° C), avoiding light.

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