Atoris - malangizo a boma ogwiritsira ntchito

mapiritsi okhala ndi filimu

Piritsi 1 lomwe limakhala ndi 10 mg / 20 mg lili ndi:
Pakatikati
Chithandizo:
Atorvastatin calcium 10,36 mg / 20,72 mg (wofanana ndi atorvastatin 10.00 mg / 2000 mg)
Othandizira:
povidone - K25, sodium lauryl sulfate, calcium carbonate, microcrystalline cellulose, lactose monohydrate, croscarmellose sodium, magnesium stearate
Filamu pachimake
Opadry II HP 85F28751 White *
* Opadry II HP 85F28751 yoyera imakhala ndi: mowa wa polyvinyl, titanium dioxide (E171), macrogol-3000, talc

Kufotokozera

Ponseponse, mapiritsi a biconvex pang'ono, oyera-owoneka oyera kapena pafupifupi oyera.
Mawonedwe a kink: misa yoyera ndi filimu yotulutsa yoyera kapena yoyera.

Mankhwala

Atorvastatin ndi wothandizira wa hypolipidemic kuchokera pagulu la ma statins. Njira yayikulu yogwirira ntchito ya atorvastatin ndikulepheretsa zochitika za 3-hydroxy-3-methylglutaryl-coenzyme A - (HMG-CoA) reductase, enzyme yomwe imathandizira kusintha kwa HMG-CoA kukhala mevalonic acid. Kusintha uku ndi limodzi mwamagawo oyambira mu cholesterol synthesis mu thupi.

Atorvastatin kuponderezana kwa cholesterol synthesis kumabweretsa kuchuluka kwa otsika kachulukidwe lipoprotein zolandilira (LDL) mu chiwindi, komanso owonjezera minofu. Ma receptor amenewa amamanga tinthu tating'ono ta LDL ndikuwachotsa m'madzi a m'magazi, zomwe zimapangitsa kuchepa kwa kuchuluka kwa LDL cholesterol (Ch) LDL (Ch-LDL) m'magazi. Mphamvu ya antisulinotic ya atorvastatin ndi chifukwa cha momwe imakhudzira makoma amitsempha yamagazi ndi zigawo zamagazi. Atorvastatin linalake ndipo tikulephera kapangidwe ka isoprenoids, omwe ndi zinthu zomwe zimapanga kukula kwamitsempha yamagazi. Mothandizidwa ndi atorvastatin, endothelium-yomwe imadalira mitsempha yamagazi imayenda bwino, kuchuluka kwa LDL-C, LDL, apolipoprotein B, triglycerides (TG) kumachepa, ndikuwonetsetsa kuti lipoprotein yapamwamba kwambiri (HDL-C) ndi apolipoprotein Kuchulukitsa.

Atorvastatin amachepetsa mamasukidwe akayendedwe amwazi ndi ntchito zina zophatikizika ndi kuphatikizira kwa maselo. Chifukwa cha izi, imakonza hemodynamics ndipo imasintha mkhalidwe wamathandizo. HMG-CoA reductase inhibitors imakhudzanso kagayidwe ka macrophages, kutseka kutsegulira kwawo ndikutchingira kupasuka kwa zolembera za atherosulinotic.

Monga lamulo, achire zotsatira za atorvastatin amakula pambuyo pa milungu iwiri yogwiritsa ntchito atorvastatin, ndipo mphamvu yakeyo imatheka patadutsa milungu inayi.

Atorvastatin muyezo wa 80 mg kwambiri amachepetsa chiwopsezo cha kusokonezeka kwa ischemic (kuphatikizapo kufa kuchokera ku infarction ya myocardial) ndi 16%, chiwopsezo chogonekedwanso kuchipatala cha angina pectoris, limodzi ndi zizindikiro za myocardial ischemia - ndi 26%.

Pharmacokinetics

Mayamwidwe a Atorvastatin ndi okwera, pafupifupi 80% amatengedwa kuchokera m'mimba. Mlingo wa mayamwidwe ndi ndende mu madzi am`magazi ukuwonjezeka mogwirizana ndi mlingo. Nthawi yofika ndende yozizira kwambiri (TCmax) ndi, pafupifupi, maola 1-2. Kwa akazi, TCmax ndi yokwera ndi 20%, ndipo dera lomwe lili pansi pa ndende (AUC) ndi 10% kutsika. Kusiyana kwa pharmacokinetics mwa odwala ndi zaka komanso jenda ndizochepa ndipo sikufuna kusintha kwa mlingo.

Odwala omwe ali ndi vuto la chiwindi cha chidakwa, TCmax imakhala yokwera kwambiri kuposa momwe imakhalira. Kudya pang'ono kumachepetsa kuthamanga ndi kutalika kwa mankhwalawa (mwa 25% ndi 9%, motsatana), koma kuchepa kwa ndende ya LDL-C kuli kofanana ndi kwa atorvastatin wopanda chakudya.

Atorvastatin bioavailability wotsika (12%), systemic bioavailability of inhibitory zochita motsutsana ndi HMG-CoA reductase ndi 30%. Kutsika kwachilengedwe kwa bioavailability kumachitika chifukwa cha kagayidwe kachakudya ka mucous membrane wam'mimba komanso "gawo loyambira" kudzera m'chiwindi.

Voliyumu yapakati yogawa atorvastatin ndi 381 malita. Zoposa 98% za atorvastatin zimamanga mapuloteni a plasma.

Atorvastatin sikuwoloka chotchinga cha magazi.

Amapangidwa makamaka mu chiwindi mothandizidwa ndi ZA4 isoenzyme ya cytochrome P450 ndikupanga ma metabolacologically yogwira metabolites (ortho- ndi parahydroxylated metabolites, mankhwala a beta-oxidation), omwe amakhala pafupifupi ndi 70% ya zotchinga zoletsa motsutsana ndi maola a 20-30.

Hafu ya theka la moyo (T1 / 2) ya atorvastatin ndi maola 14. Imapukusidwa makamaka ndi bile (sichichita mobwerezabwereza mobwerezabwereza, sichimatulutsidwa panthawi ya hemodialysis). Pafupifupi 46% ya atorvastatin imachotsedwa m'matumbo ndikuchepera 2% ndi impso.

Zizindikiro zogwiritsidwa ntchito

Zowonetsa kugwiritsa ntchito mankhwala Atoris 20 mg ndi:

Hypercholesterolemia (heterozygous mabanja komanso osakhala pabanja hypercholesterolemia (mtundu II malinga ndi Fredrickson),
Mitundu yosakanizika (yosakanizika) ya hyperlipidemia (IIa ndi IIb malinga ndi Fredrickson),
Dysbetalipoproteinemia (mtundu wa III malinga ndi Fredrickson) (monga chowonjezera pazakudya),
Familial endo native hypertriglyceridemia (mtundu wa IV wolemba Fredrickson), yogonjetsedwa ndi zakudya,
Homozygous achibale hypercholesterolemia osakwanira kudya mankhwala ndi njira zina sanali mankhwala

Kuteteza Matenda a Mtima:

Kupewera kwa mtima ndi vuto la mtima mwa odwala omwe alibe chizindikiro cha matenda a mtima, koma ndi zinthu zingapo zomwe zingayambitse kukula kwake: zaka zosaposa zaka 55, kusuta kwa chikonga, matenda oopsa, matenda ashuga, kutsika kwa HDL-C m'magazi am'magazi, kuphatikizika kwa majini, kuphatikizapo motsutsana ndi maziko a dyslipidemia,
Kupewera kwachiwiri kwa zovuta zamtima mwa odwala omwe ali ndi matenda a mtima (CHD) kuti muchepetse chiwerengero cha anthu omwalira, kulowerera m'mitsempha, matenda opha ziwalo, kuyambiranso kuchipatala kwa angina pectoris ndi kufunika kosinthanso.

Contraindication

Zotsatira pa kugwiritsa ntchito mapiritsi a Atoris:

Hypersensitivity ku zilizonse za mankhwala,
matenda a chiwindi mu gawo yogwira (kuphatikiza matenda a chiwindi, hepatitis yayitali),
matenda a chiwindi chilichonse etiology,
kuchuluka kwa "chiwindi" transaminase achilendo osachulukitsidwa katatu poyerekeza ndi malire apamwamba,
chotupa minofu matenda
Mimba ndi kuyamwa
zaka mpaka zaka 18 (Kuchita bwino komanso chitetezo sizinakhazikike),
lactase akusowa, lactose tsankho, shuga-galactose malabsorption syndrome.

Gwiritsani ntchito panthawi yoyembekezera komanso poyamwitsa

Atoris amatsutsana ndi pakati komanso poyamwitsa. Kafukufuku wazinyama akuwonetsa kuti chiwopsezo kwa mwana wosabadwa chingadutse phindu lililonse kwa mayi.

Mwa amayi omwe ali ndi zaka zakubala omwe sagwiritsa ntchito njira zodalirika zakulera, kugwiritsa ntchito Atoris sikofunikira. Pokonzekera kukhala ndi pakati, muyenera kusiya kugwiritsa ntchito Atoris osachepera mwezi umodzi musanakonzekere kutenga pakati.

Palibe umboni pakugawika kwa atorvastatin mkaka wa m'mawere. Komabe, mitundu ina ya nyama, kuchuluka kwa atorvastatin mu seramu yamagazi ndi mkaka wa nyama yotsekera ndi zofanana. Ngati n`kofunika kugwiritsa ntchito mankhwala Atoris pa mkaka wa m`mawere, pofuna kupewa chiopsezo cha zovuta mavuto ana, kuyamwitsa kuyimitsidwa.

Mlingo ndi makonzedwe

Asanayambe kugwiritsa ntchito Atoris, wodwalayo ayenera kusamutsidwa ku chakudya. kupereka kuchepa kwa ndende ya lipids m'magazi, omwe amayenera kuonedwa panthawi yonse ya mankhwala. Musanayambe chithandizo, muyenera kuyesa kuthandizira kuwongolera kwa hypercholesterolemia kudzera mu masewera olimbitsa thupi komanso kuchepa thupi kwa odwala omwe ali ndi kunenepa kwambiri, komanso chithandizo cha matenda oyambitsidwa.

Mankhwala amatengedwa pakamwa, ngakhale chakudyacho. Mlingo wa mankhwalawa umasiyana kuchokera ku 10 mg mpaka 80 mg kamodzi patsiku ndipo umasankhidwa poganizira kuchuluka kwa LDL-C, cholinga cha mankhwala ndi chithandizo cha munthu.

Atoris imatha kutengedwa kamodzi nthawi iliyonse patsiku, koma nthawi yomweyo tsiku lililonse.

The achire zotsatira zimawonedwa patatha milungu iwiri, ndipo mphamvu yake imayamba pambuyo pa milungu inayi. Chifukwa chake, mankhwalawa sayenera kusinthidwa kale kuposa masabata anayi pambuyo pa kuyamba kwa mankhwalawo m'mbuyomu.

Kumayambiriro kwa mankhwalawa komanso / kapena pakukula kwa kuchuluka kwa mankhwalawa, ndikofunikira kuyang'anira kuchuluka kwa zamadzimadzi m'madzi a m'magazi onse a 2-4 ndikusintha mlingo moyenerera.

Homozygous cholowa hypercholesterolemia

Mulingo wofanana ndi mitundu ina ya hyperlipidemia.

Mlingo woyambirira amasankhidwa payekha kutengera kuopsa kwa matendawa. Odwala ambiri omwe ali ndi homozygous cholowa hypercholesterolemia, amatha kugwiritsa ntchito mankhwalawa tsiku lililonse 80 mg (kamodzi). Atoris ® imagwiritsidwa ntchito ngati adjunctive Therapy njira zina zamankhwala (plasmapheresis) kapena chithandizo chachikulu ngati chithandizo chamankhwala ndi njira zina sichingatheke.

Gwiritsani ntchito mwa okalamba

Mwa odwala okalamba ndi odwala omwe ali ndi matenda a impso, mlingo wa Atoris suyenera kusinthidwa. Kuwonongeka kwa impso sikukhudza kuchuluka kwa atorvastatin m'madzi am'magazi kapena kuchepa kwa kuchuluka kwa LDL-C kugwiritsa ntchito atorvastatin, motero, kusintha kwa mankhwalawa sikufunika.

Kuwonongeka kwa chiwindi

Odwala omwe ali ndi vuto la chiwindi ntchito, kusamala ndikofunikira (chifukwa cha kutsika pang'ono pa mankhwalawa kuchokera mthupi). Muzochitika zotere, magawo azachipatala ndi a labotale amayenera kuyang'aniridwa mosamala (kuwunika pafupipafupi zochitika za aspartate aminotransferase (ACT) ndi alanine aminotransferase (ALT). Ndi kuwonjezeka kwakukulu kwa ntchito ya hepatic transaminases, mlingo wa Atoris uyenera kuchepetsedwa kapena chithandizo chitha.

Zotsatira zoyipa

Pogwiritsa ntchito mapiritsi a Atoris 20 mg, zotsatira zoyipa zimatha kuchitika:

Kuchokera kwamanjenje: kawirikawiri: kupweteka mutu, kusowa tulo, chizungulire, paresthesia, asthenic syndrome, mosavomerezeka: zotumphukira zamitsempha. amnesia, Hypesthesia,
Kuchokera ku ziwalo zam'malingaliro: kawirikawiri: tinnitus, kawirikawiri: nasopharyngitis, nosebleeds,
Kuchokera ku ziwalo za hemopoietic: kawirikawiri: thrombocytopenia,
Kuchokera pakapumidwe: nthawi zambiri: kupweteka pachifuwa,
Kuchokera mmimba ochita kugaya: nthawi zambiri: kudzimbidwa, dyspepsia, nseru, m'mimba. kuphwanya m'mimba, kufinya m'mimba, kuperewera: kugona, kusokonekera kwamkati, kusanza, kapamba, kawirikawiri: hepatitis, cholestatic jaundice,
Kuchokera ku minculoskeletal system: Nthawi zambiri: myalgia, arthralgia, kupweteka kumbuyo. kuphatikizika kwa molumikizana, kawirikawiri: myopathy, minofu kukokana, kawirikawiri: myositis, rhabdomyolysis, tendopathy (nthawi zina kupindika kwa tendon),
Kuchokera ku genitourinary system: mokulira: kuchepa kwa potency, kulephera kwa aimpso,
Pa khungu: pafupipafupi: zotupa pakhungu, kuyabwa, kawirikawiri: urticaria, kawirikawiri: angioedema, alopecia, zidzolo zokupha, erythema multiforme, Stevens-Johnson syndrome, poyizoni epermermal necrolysis,
Thupi lawo siligwirizana: Nthawi zambiri: Thupi lawo siligwirizana, kawirikawiri: anaphylaxis,
Zizindikiro zasayansi: pafupipafupi: kuchuluka kwa ntchito za aminotransferase (ACT, ALT), kuchuluka kwa serum creatine phosphokinase (CPK), kawirikawiri: hyperglycemia, hypoglycemia,
Ena: Nthawi zambiri: zotumphukira edema, mosachepera: malaise, kutopa, kutentha thupi, kulemera.
Chibale chomwe chimapangitsa pazovuta zina pogwiritsa ntchito mankhwala Atoris, omwe amadziwika kuti "osowa kwambiri", sichinakhazikitsidwe. Ngati zovuta zazikulu zosafunikira zikuwoneka, kugwiritsa ntchito Atoris kuyenera kuyimitsidwa.

Bongo

Milandu ya mankhwala osokoneza bongo sichinafotokozedwe.

Pankhani ya mankhwala osokoneza bongo, njira zotsatirazi ndizofunikira: kuwunikira ndikusamalira ntchito zofunikira za thupi, komanso kupewa kuyamwa kwa mankhwalawa (gastric lavage, kumwa makala oyambitsa kapena mankhwala oletsa).

Ndi chitukuko cha myopathy, chotsatira rhabdomyolysis ndi pachimake aimpso kulephera (osowa koma wamphamvu zotsatira), mankhwalawa ayenera kuthetsedwa ndipo kulowetsedwa kwa diuretic ndi sodium bicarbonate kunayambika. Ngati ndi kotheka, hemodialysis iyenera kuchitidwa. Rhabdomyolysis ikhoza kuyambitsa hyperkalemia, yomwe imafuna kukhazikika kwa khosi ya calcium chloride kapena yankho la calcium gluconate, kulowetsedwa kwa 5% yankho la dextrose (glucose) ndi insulini, kugwiritsa ntchito ma resini a potaziyamu, kapena, makamaka, hemodialysis. Hemodialysis siyothandiza.

Palibe mankhwala enieni.

Kuyanjana kwa mankhwala osokoneza bongo

Kugwiritsa ntchito pamodzi kwa atorvastatin ndi cyclosporine, maantibayotiki (erythromycin, clarithromycin, quinupristine / dalphopristine), HIV proteinase inhibitors (indinavir, ritonavir), ma antifungal agents (fluconazole, itraconazole, ketoconazole) kapena kuchuluka kwa ndende. chiopsezo chotenga myopathy ndi rhabdomyolysis ndi kulephera kwaimpso. Chifukwa chake, ndi munthawi yomweyo kugwiritsa ntchito erythromycin TCmax atorvastatin kumawonjezeka ndi 40%. Mankhwalawa amaletsa cytochrome CYP4503A4 isoenzyme, yomwe imakhudzidwa ndi metabolism ya atorvastatin m'chiwindi.

Kuyanjana kofananako ndikotheka ndikugwiritsa ntchito nthawi yomweyo atorvastatin wokhala ndi michere ndi nicotinic acid mu milid yotsitsa lipid (1 g patsiku). Kugwiritsa ntchito munthawi yomweyo mankhwala a atorvastatin 40 mg ndi diltiazem pa mlingo wa 240 mg kumabweretsa kuwonjezeka kwa ndende ya atorvastatin m'madzi a m'magazi. Kugwiritsa ntchito pamodzi kwa atorvastatin ndi phenytoin, rifampicin, komwe kumapangitsanso ma cytochrome CYP4503A4 isoenzyme, kungayambitse kuchepa kwa mphamvu ya atorvastatin. Popeza atorvastatin imapangidwa ndi ma isoenzyme a CYP4503A4 cytochrome, kugwiritsa ntchito pamodzi kwa atorvastatin ndi ma inhibitors a cytochrome CYP4503A4 isoenzyme kungayambitse kuchuluka kwa plasma ndende ya atorvastatin.

OAT31B1 protein protein inhibitors (mwachitsanzo, cyclosporine) angakulitse bioavailability wa atorvastatin.

Ndi munthawi yomweyo kugwiritsa ntchito ma antacid (kuyimitsidwa kwa magnesium hydroxide ndi aluminium hydroxide), ndende ya atorvastatin m'madzi a m'magazi amachepa.

Ndi munthawi yomweyo kugwiritsa ntchito atorvastatin ndi colestipol, ndende ya atorvastatin m'madzi am'madzi amachepetsa 25%, koma achire zotsatira zakuphatikiza ndizapamwamba kuposa mphamvu ya atorvastatin yokha.

Kugwiritsa ntchito munthawi yomweyo mankhwala a atorvastatin okhala ndi mankhwala omwe amachepetsa kuchuluka kwa mahomoni amkati (kuphatikizapo cimetidine, ketoconazole, spironolactone) kumawonjezera chiopsezo chochepetsera mahomoni amkati a steroid (kusamala kuyenera kuchitidwa).

Pogwiritsa ntchito munthawi yomweyo mankhwala a atorvastatin omwe ali ndi vuto la kulera pakamwa (norethisterone ndi ethinyl estradiol), ndizotheka kuwonjezera kuyamwa kwa njira zakulera ndikuwonjezera kukhudzidwa kwawo m'madzi a m'magazi. Kusankhidwa kwa njira zakulera mwa amayi omwe amagwiritsa ntchito atorvastatin kuyenera kuyang'aniridwa.

Kugwiritsa ntchito munthawi yomweyo atorvastatin ndi warfarin m'masiku oyambilira kumatha kuwonjezera mphamvu ya warfarin pa coagulation ya magazi (kuchepetsa kwa prothrombin nthawi).Izi zimatha pambuyo masiku 15 ogwiritsa ntchito limodzi mankhwalawa.

Ndi munthawi yomweyo kugwiritsa ntchito atorvastatin ndi terfenadine, kusintha kwakukulu mu pharmacokinetics ya terfenadine sikunapezeka.

Pogwiritsa ntchito atorvastatin ndi antihypertensive othandizira ndi ma estrogens ngati gawo lamankhwala olowa m'malo, panalibe zizindikilo zokhudzana ndi kukhudzidwa kosafunikira kwenikweni.

Kugwiritsa ntchito msuzi wa mphesa panthawi yogwiritsira ntchito Atoris® kungapangitse kuwonjezeka kwa plasma mozama kwa atorvastatin. Mwakutero, odwala omwe amamwa mankhwalawa Atoris® ayenera kupewa kumwa madzi a mphesa oposa malita 1.2 patsiku.

Malangizo apadera

Mukutenga Atoris, chiopsezo chokhala ndi myalgia chikukula. Odwala ayenera kuyang'aniridwa ndi achipatala mosalekeza. Panthawi yomwe pali zodandaula za kufooka ndi kukula kwa kupweteka kwa minofu, kugwiritsa ntchito Atoris kumayimitsidwa nthawi yomweyo.

Kapangidwe ka mankhwalawa kumaphatikizapo lactose, izi ziyenera kukumbukiridwa mwa odwala omwe ali ndi vuto lactose ndi kuchepa kwa lactase.

Mankhwala a Atoris ayenera kugwiritsidwa ntchito mosamala kwambiri odwala omwe ali ndi vuto la zakumwa zoledzeretsa ndipo ngati pali mbiri yovuta ya chiwindi.

Pomwe mawonekedwe a myopathy amawonekera, kugwiritsa ntchito Atoris kuyenera kuyimitsidwa.

Atoris imathandizira kukulitsa chizungulire, kotero, kwa nthawi yayitali ya chithandizo sayenera kuyendetsa magalimoto ndi zochitika zofunikira kwambiri.

Mankhwala Okhala Pamalo a Pharmacy

Atoris analogues ndi mankhwala otsatirawa: Liprimar, Atorvastatin-Teva, Torvakard, Liptonorm. Ngati pakufunika kusankha kwina, ndikulimbikitsidwa kuti mufunse kaye ndi dokotala wanu.

Mtengo wa mapiritsi a Atoris 20 mg pama pharmacies ku Moscow ndi:

20 mg mapiritsi, 30 ma PC. - 500-550 rub.
Mapiritsi 20 mg, 90 ma PC. - 1100-1170 rub.

Mankhwala

Mankhwala
Atorvastatin ndi wothandizira wa hypolipidemic kuchokera pagulu la ma statins. Njira yayikulu yogwirira ntchito ya atorvastatin ndikulepheretsa zochitika za 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, enzyme yomwe imathandizira kusintha kwa HMG-CoA kukhala mevalonic acid. Kusintha uku ndi limodzi mwamagawo oyambira mu cholesterol synthesis mu thupi. Kupsinjika kwa atorvastatin cholesterol synthesis kumabweretsa kuwonjezereka kwa otsika kachulukidwe lipoprotein receptors (LDL) m'chiwindi, komanso mu minyewa yowonjezera. Ma receptor amenewa amamangirira ku ma cell a LDL ndikuwachotsa ku plasma yamagazi, zomwe zimapangitsa kutsika kwa plasma cholesterol (Ch) LDL (Ch-LDL) mu plasma yamagazi.
Mphamvu ya antisulinotic ya atorvastatin ndi chifukwa cha momwe imakhudzira makoma amitsempha yamagazi ndi zigawo zamagazi. Atorvastatin linalake ndi isoprepoids, omwe ali zinthu zofunika kukula kwa mkati mwa mtsempha wamagazi. Mothandizidwa ndi atorvastatin, kuchuluka kwa mitsempha ya endothelium kumatheka, kukhazikika kwa LDL-C, apolipyrotein B (apo-B) kumachepa. triglycerides (TG). pali kuwonjezeka kwa kuchuluka kwa cholesterol yapamwamba kachulukidwe lipoproteins (HDL-C) ndi apolipoprotein A (apo-A).
Atorvastatin amachepetsa mamasukidwe akayendedwe amwazi ndi ntchito zina zophatikizika ndi kuphatikizira kwa maselo. Chifukwa cha izi, imakonza hemodynamics ndipo imasintha mkhalidwe wamathandizo. HMG-CoA reductase inhibitors imakhudzanso kagayidwe ka macrophages, kutseka kutsegulira kwawo ndikutchingira kupasuka kwa zolembera za atherosulinotic.
Monga lamulo, achire zotsatira za atorvastatin zimawonedwa pambuyo 2 milungu mankhwala, ndipo pazotheka zotsatira zimachitika pambuyo 4 milungu.
Atorvastatin pa mlingo wa 80 mg kwambiri amachepetsa chiopsezo chotenga matenda a ischemic (kuphatikizapo kufa kuchokera ku infarction ya myocardial) ndi 16%, chiwopsezo chogonekedwanso kuchipatala cha angina pectoris chotsatira ndi zizindikiro za myocardial ischemia ndi 26%.
Pharmacokinetics
Mayamwidwe a Atorvastatin ndi okwera, pafupifupi 80% amatengedwa kuchokera m'mimba. Mlingo wa mayamwidwe ndi kuchuluka kwa madzi am'magazi ukuwonjezeka molingana ndi mpesa. Nthawi yofika ndende kwambiri (TCmax), pafupifupi, maola awiri ndi awiri. Mwa akazi, TCmax ndi apamwamba kuposa 20%, ndipo dera lomwe lili pansi pa ndende (AUC) ndi 10% kutsika. Kusiyana kwa pharmacokyetics mwa odwala ndi zaka komanso jenda ndizochepa ndipo sikutanthauza kuti mpesa uzikonzedwa.
Odwala omwe ali ndi vuto la chiwindi cha chidakwa, TCmax imakhala yokwera kwambiri kuposa momwe imakhalira. Kudya pang'ono kumachepetsa kuthamanga ndi kutalika kwa mankhwalawa (mwa 25% ndi 9%, motsatana), koma kuchepa kwa ndende ya LDL-C kuli kofanana ndi kwa atorvastatin wopanda chakudya. Atorvastatin bioavailability wotsika (12%), systemic bioavailability of inhibitory zochita motsutsana ndi HMG-CoA reductase ndi 30%. Low systemic bioavailability imachitika chifukwa cha kupangika kwa kagayidwe kachakudya ka mucous membrane am'mimba ndi "gawo loyambira" kudzera m'chiwindi. Voliyumu yapakati yogawa atorvastatin ndi 381 malita. Zoposa 98% za atorvastatin zimamanga mapuloteni a plasma. Atorvastatin sikuwoloka chotchinga cha magazi. Amapangidwa makamaka mu chiwindi mothandizidwa ndi CYP3A4 isoenzyme ndikupanga metabolacologically yogwira metabolites (ortho- ndi parahydroxylated metabolites, zinthu za beta-oxidation), zomwe zimapangitsa pafupifupi 70% ya zochita zoletsa motsutsana ndi HMG-CoA-reductase kwa maola 20-30.
Hafu ya moyo (T1 / 2) wa atorvastatin ndi maola 14. Imafakidwa makamaka ndi ndulu (sichimatchulidwanso mobwerezabwereza, sichinatulutsidwe nthawi ya hemodialysis). Pafupifupi 46% ya atorvastatin imachotsedwa m'matumbo ndikuchepera 2% ndi impso.
Magulu apadera a odwala
Ana
Pali zowerengeka pazosankha zowerengeka zamasabata a 8 za ana omwe ali ndi zaka 6 - 6 ndi heterozygous Famer hypercholesterolemia ndi kuchuluka koyambirira kwa LDL cholesterol ≥4 mmol / l, omwe amathandizidwa ndi atorvastatin monga mapiritsi osavuta a 5 mg kapena 10 mg kapena mapiritsi filimu yokutidwa ndi mlingo wa 10 mg kapena 20 mg 1 nthawi patsiku, motero. Covariate yekha wofunikira mu pharmacokinetic chitsanzo cha anthu omwe amalandila atorvastatin anali kulemera kwa thupi. Kuwonekera kwa atorvastatin mwa ana sikunali kosiyana ndi kwa achikulire odwala omwe ali ndi muyeso wa allometric mwa kuchuluka kwa thupi. Mu machitidwe a atorvastatin ndi o-hydroxyatorvastatin, kuchepa kosasintha kwa LDL-C ndi LDL kunawonedwa.
Odwala okalamba
Pazitali kwambiri (Cmax) mu plasma ndi AUC ya mankhwalawa okalamba odwala (opitilira 65) ndi 40% ndi 30%, motero, apamwamba kuposa odwala okalamba a zaka zazing'ono. Panalibe kusiyana pakukwaniritsidwa komanso chitetezo cha mankhwalawo, kapena kukwaniritsa zolinga zamankhwala ochepetsa lipid mwa odwala okalamba poyerekeza ndi ambiri.
Matenda aimpso
Aimpso kuwonongeka ntchito sizikhudza kuchuluka kwa atorvastatin mu madzi am`magazi kapena kukhudzana ndi lipid kagayidwe, kotero, kusintha kwa odwala omwe ali ndi vuto laimpso sikofunikira.
Kuwonongeka kwa chiwindi
Kukumana kwa mankhwalawa kumawonjezeka kwambiri (Cmax - pafupifupi nthawi 16, AUC - pafupifupi nthawi 11) mwa odwala omwe ali ndi vuto la zakumwa zoledzeretsa (kalasi B malinga ndi gulu la Mwana-Pugh).

Gwiritsani ntchito pa nthawi yoyembekezera komanso nthawi yoyamwitsa

Mankhwala Atoris ® amatsutsana panthawi ya pakati komanso poyamwitsa.
Kafukufuku wazinyama akuwonetsa kuti chiwopsezo kwa mwana wosabadwa chingadutse phindu lililonse kwa mayi.
Mwa amayi omwe ali ndi zaka zakubala omwe sagwiritsa ntchito njira zodalirika zakulera, kugwiritsa ntchito Atoris ® sikulimbikitsidwa. Pokonzekera kukhala ndi pakati, muyenera kusiya kugwiritsa ntchito Atoris ®, osachepera, mwezi umodzi musanakonzekere kutenga pakati.
Palibe chidziwitso pakugawidwa kwa atorvastatia mkaka wa m'mawere. Komabe, mitundu ina ya nyama nthawi ya mkaka wa m'mawere, kuchuluka kwa atorvastatia mu seramu yamkaka ndi mkaka ndizofanana. Ngati mukufunika kugwiritsa ntchito mankhwala Atoris ® poyamwitsa, kuti mupewe chiwopsezo cha zochitika zoyipa makanda, kuyamwitsa kuyenera kuyimitsidwa.

Mlingo ndi makonzedwe

Asanayambe kugwiritsa ntchito mankhwala Atoris ®, wodwalayo ayenera kusinthidwa ku chakudya chomwe chimatsimikizira kuchepa kwa kuchuluka kwa lipids mu madzi am'magazi, omwe amayenera kuwonedwa panthawi yonse ya mankhwalawa. Musanayambe chithandizo, muyenera kuyesa kuthandizira kuwongolera kwa hypercholesterolemia kudzera mu masewera olimbitsa thupi komanso kuchepa thupi kwa odwala omwe ali ndi kunenepa kwambiri, komanso chithandizo cha matenda oyambitsidwa.
Mankhwala amatengedwa pakamwa, ngakhale nthawi yakudya. Mlingo wa mankhwalawa umasiyanasiyana 10 mg mpaka 80 mg I kamodzi patsiku ndipo amasankhidwa poganizira kuchuluka kwa LDL-C mu plasma, cholinga cha mankhwala ndi chithandizo cha munthu payekha.
Atoris ® imatha kutengedwa kamodzi nthawi iliyonse patsiku, koma nthawi yomweyo tsiku lililonse. The achire zotsatira zimawonedwa pambuyo 2 milungu mankhwala, ndipo pazotheka zambiri pambuyo 4 milungu.
Kumayambiriro kwa mankhwalawa komanso / kapena pakukula kwa kuchuluka kwa mankhwalawa, ndikofunikira kuyang'anira kuchuluka kwa zamadzimadzi m'madzi a m'magazi onse a 2-4 ndikusintha mlingo moyenerera.
Hypercholesterolemia yoyambirira ndi kuphatikiza (wowawasa) hyperlipidemia
Kwa odwala ambiri, mlingo woyenera wa Atoris ® ndi 10 mg kamodzi patsiku, achire amadziwonetsa yekha mkati mwa masabata awiri ndipo nthawi zambiri amakhala akufika patatha ma 4. Ndi chithandizo chakanthawi, zotsatira zake zimapitilira.
Homozygous achibale hypercholesterolemia
Nthawi zambiri, koma 80 mg amadziwika kamodzi patsiku (kuchepa kwa ndende ya LDL-C mu plasma ndi 18-45%).
Heterozygous achibale hypercholesterolemia
Mlingo woyambirira ndi 10 mg patsiku. Mlingo uyenera kusankhidwa payekhapayekha ndikuwunika kuyeneranso kumwa kwa masabata anayi alionse ndikuwonjezereka kwa 40 mg patsiku. Kenako, mwina mlingo utha kuwonjezereka mpaka 80 mg tsiku lililonse, kapena n`zotheka kuphatikiza olowa ndi michere ya bile pogwiritsa ntchito atorvastatin pa mlingo wa 40 mg patsiku.
Mtima Kupewa matenda
Mu maphunziro a kupewera koyambirira, mlingo wa atorvastatin anali 10 mg patsiku.
Kuchulukitsa kwa mankhwalawa kungakhale kofunikira kuti mukwaniritse zofunika za LDL-C zogwirizana ndi malangizo apano.
Gwiritsani ntchito ana kuyambira zaka 10 mpaka 18 ndi heterozygous Famer hypercholesterolemia
Mpesa woyambitsidwa woyamba ndi 10 mg kamodzi patsiku. Mlingo utha kuwonjezeka mpaka 20 mg patsiku, kutengera zovuta zamatenda. Zochitika ndi mlingo wopitilira 20 mg (wofanana ndi 0,5 mg / kg) ndizochepa.
Mlingo wa mankhwalawa umayenera kusankhidwa malinga ndi cholinga cha kutsitsa kwa lipid. Kusintha kwa Mlingo kuyenera kuchitika mosiyanasiyana nthawi 1 m'milungu inayi kapena kupitilira.
Kulephera kwa chiwindi
Ngati chiwindi sichikwanira, mlingo wa Atoris ® uyenera kuchepetsedwa, kuwunikira zochitika za "chiwindi" transaminases: aspartate aminotransferase (ACT) ndi alanine aminotransferase (ALT) m'magazi a m'magazi.
Kulephera kwina
Kuwonongeka kwa impso sikukhudza kuchuluka kwa atorvastatin kapena kuchepa kwa kuchuluka kwa LDL-C mu plasma, motero, kusintha kwa mankhwalawa sikofunikira (onani gawo "Pharmacokinetics").
Odwala okalamba
Panalibe kusiyanasiyana pakuchita bwino kwa achire ndi chitetezo cha atorvastatin mwa odwala okalamba poyerekeza ndi anthu ambiri, kusintha kwa mankhwalawa sikofunikira (onani gawo la Pharmacokinetics).
Gwiritsani ntchito limodzi ndi mankhwala ena
Ngati pakufunika kuigwiritsa ntchito nthawi yomweyo ndi cyclosporine, telaprevir, kapena kuphatikiza kwa tipranavir / ritonavir, mlingo wa Atoris ® sayenera kupitirira 10 mg / tsiku (onani gawo "Maupangiri Apadera").
Muyenera kusamala ndikuwonetsetsa kuti mankhwala ochepetsa mphamvu ya atorvastatin azigwiritsidwa ntchito pamene akugwiritsidwa ntchito ndi kachilombo ka HIV proteinase inhibitors, ma virus a hepatitis C proteinase inhibitors (boceprevir), clearithromycin ndi itraconazole.
Malangizo a Russian Cardiological Society, a National Society for the Study of Atherosulinosis (NLA) ndi Russian Society of Cardiosomatic Regencyation and Secondary Prevention (RosOKR) (V rev 2012)
Kuzungulira kwakukulu kwa LDL-C ndi cholesterol yathunthu kwa odwala omwe ali pachiwopsezo chachikulu ndi: ≤2.5 mmol / L (kapena ≤100 mg / dL) ndi ≤4.5 mmol / L (kapena ≤ 175 mg / dL), motsatana komanso kwa odwala omwe ali ndi chiopsezo chachikulu: ≤1.8 mmol / l (kapena ≤70 mg / dl) ndi / kapena, ngati sizingatheke, tikulimbikitsidwa kuchepetsa kuchuluka kwa LDL-C ndi 50% kuchokera ku mtengo woyambira ndi ≤4 mmol / l (kapena ≤150 mg / dl), motero.

Zotsatira zoyipa

Kugawidwa kwa mavuto obwera chifukwa cha World Health Organisation (WHO):

nthawi zambiri

≥1/10

nthawi zambiri

≥1 / 100 mpaka 1/1000 kuti Matenda opatsirana komanso parasitic:
Nthawi zambiri: nasopharyngitis.
Kusokonezeka kwa magazi ndi dongosolo la lymphatic:
kawirikawiri: thrombocytopenia.
Matenda owononga chitetezo chamthupi:
Nthawi zambiri:
chosowa kwambiri: anaphylaxis.
Matenda a Metabolic ndi zakudya:
pafupipafupi: kulemera, kudwala,
osowa kwambiri: hyperglycemia, hypoglycemia.
Mavuto amisala:
Nthawi zambiri: Kusokonezeka kwa tulo, kuphatikizira kugona tulo ndi maloto a "zovuta":
pafupipafupi osadziwika: kukhumudwa.
Kuphwanya kwamanjenje:
Nthawi zambiri: mutu, chizungulire, paresthesia, asthenic syndrome,
pafupipafupi: zotumphukira neuropathy, Hypesthesia, kukoma mkhutu, kuwonongeka kapena kuiwalika.
Kumva mavuto ndi vuto la labyrinth:
pafupipafupi: tinnitus.
Zovuta za kupuma,
Nthawi zambiri: zilonda zapakhosi, mphuno,
pafupipafupi osadziwika: milandu yokhala patali ya matenda am'mapapo (nthawi zambiri amakhala akugwiritsidwa ntchito kwa nthawi yayitali).
Matumbo:
Nthawi zambiri: kudzimbidwa, dyspepsia, nseru, kutsegula m'mimba, kusanza (kutulutsa mabala), kupweteka kwam'mimba,
pafupipafupi: kusanza, kapamba.
Kuphwanya chiwindi ndi chindapusa:
kawirikawiri: hepatitis, cholestatic jaundice.
Zovuta za pakhungu ndi minofu yolowera:
Nthawi zambiri: zotupa pakhungu, kuyabwa,
kawirikawiri: urticaria,
osowa kwambiri: angioedema, alopecia, zidzolo zokupha, erythema multiforme, Stevens-Johnson syndrome, poermal necrolysis yoopsa.
Kuphwanya minofu:
Nthawi zambiri: myalgia, arthralgia, kupweteka kwa msana, kutupa kwa mafupa,
kawirikawiri: myopathy, minofu kukokana,
kawirikawiri: myositis, rhabdomyolysis, genopathy (nthawi zina amakhala ndi chotupa cha tendon),
pafupipafupi osadziwika: milandu ya noncrotizing myopathy.
Kuphwanya impso ndi kwamikodzo thirakiti:
pafupipafupi: kulephera kwachiwiri kwaimpso.
Kuphwanya maliseche ndi chithokomiro cha mayi:
chosawerengeka: kusowa pogonana,
osowa kwambiri: gynecomastia.
Zovuta ndi zovuta zina pamalo opangira jakisoni:
Nthawi zambiri: zotumphukira edema,
pafupipafupi: kupweteka pachifuwa, malaise, kutopa, kutentha thupi.
Zambiri zasayansi:
pafupipafupi: kuchuluka kwa aminotransferase (ACT, ALT), kuchuluka kwa serum creatine phosphokinase (CPK) m'madzi a m'magazi,
kawirikawiri kwambiri: kuchuluka kwa glycosylated hemoglobin (HbAl).
Chiyanjano cha zotsatira zina zosasangalatsa ndikugwiritsa ntchito mankhwala Atoris ®, omwe amadziwika kuti "osowa kwambiri", sanakhazikitsidwe. Ngati zovuta zazikulu zosafunikira zikuwoneka, kugwiritsa ntchito Atoris ® kuyenera kusiyidwa.

Kutulutsa Fomu

Mapiritsi okhala ndi mafilimu, 10 mg ndi 20 mg.
10 mapiritsi pachimake (chovala matuza) kuchokera pazophatikizira polyamide / aluminium zojambulazo / PVC - zojambulazo aluminiyamu (Coldforming OPA / A1 / PVC-AI).
1, 3, 6 kapena 9 matuza (matuza) pamodzi ndi malangizo ogwiritsira ntchito adzaikidwa pabokosi la makatoni.

Zochita zamankhwala osokoneza bongo

Chiwopsezo chokhala ndi myopathy chimawonjezeka panthawi ya chithandizo ndi HMG-CoA reductase inhibitors ndi kugwiritsa ntchito nthawi yomweyo cyclosporin, zotuluka za fibroic acid, boceprevir, nicotinic acid ndi cytochrome P450 3A4 inhibitors. Odwala nthawi yomweyo amatenga atorvastatin ndi boceprevir, tikulimbikitsidwa kugwiritsa ntchito Atoris® pang'onopang'ono poyambira kumwa ndikuwonetsetsa. Pa kuphatikiza pamodzi ndi boceprevir, mlingo wa atorvastatin wa tsiku lililonse sayenera kupitirira 20 mg.

Malipoti osowa kwambiri a immuno-Mediated necrotizing myopathy (OSI) adanenedwa nthawi kapena atatha kulandira chithandizo ndi ma statins, kuphatikizapo atorvastatin. OSI imadziwika ndi kufooka kwa minofu komanso kuchuluka kwamphamvu kwa serum creatine kinase, komwe kumapitilira ngakhale kuchotsedwa kwa mankhwala a statin.

P450 3A4 Inhibitors: atorvastatin imapangidwa ndi cytochrome P450 3A4. Kugwiritsa ntchito nthawi yomweyo kwa Atoris ndi cytochrome P450 3A4 inhibitors kungayambitse kuchuluka kwa atorvastatin m'madzi a m'magazi. Mlingo wogwirizana komanso kuthekera kwa zotengera kumatengera kusinthasintha kwa zochitika pa cytochrome P450 3A4.

Kugwiritsa ntchito nthawi imodzi zolimba zoletsaP450 3A4(mwachitsanzo, cyclosporine, telithromycin, clarithromycin, delavirdine, styripentol, ketoconazole, voriconazole, itraconazole, posaconazole ndi ma proteinase zoletsa za HIV.kuphatikiza ritonavir, lopinavir, atazanavir, indinavir, darunavir, etc..) ayenera kupewedwa momwe angathere. Mu milandu momwe munthawi yomweyo kugwiritsa ntchito mankhwalawa ndi atorvastatin sikupewedwa, tikulimbikitsidwa kupereka mankhwala ochepa komanso oyambira a atorvastatin, komanso kuchita moyenera matenda omwe wodwala ali nawo.

Zoletsa zolimbitsa thupiP450 3A4 (i.e. erythromycin, diltiazem, verapamil ndi fluconazole) atha kuwonjezera plasma woipa wa atorvastatin. Mukamagwiritsa ntchito erythromycin kuphatikiza ndi ma statins, pamakhala chiwopsezo chowonjezereka cha myopathy. Maphunziro oyanjana omwe amawunika zotsatira za amiodarone kapena verapamil pa atorvastatin sanachitike. Onseododone ndi verapamil amalepheretsa zochitika za P450 3A4, ndipo kugwiritsa ntchito kwawo ndi atorvastatin kungayambitse kuwonetsa kwambiri kwa atorvastatin. Chifukwa chake, pogwiritsa ntchito munthawi yomweyo P450 3A4 inhibitors, tikulimbikitsidwa kupereka mankhwala ochepetsa mphamvu ya atorvastatin ndikuyang'anira wodwala. Kuwunika koyenera kovomerezeka kumathandizidwa pambuyo poyambitsa chithandizo kapena mutasintha mlingo wa inhibitor.

Transporter inhibitors: atorvastatin ndi ma metabolites ake ndi gawo lapansi la OATP1B1 transporter. OATP1B1 inhibitors (mwachitsanzo, cyclosporine) angakulitse bioavailability wa atorvastatin. Kugwiritsa ntchito pamodzi kwa 10 mg ya atorvastatin ndi cyclosporine (5.2 mg / kg / tsiku) kumabweretsa kuwonjezereka kwa kuwonetsa kwa atorvastatin ndi nthawi 7.7.

Pogwiritsa ntchito munthawi yomweyo atorvastatin ndi zoletsa za CYP3A4 isoenzyme kapena mapuloteni onyamula, kuwonjezeka kwa kuchuluka kwa atorvastatin m'madzi am'magazi komanso chiopsezo cha myopathy ndikotheka. Chiwopsezochi chitha kukulira ndi kugwiritsa ntchito nthawi yomweyo atorvastatin ndi mankhwala ena omwe amatha kuyambitsa myopathy, monga zotumphukira za fibroic acid ndi ezetimibe.

Erythromycin / clarithromycin: ndi munthawi yomweyo kugwiritsa ntchito atorvastatin ndi erythromycin (500 mg kanayi patsiku) kapena clarithromycin (500 mg kawiri pa tsiku), zomwe zimalepheretsa cytochrome P450 3A4, kuwonjezeka kwa kuchuluka kwa atorvastatin m'magazi a magazi kumawonedwa.

Protease Inhibitors: Kugwiritsira ntchito kwa atorvastatin ndi ma proteinase zoletsa wotchedwa cytochrome P450 3A4 inhibitors limodzi ndi kuwonjezeka kwa plasma mozama kwa atorvastatin.

Diltiazem hydrochloride: kugwiritsa ntchito munthawi yomweyo mankhwala a atorvastatin (40 mg) ndi diltiazem (240 mg) kumawonjezera kuchuluka kwa atorvastatin m'madzi a m'magazi.

Cimetidine: Kafukufuku adachitika pa kuyanjana kwa atorvastatin ndi cimetidine, palibe machitidwe apakati pazachipatala omwe adapezeka.

Itraconazole: kugwiritsa ntchito munthawi yomweyo mankhwala a atorvastatin (20 mg-40 mg) ndi itraconazole (200 mg) kumabweretsa kuwonjezeka kwa AUC ya atorvastatin.

Madzi a Mphesa: ili ndi chimodzi kapena ziwiri zomwe zimalepheretsa CYP 3A4 ndipo zitha kuwonjezera kuchuluka kwa atorvastatin m'madzi am'magazi, makamaka kumwa kwambiri madzi a mphesa (oposa malita 1.2 patsiku).

Zowonetsa za cytochrome P450 3A4: kugwiritsa ntchito munthawi yomweyo mankhwala a atorvastatin okhala ndi cytochrome P450 3A4 inducers (efavirenz, rifampin ndi kukonzekera kwa wort wa St. John) kungayambitse kuchepa kwa kuchuluka kwa atorvastatin m'madzi a m'magazi. Popeza magawo awiri a zochita za rifampin (kulowetsedwa kwa cytochrome P450 3A4 ndi kuletsa kwa mphamvu ya OATP1B1 mu chiwindi), tikulimbikitsidwa kupereka Atoris® nthawi yomweyo ndi rifampin, popeza kutenga atoris pambuyo pa rifampin kumabweretsa kuchepa kwakukulu kwa mulingo wa atorvastatin m'magazi.

Maantacid: kuyambitsa munthawi yomweyo kwa kuyimitsidwa komwe kumakhala ndi magnesium ndi ma aluminium hydroxides kunachepetsa kuchuluka kwa atorvastatin m'madzi amwazi ndi pafupifupi 35%, komabe, kuchepa kwa zomwe LDL-C sinasinthe sizinasinthe.

Antipyrine: atorvastatin sichikhudza pharmacokinetics ya antipyrine, chifukwa chake, kuyanjana ndi mankhwala ena omwe amapangidwa ndi cytochrome isoenzymes yomwe sayembekezereka.

Gemfibrozil / fibroic acid zotumphukira: monotherapy yokhala ndi ma fibrate nthawi zina imayendera limodzi ndi zovuta zosachokera ku minofu, kuphatikizapo rhabdomyolysis. Chiwopsezo cha zinthu izi chikhoza kuwonjezeka ndi makonzedwe amodzi a zotumphukira za fibroic acid ndi atorvastatin. Ngati kugwiritsa ntchito munthawi yomweyo sikungapewedwe, kuti mukwaniritse cholinga chothandizira, mulingo wochepetsetsa wa atorvastatin uyenera kugwiritsidwa ntchito ndipo odwala ayenera kuyang'aniridwa moyenera.

Ezetimibe: Ezetimibe monotherapy imayendera limodzi ndi zovuta kuchokera kumisempha, kuphatikizapo rhabdomyolysis. Zotsatira zake, chiwopsezo cha izi chimatha kuwonjezeka ndi makulidwe amodzi a ezetimibe ndi atorvastatin. Kuwunika koyenera kumalimbikitsidwa mwa odwalawa.

Colestipol: ndi munthawi yomweyo kugwiritsa ntchito colestipol, kuchuluka kwa atorvastatin m'madzi am'magazi kunatsika pafupifupi 25%, komabe, lipid-kutsitsa mphamvu ya kuphatikiza kwa atorvastatin ndi colestipol imaposa ya aliyense mankhwala payekhapayekha.

Digoxin: Ndi mobwerezabwereza makonzedwe a digoxin ndi atorvastatin pa 10 mg, kuchuluka kwa ndende ya digoxin m'madzi a m'magazi sikunasinthe. Komabe, pamene digoxin imagwiritsidwa ntchito limodzi ndi atorvastatin pa mlingo wa 80 mg / tsiku, kuchuluka kwa digoxin kumawonjezeka pafupifupi 20%. Odwala omwe amalandira digoxin osakanikirana ndi atorvastatin amafunikira kuwunika koyenera.

Azithromycin: kugwiritsa ntchito munthawi yomweyo atorvastatin (10 mg kamodzi patsiku) ndi azithromycin (500 mg kamodzi patsiku), kuchuluka kwa atorvastatin mu plasma sikunasinthe.

Kulera kwamlomo: ndi munthawi yomweyo kugwiritsa ntchito atorvastatin komanso kuletsa kwa pakamwa komwe kumakhala ndi norethindrone ndi ethinyl estradiol, panali kuwonjezeka kwakukulu mu AUC ya norethindrone ndi ethinyl estradiol pafupifupi 30% ndi 20%, motero. Izi ziyenera kuganiziridwa posankha njira yakulera yolerera ya pakamwa ya mayi yemwe akutenga atorvastatin.

Warfarin: mu kafukufuku wazachipatala kwa odwala omwe amalandira chithandizo cha warfarin kwa nthawi yayitali, kugwiritsa ntchito pamodzi kwa atorvastatin pa mlingo wa 80 mg patsiku ndi warfarin kunapangitsa kuchepa kwapang'onopang'ono kwa prothrombin nthawi ndi pafupifupi masekondi 1.7 mkati mwa masiku 4 oyambirira a mankhwala, omwe abwerera mwachangu mkati mwa masiku 15 a chithandizo atorvastatin. Ngakhale milandu yocheperako kwambiri yokhudzana kwambiri ndi ma anticoagulants imanenedwa, odwala omwe atenga coumarin anticoagulants, nthawi ya prothrombin iyenera kutsimikizika musanayambe chithandizo ndi atorvastatin ndipo nthawi zambiri mokwanira m'magawo oyambira othandizira kuti mutsimikizire kuti palibe kusintha kwakukulu kwa nthawi ya prothrombin. Nthawi yokhazikika ya prothrombin ikajambulidwa, imatha kuyang'aniridwa pafupipafupi yomwe amalimbikitsa odwala omwe amalandila coumarin anticoagulants. Ndondomeko yomweyo iyenera kubwerezedwa pakusintha kwa atorvastatin kapena kufalikira. Atorvastatin mankhwala sanali limodzi ndi milandu magazi kapena kusintha kwa prothrombin nthawi odwala ayi

Warfarin: Palibe kuyanjana kwakukulu kwa atorvastatin ndi warfarin komwe kwapezeka.

Amlodipine: ndi munthawi yomweyo kugwiritsa ntchito atorvastatin 80 mg ndi amlodipine 10 mg, ma pharmacokinetics a atorvastatin mu boma lofanana sanasinthe.

Colchicine: Ngakhale kafukufuku wazokhudza atorvastatin ndi colchicine sanachitepo, milandu ya myopathy yanenedwa kuti pali ogwiritsira ntchito a atorvastatin ndi colchicine.

Fusidic acid: maphunziro pa mgwirizano wa atorvastatin ndi fusidic acid sanachitidwe, komabe, milandu ya rhabdomyolysis ndi kugwiritsa ntchito kwawo munthawi yomweyo inanenedwa m'maphunziro a malonda otsatsa. Chifukwa chake, odwala ayenera kuyang'aniridwa ndipo ngati kuli koyenera, chithandizo cha Atoris chitha kuyimitsidwa kwakanthawi.

Mankhwala ena ophatikizika: mu maphunziro azachipatala, atorvastatin adagwiritsidwa ntchito limodzi ndi mankhwala a antihypertensive ndi estrogens, omwe adapangidwira ndi cholinga cholowa m'malo, panalibe zizindikiritso zothandizidwa mosafunikira.

Zochita pa chiwindi

Pambuyo pa mankhwala a atorvastatin, kuwonjezeka kwakukulu (kopitilira katatu poyerekeza ndi malire apamwamba) a serum ntchito ya "chiwindi" transaminases adadziwika.

Kuwonjezeka kwa ntchito ya hepatic transaminases nthawi zambiri sikumayendetsedwa ndi jaundice kapena mawonekedwe ena achipatala. Ndi kuchepa kwa mlingo wa atorvastatin, kusiya kwakanthawi kapena kwathunthu kwa mankhwalawa, zochitika za hepatic transaminases zimabweza msanga. Odwala ambiri anapitiliza kumwa atorvastatin muyezo wochepetsedwa popanda zotsatira.

Ndikofunikira kuwunika zizindikiro za chiwindi nthawi yonse ya chithandizo, makamaka ngati zizindikiro za kuwonongeka kwa chiwindi zikuwoneka. Pakuwonjezereka kwa zomwe zili mu hepatic transaminases, ntchito zawo ziyenera kuyang'aniridwa mpaka malire azomwe amapezeka. Ngati kuchuluka kwa ntchito ya AST kapena ALT mwa kuchulukitsa katatu poyerekeza ndi malire apamwamba anakhalabe, tikulimbikitsidwa kuti mankhwalawo athetsedwe kapena kufooketsedwa.

Mafupa a minofu

Pofotokoza atorvastatin mu hypolipidemic Mlingo wophatikizana ndi zotumphukira za fibroic acid, erythromycin, immunosuppressants, azole antifungal mankhwala kapena nicotinic acid, dokotala ayenera kuyang'anitsitsa mosamala zopindulitsa ndi zoopsa zamankhwala ndikuwonetsetsa odwala kuti azindikire kupweteka kapena kufooka kwa minofu, makamaka m'miyezi yoyambirira. mankhwala ndi nthawi kuchuluka Mlingo wa mankhwala. Muzochitika zotere, kutsimikiza kwakanthawi kantchito ya CPK kungalimbikitsidwe, ngakhale kuwunika koteroko sikumalepheretsa kukula kwa myopathy. Atorvastatin ikhoza kuyambitsa kuwonjezeka kwa ntchito ya creatine phosphokinase.

Pogwiritsa ntchito atorvastatin, milandu yovuta ya rhabdomyolysis yovuta kwambiri chifukwa cha myoglobinuria ndi myoglobinemia afotokozedwa. Mankhwala a Atorvastatin ayenera kusiyidwa kwakanthawi kapena kusiyiratu ngati pali zizindikiro za kuthekera kwa myopathy kapena vuto lomwe lingakhalepo chifukwa chokhala ndi kulephera kwa impso chifukwa cha rhabdomyolysis (mwachitsanzo, matenda opweteka kwambiri, kusokonekera kwa hypotension, opaleshoni yayikulu, kuvulala, metabolic, endocrine ndi kusokonekera kwa elekitirodi.

Zambiri za wodwala: odwala akuyenera kuchenjezedwa kuti ayenera kupita kwa dokotala nthawi yomweyo ngati ululu wosakhudzika kapena kufooka m'misempha kumawonekera, makamaka ngati akuphatikizidwa ndi malaise kapena malungo.

Gwiritsani ntchito mosamala odwala omwe amamwa mowa kwambiri komanso / kapena omwe ali ndi matenda a chiwindi (mbiri).

Kafukufuku wofufuza wa 4731 odwala wopanda matenda a mtima (CHD) omwe adadwala matenda opha ziwopsezo m'miyezi 6 yapitayo ndipo omwe adayamba kumwa atorvastatin 80 mg adawonetsa kuchuluka kwa mikwingwirima ya hemorrhagic m'gululi limatenga 80 mg ya atorvastatin poyerekeza ndi placebo ( 55 pa atorvastatin motsutsana 33 pa placebo). Odwala omwe ali ndi vuto la hemorrhagic adawonetsa chiopsezo chobwereza sitiroko (7 pa atorvastatin motsutsana ndi 2 pa placebo). Komabe, odwala omwe amamwa atorvastatin 80 mg anali ndi mikwingwirima yocheperako yamtundu uliwonse (265 motsutsana ndi 311) komanso matenda ochepa a mtima.

Matenda am'mapapo

Pogwiritsa ntchito ma statins ena, makamaka ndi chithandizo cha nthawi yayitali, milandu yachilendo kwambiri yamankhwala yati yanenedwa. Kuwonekera kungaphatikizepo dyspnea, chifuwa chosabereka, ndi thanzi labwino (kutopa, kuchepa thupi, komanso kutentha thupi). Ngati mukukayikira wodwala yemwe ali ndi matenda am'mapapo ochepa, chithandizo cha statin chiyenera kusiyidwa.

Umboni wina ukusonyeza kuti ma statins, monga kalasi, amawonjezera shuga m'magazi ndipo mwa odwala ena omwe ali pachiwopsezo chachikulu chotenga matenda obwera ndi matenda am'tsogolo, amatha kutsogolera matenda a hyperglycemia, momwemo ndikofunikira kuyamba chithandizo cha matenda ashuga. Komabe, chiwopsezochi chikuwonjezeredwa ndi maubwino ochepetsa chiwopsezo ku mitsempha yamagazi ndi ma statins, chifukwa chake sayenera kukhala chifukwa choletsa chithandizo cha statin. Odwala omwe ali pachiwopsezo (shuga othamanga a 5.6-6.9 mmol / l, BMI> 30 kg / m2, okwera triglycerides, matenda oopsa)

Iyenera kuwunikiridwa mothandizidwa ndi zamankhwala mothandizidwa ndi malangizo amtundu uliwonse.

Mimba komanso kuyamwa

Amayi a msinkhu wobereka ayenera kugwiritsa ntchito njira zokwanira zolerera panthawi ya chithandizo. Atorvastatin itha kutumizidwa kwa amayi omwe ali ndi zaka zakubadwa pokhapokha ngati mwayi wokhala ndi pakati ndi wochepa kwambiri, ndipo wodwalayo akudziwitsidwa za chiopsezo chotheka kwa mwana wosabadwayo panthawi ya chithandizo.

Chenjezo lapadera za omwe adzalandira Atoris® ili ndi lactose. Odwala omwe ali ndi chibadwa cha galactose chosowa chambiri, kuperewera kwa lappase, kapena glucose-galactose malabsorption sayenera kumwa mankhwalawa. Zomwe zimachitika chifukwa cha mankhwalawa amatha kuyendetsa galimoto komanso njira zoopsa

Poganizira zovuta za mankhwalawa, kusamala kuyenera kugwiritsidwa ntchito poyendetsa magalimoto ndi njira zina zowopsa.

Wogwirizira Sitifiketi Yoyang'anira

Krka, dd, Novo mesto, Slovenia

Adilesi ya bungweli yomwe imalandila zofunsidwa kuchokera kwa ogula pamsika wa zinthu (katundu) mdera la Republic of Kazakhstan ndipo imayang'anira kuyang'anira kulembetsa kwa chitetezo cha mankhwala m'dera la Republic of Kazakhstan

Krka Kazakhstan LLP, Kazakhstan, 050059, Almaty, Al-Farabi Ave. 19,