Atorvastatin 20 mg - malangizo > Chithandizo ndi kupewa

Mapiritsi okhala ndi mafilimu, 20 mg.

Piritsi limodzi lili

yogwira mankhwala - atorvastatin (munthawi ya mchere wa atorvastatin) - 20 mg
Excipients - lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hypromellose 2910, polysorbate 80, calcium stearate, calcium calcium
kaphatikizidwe kazigoba - hypromellose 2910, polysorbate 80, titanium dioxide (E 171), talc

Mapiritsi ozungulira ozungulira a biconvex. Pa nthawi yopuma, miyala ndi yoyera kapena pafupifupi yoyera.

Mankhwala

Hypolipidemic wothandizila kuchokera pagulu la statins. Njira yayikulu yogwirira ntchito ya atorvastatin ndikulepheretsa ntchito ya 3-hydroxy-3-methylglutarylcoenzyme 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 LDL receptors (otsika kachulukidwe lipoproteins) mu chiwindi, komanso mu minyewa yowonjezera. Ma receptor amenewa amamanga tinthu tating'onoting'ono ta LDL ndikuwachotsa m'madzi a m'magazi, zomwe zimapangitsa kutsika cholesterol ya LDL m'magazi.

Mphamvu ya antisulinotic ya atorvastatin ndi chifukwa cha zotsatira za mankhwala pazitseko zamitsempha yamagazi ndi zigawo zamagazi. Mankhwala tikulephera kaphatikizidwe isoprenoids, omwe ali zinthu kukula kwa mkati mwa mtsempha wamagazi. Mothandizidwa ndi atorvastatin, kukula kwa kudalira kwa endothelium kumayenda bwino. Atorvastatin amatsitsa cholesterol, otsika kachulukidwe lipoprotein, apolipoprotein B, triglycerides. Zimayambitsa kuwonjezeka kwa cholesterol ya HDL (lipotroteins high) ndi apolipoprotein A.

Kuchita kwa mankhwalawa, monga lamulo, kumachitika pakatha milungu iwiri ya makonzedwe, ndipo mphamvu yakeyo imatheka patadutsa milungu inayi.

Pharmacokinetics

Mafuta ndi okwera. Nthawi yofika kwambiri ndende ndi maola 1-2, kuchuluka kwambiri kwa azimayi ndi 20% kuposa, AUC (dera lomwe ili pansi pajika) ndi 10%, kutsika kwambiri kwa odwala omwe ali ndi vuto la zakumwa zoledzeretsa kuli kangapo 16, Auc ndi 11 kuposa momwe amagwirira. Kudya pang'ono kumachepetsa kuthamanga ndi kutalika kwa mankhwalawa (mwa 25% ndi 9%, motsatana), koma kuchepa kwa cholesterol ya LDL ndikofanana ndi kugwiritsidwa ntchito kwa atorvastatin popanda chakudya. Kuchulukitsidwa kwa atorvastatin pamene ntchito madzulo kumatsika kuposa m'mawa (pafupifupi 30%). Ubale wapakati pakati pa kuchuluka kwa mayamwidwe ndi mlingo wa mankhwalawo unawululidwa.

Bioavailability - 14%, zokhudza bioavailability wa zoletsa ntchito motsutsana HMG-CoA reductase - 30%. Kutsika kwachilengedwe kwa bioavailability kumachitika chifukwa cha kagayidwe kachakudya ka mucous membrane wa m'mimba ndipo mkati mwa "gawo loyamba" kudzera pachiwindi.

Kuchulukitsa kwapakati kumagawa ndi 381 l, kulumikizana ndi mapuloteni a plasma ndi 98%. Amapangidwa makamaka mu chiwindi mothandizidwa ndi cytochrome P450 CYP3A4, CYP3A5 ndi CYP3A7 mapangidwe a metabolac yogwira metabolites (ortho- ndi parahydroxylated zotengera, mankhwala a beta-oxidation). Mphamvu yoletsa kukonzekera kwa mankhwala oletsa HMG-CoA reductase ndi pafupifupi 70% yotsimikizika ndi ntchito yozungulira metabolites.

Imafukusidwa mu ndulu pambuyo pakuchepa kwa hepatic ndi / kapena metabolism yowonjezera (sikuti imayambiranso kwambiri).

Hafu ya moyo ndi maola 14. Ntchito ya inhibitory motsutsana ndi HMG-CoA reductase imangokhalira pafupifupi maola 20-30, chifukwa cha kukhalapo kwa metabolites yogwira. Osakwana 2% ya mlingo wa pakamwa amadziwika mu mkodzo.

Sichotsetsedweratu pa hemodialysis.

Zizindikiro zogwiritsidwa ntchito

Zowonetsa kugwiritsa ntchito atorvastatin ndi:

hypercholesterolemia, monga chowonjezera chazakudya zochizira odwala omwe ali ndi kuchuluka kwa cholesterol, LDL cholesterol (otsika kachulukidwe lipoproteins), apolipoprotein B ndi triglycerides, komanso kuwonjezera HDL cholesterol (High density lipoprotein) mwa odwala okhala ndi hypercholesterolemia heteria non-hereditary hypercholesterolemia), yophatikizika (yosakanikirana) hyperlipidemia (Fredrickson mtundu IIa ndi IIb), milingo yayikulu ya plasma triglyceride (Fredrickson mtundu III), m'malo pomwe zakudya sizikhala ndi zotsatira zokwanira.
Kuchepetsa cholesterol yathunthu ndi LDL cholesterol mwa odwala homozygous cholowa hypercholesterolemia m'malo osakwanira chifukwa chakudya kapena njira zina zosagwiritsa ntchito mankhwala.
prophlaxis mwa odwala omwe alibe zizindikiro zamatenda a mtima, kapena opanda dyslipidemia, koma ali ndi zovuta zambiri pamatenda amtima monga kugwirira, matenda oopsa, matenda a shuga, otsika HDL cholesterol (HDL-C), kapena koyambirira matenda a mtima mu mbiri ya banja (kuchepetsa chiopsezo cha kufa kwa matenda am'mitima ya coronary ndi infarction ya non-fatty myocardial, kuchepetsa chiopsezo cha sitiroko).

Zotsatira za pharmacological

The pharmacological zotsatira ndi hypolipidemic.

Chithandizo chogwira chimalepheretsa enzyme HMG-CoA reductase, yomwe imakhudzana ndi kapangidwe ka cholesterol ndi lipotrotein ya atherogenic komanso imakulitsa kuchuluka kwa ma membrane a cell ya hepatic omwe amalanda LDL. Kumwa mankhwalawa 20 mg kumabweretsa kutsika kwa cholesterol wokwanira ndi 30-46%, lipoproteins wotsika ndi 41-61%, triglycerides ndi 14-33%, komanso kuwonjezeka kwa osachulukitsa a antiatherogenic lipoproteins.

Kukhazikitsa mankhwala muyezo waukulu wa 80 mg kumayambitsa kuchepa kwa vuto la mtima, kuchepa kwa ziwopsezo komanso kufupikitsa kwa zipatala kuchipatala cha mtima, kuphatikizapo odwala omwe ali pachiwopsezo chachikulu.

Mlingo wa mankhwalawa umasinthidwa malinga ndi mulingo wa LDL.

Kuchita bwino kumakwaniritsidwa mwezi umodzi pambuyo poyambira chithandizo.

Pharmacokinetics: wotengedwa kuchokera m'mimba thirakiti, kufikira pazambiri za plasma pambuyo pa maola 1-2. Kudya ndi nthawi yamasiku sikukhudza kugwira ntchito. Kutengedwa mu plasma protein protein state. Amaphatikizidwa mu chiwindi ndikupanga ma metabolacogic metabolites. Amachotseredwa ndi bile.

Kwa odwala omwe ali ndi zaka zopitilira 65, poyerekeza ndi odwala achichepere, mphamvu ndi chitetezo cha mankhwalawa ndizofanana.

Kuchepetsa kuchepa kwa impso sikukhudza kagayidwe ndi katemera wa mankhwalawa ndipo sikutanthauza kusintha kwa mlingo.

Kukomoka kwambiri kwa chiwindi ndi kutsutsana kwa kugwiritsa ntchito atorvastatin.

Chifukwa chiyani mapiritsi Atorvastatin 20

Zisonyezero zogwiritsidwa ntchito:

kagayidwe kachakudya matenda lipoproteins ndi zina lipidemia,
Hypercholesterolemia
Hypertriglyceridemia
Hyperlipidemia yosakanizidwa
kupewa zochitika za mtima ndi odwala omwe ali pachiwopsezo chachikulu,
matenda a mtima (angina pectoris, infarction ya myocardial),
adadwala sitiroko.

Mankhwala

Pharmacokinetics

Mafuta ndi okwera. Kutha kwa theka-moyo ndi maola 1-2, Cmax mwa akazi ndi 20% apamwamba, AUC ndi otsika 10%, Cmax mwa odwala omwe ali ndi vuto la chiwindi cha chidakwa ndi 16, AUC ndi 11 peresenti kuposa momwe imakhalira. Kudya pang'ono kumachepetsa kuthamanga ndi kutalika kwa mankhwalawa (mwa 25 ndi 9%, motsatana), koma kuchepa kwa cholesterol ya LDL kuli chimodzimodzi ndi kugwiritsidwa ntchito kwa atorvastatin popanda chakudya. Kuchulukitsidwa kwa atorvastatin pamene ntchito madzulo kumatsika kuposa m'mawa (pafupifupi 30%). Ubale wapakati pakati pa kuchuluka kwa mayamwidwe ndi mlingo wa mankhwalawo unawululidwa. Bioavailability - 14%, zokhudza bioavailability wa zoletsa ntchito motsutsana HMG-CoA reductase - 30%. Systemic bioavailability yochepa imayamba chifukwa cha kagayidwe kachakudya m'matumbo am'mimba komanso mu "gawo loyamba" kudzera pachiwindi. Kuchulukitsa kwapakati kumagawa ndi 381 l, kulumikizana ndi mapuloteni a plasma ndi oposa 98%. Amapangidwa makamaka mu chiwindi mothandizidwa ndi cytochrome CYP3A4, CYP3A5 ndi CYP3A7 ndikupanga ma metabolac yogwira metabolites (ortho ndi parahydroxylated, mankhwala a beta oxidation). In vitro, ortho- ndi para-hydroxylated metabolites imalepheretsa kusintha kwa HMG-CoA, kufananizidwa ndi atorvastatin. Mphamvu yoletsa kukonzekera kwa mankhwalawa motsutsana ndi HMG-CoA reductase pafupifupi 70% yotsimikizika ndi ntchito yozungulira metabolites ndipo imapitilira pafupifupi maola 20-30 chifukwa cha kupezeka kwawo. Kuchotsa theka-moyo ndi maola 14. Imafukusidwa mu ndulu pambuyo pakuchepa kwa hepatic ndi / kapena metabolism yowonjezera (sikuti imayambiranso kwambiri). Osakwana 2% ya mlingo wa pakamwa amadziwika mu mkodzo. Sichotsetsedwedwa pa hemodialysis chifukwa chomangirira mapuloteni a plasma. Ndi kulephera kwa chiwindi kwa odwala omwe ali ndi zidakwa za cirrhosis (Child-Pyug B), Cmax ndi AUC zimachulukirachulukira (nthawi 16 ndi 11, motero). Cmax ndi AUC ya mankhwalawa mu okalamba (zaka 65) ndi 40 ndi 30%, motero, apamwamba kuposa omwe ali ndi odwala omwe ali ndi zaka zazing'ono (alibe tanthauzo lakuchipatala). Cmax mwa akazi ndiwokwera 20%, ndipo AUC ndi yotsika 10% poyerekeza ndi amuna (alibe mtengo). Kulephera kwamkati sikukhudza plasma ndende ya mankhwalawa.

Mankhwala

Atorvastatin ndi wothandizira wa hypolipidemic kuchokera pagulu la ma statins. Ndi osokoneza mpikisano wosankha wa HMG-CoA reductase, enzyme yomwe imatembenuza 3-hydroxy-3-methylglutaryl coenzyme A mpaka mevalonic acid, yomwe ili patsogolo pa sterols, kuphatikiza cholesterol. Triglycerides ndi cholesterol m'chiwindi zimaphatikizidwa pakupanga milomo yotsika kwambiri ya lipoproteins (VLDL), kulowa mu plasma ndipo amatengedwa kupita ku zotumphukira. Low density lipoproteins (LDL) amapangidwa kuchokera ku VLDL panthawi yolumikizana ndi ma LDL receptors. Amachepetsa cholesterol ya plasma ndi lipoprotein chifukwa cha kuletsa kwa HMG-CoA reductase, kaphatikizidwe ka cholesterol m'chiwindi komanso kuchuluka kwa "chiwindi" cholandilira cha LDL pamaselo a cell, zomwe zimatsogolera pakuwonjezeka ndikuwopsa kwa LDL. Imachepetsa kupangika kwa LDL, imayambitsa kuwonjezereka komanso kulimbikira mu ntchito ya ma LDL receptors. Amachepetsa LDL odwala omwe ali ndi homozygous Famer hypercholesterolemia, yomwe nthawi zambiri siziwathandiza kuchiritsa ndi lipid-kuchepetsa mankhwala. Amachepetsa kuchuluka kwa cholesterol yonse ndi 30-46%, LDL - mwa 41-61%, apolipoprotein B - ndi 34-50% ndi triglycerides - pofika 14-33%, amachititsa kuchuluka kwa kachulukidwe kolesterol-lipoproteins ndi apolipoprotein A. Dose-modalira kumachepetsa mulingo LDL odwala homozygous cholowa hypercholesterolemia, kugonjetsedwa ndi mankhwala ena lipid-kutsitsa mankhwala. Momwe zimachepetsera chiopsezo chokhala ndi zovuta za ischemic (kuphatikizapo kukula kwa kufa kuchokera ku infarction ya myocardial) ndi 16%, chiwopsezo chogonekedwanso kuchipatala cha angina pectoris, chotsatira ndi zizindikiro za myocardial ischemia, ndi 26%. Zilibe zotsatira za carcinogenic ndi mutagenic. The achire zotsatira zimatheka patatha masabata awiri chiyambireni kuyambika kwa mankhwalawa, chimafika pakatha masabata 4 ndipo chimatha nthawi yonse ya chithandizo.

Mlingo ndi makonzedwe

Mkati, tengani nthawi iliyonse masana, mosasamala za kudya. Musanayambe chithandizo, muyenera kusinthana ndi zakudya zomwe zimatsimikizira kuchepa kwa lipids m'magazi, ndikuwonetsetsa panthawi yonse ya chithandizo.

Poletsa matenda a mtima Mlingo woyamba wa akulu ndi 10 mg kamodzi patsiku. Mlingo uyenera kusinthidwa ndi nthawi osachepera milungu 2-4 mothandizidwa ndi lipid magawo a plasma. Pazipita tsiku lililonse 80 mg mu 1 mlingo. Ndi munthawi yomweyo makonzedwe a cyclosporine, pazipita tsiku lililonse mlingo wa atorvastatin 10 mg, ndi clarithromycin - 20 mg, ndi itraconazole - 40 mg.

Athypercholesterolemia yoyamba komanso yophatikiza (yophatikizika) hyperlipidemia 10 mg kamodzi patsiku. Zotsatira zimawonekera mkati mwa masabata a 2, kuchuluka kwake kumawonedwa mkati mwa masabata anayi.

Athomozygous achibale hypercholesterolemia Mlingo woyambayo ndi 10 mg kamodzi patsiku, kenako kuwonjezeka mpaka 80 mg kamodzi patsiku (kutsika kwa LDL ndi 18-45%). Asanayambe chithandizo, wodwalayo ayenera kuikidwa muyezo wa hypocholesterolemic zakudya, zomwe ayenera kutsatira pakumwa. Ndi kulephera kwa chiwindi, mlingo uyenera kuchepetsedwa. Kwa ana kuyambira zaka 10 mpaka 17 (anyamata okha ndi atsikana obwera kusamba) omwe ali ndi heterozygous Famer hypercholesterolemia, mlingo woyambirira ndi 10 mg 1 nthawi patsiku. Mlingo uyenera kuchuluka osapitilira milungu 4 kapena kupitilira. Mlingo wambiri watsiku ndi tsiku ndi 20 mg (kugwiritsa ntchito Mlingo woposa 20 mg sunaphunzire).

Okalamba ndi odwala omwe ali ndi matenda a impso Kusintha mndandanda wa mankhwala sikufunika.

Odwala omwe ali ndi vuto la chiwindi chisamaliro chiyenera kutengedwa pokhudzana ndikuchepetsa kuchepa kwa mankhwala m'thupi. Zowonetsa zamankhwala ndi zamankhwala zokhudzana ndi ntchito ya chiwindi ziyenera kuyang'aniridwa mosamala ndipo, ndikusintha kwakukulu kwa pathological, mlingo uyenera kuchepetsedwa kapena kufooka.

Gwiritsani ntchito limodzi ndi mankhwala ena. Ngati munthawi yomweyo kugwiritsa ntchito atorvastatin ndi cyclosporine kuli kofunikira, mlingo wa atorvastatin sayenera kupitirira 10 mg.

Zotsatira zoyipa

Kuchokera ku dongosolo lamanjenje: kugona, mutu, asthenic syndrome, malaise, chizungulire, zotumphukira zamitsempha, amnesia, paresthesia, Hypesthesia, kupsinjika.

Kuchokera m'mimba: nseru, kutsegula m'mimba, kupweteka kwam'mimba, kukomoka, kugona, kudzimbidwa, kusanza, matenda a anorexia, hepatitis, kapamba, cholestatic jaundice.

Kuchokera ku minculoskeletal system: myalgia, kupweteka kwa msana, arthralgia, kukokana kwa minofu, myositis, myopathy, rhabdomyolysis.

Zotsatira zoyipa: urticaria, pruritus, zotupa pakhungu, ziphuphu zakumaso, anaphylaxis, polymorphic exudative erythema (kuphatikizapo Stevens-Johnson syndrome), matenda a Laille.

Kuchokera ku ziwalo za hemopoietic: thrombocytopenia.

Kuchokera kumbali ya kagayidwe: hypo- kapena hyperglycemia, kuchuluka kwa seramu CPK.

Dongosolo la Endocrine.

Zina: tinnitus, kutopa, kusokonezeka kwa kugonana, zotumphukira edema, kunenepa kwambiri, kupweteka pachifuwa, kuchepa kwa magazi, matenda osokoneza bongo, makamaka ndi kugwiritsidwa ntchito kwa nthawi yayitali, matenda a hemorrhagic (atagwiritsiridwa ntchito waukulu ndi CYP3A4 zoletsa), kulephera kwachiwiri kwaimpso. .

Contraindication

Hypersensitivity ku gawo lililonse la mankhwala

matenda a chiwindi, ntchito yowonjezera ya "chiwindi" transaminases (koposa katatu) yosadziwika

azimayi a msinkhu wobereka omwe sagwiritsa ntchito njira zokwanira zakulera

ana ochepera zaka 18 (mphamvu ndi chitetezo sizinakhazikitsidwe)

mogwirizana ndi HIV proteinase inhibitors (telaprevir, tipranavir + ritonavir)

cholowa chotengera galactose tsankho, kuchepa kwa lactase kapena kuyamwa kwa glucose-galactose

Atorvastatin atha kupatsidwa mwayi wopita kwa mayi wazaka zakubadwa pokhapokha atadziwika kuti sanakhale woyembekezera komanso kudziwitsidwa za kuwopsa kwa mankhwalawa kwa mwana wosabadwayo.

mbiri ya matenda a chiwindi

kuvuta kwa electrolyte

endocrine ndi kagayidwe kachakudya matenda

matenda opatsirana pachimake (sepsis)

opaleshoni yayikulu

Zochita zamankhwala osokoneza bongo

Ndi munthawi yomweyo makonzedwe a cyclosporine, fibrate, erythromycin, clarithromycin, immunosuppressive, antifungal mankhwala (okhudzana ndi azoles) ndi nicotinamide, kuchuluka kwa atorvastatin mu plasma ndi chiopsezo cha myopathy ndi rhabdomyolysis ndi kulephera kwa aimpso.

Maantacidids amachepetsa ndende ndi 35% (zotsatira za LDL cholesterol sizisintha).

Kugwiritsidwa ntchito kwina kwa atorvastatin ndi warfarin kumathandizanso kusintha kwa warfarin pa magawo a coagulation m'masiku oyamba (kuchepetsa kwa prothrombin nthawi). Izi zimatha pambuyo masiku 15 a mgwirizano wa mankhwalawa.

Kugwiritsidwa ntchito kwa atorvastatin ndi ma proteinase inhibitors omwe amadziwika kuti CYP3A4 inhibitors kumayendera limodzi ndi kuchuluka kwa plasma mozama atorvastatin (kugwiritsa ntchito munthawi yomweyo ndi erythromycin, Cmax ya atorvastatin imawonjezeka ndi 40%. Ma proteinase inhibitors a HIV ndi CYP3A4 inhibitors. Kugwiritsa ntchito kwa HIV proteinase inhibitors ndi ma statins kumawonjezera kuchuluka kwa ma seramu m'magazi, omwe nthawi zina amabweretsa kukula kwa myalgia, ndipo pazochitika zapadera mpaka rhabdomyolysis, kutupa kwapakati ndi kuphwanya kwa minofu yolimba, zomwe zimatsogolera ku myoglobulinuria ndi kulephera kwa impso. Vuto lomaliza mu gawo limodzi mwa magawo atatu a milandu limatha ndiimfa.

Gwiritsani ntchito atorvastatin mosamala komanso osachepera ogwira mankhwalawa ndi HIV proteinase inhibitors: lopinavir + ritonavir. Mlingo wa atorvastatin sayenera kupitilira 20 mg tsiku lililonse atatengedwa ndi HIV proteinase zoletsa: fosamprenavir, darunavir + ritonavir, fosamprenavir + ritonavir, saquinavir + ritonavir. Mlingo wa atorvastatin sayenera kupitilira 40 mg patsiku akamatengedwa limodzi ndi HIV proteinase inhibitor nelfinavir.

Mukamagwiritsa ntchito digoxin osakanikirana ndi atorvastatin pa mlingo wa 80 mg / tsiku, kuchuluka kwa digoxin kumawonjezera pafupifupi 20%.

Kuchulukitsa ndende (poikidwira ndi atorvastatin pa mlingo wa 80 mg / tsiku) la mankhwala amkati a norethisterone ndi 30% ndi ethinyl estradiol ndi 20%.

Lipid-kutsitsa mphamvu ya kuphatikiza ndi colestipol imaposa izi kwa aliyense payekhapayekha, ngakhale kutsika 25% pa ndende ya atorvastatin pamene imagwiritsidwa ntchito limodzi ndi colestipol.

Kugwiritsa ntchito munthawi yomweyo ndi mankhwala omwe amachepetsa kuchuluka kwa mahomoni amkati (kuphatikizapo ketoconazole, spironolactone) kumawonjezera mwayi wochepetsa mahomoni amtundu wa cello (kusamala kuyenera kuchitidwa).

Kugwiritsa ntchito madzi a mphesa nthawi ya mankhwalawa kungayambitse kuchuluka kwa plasma wozungulira atorvastatin. Chifukwa chake, pa chithandizo, msuzi wa mphesa uyenera kupewedwa.

Malangizo apadera

Atorvastatin imatha kuyambitsa kuchuluka kwa seramu CPK, yomwe iyenera kukumbukiridwa pofufuza mosiyanasiyana kupweteka pachifuwa. Tiyenera kukumbukira kuti kuwonjezeka kwa KFK nthawi 10 poyerekeza ndi chizolowezi, limodzi ndi myalgia ndi kufooka kwa minofu kungagwirizane ndi myopathy, chithandizo chikuyenera kutha.

Pogwiritsa ntchito munthawi yomweyo mankhwala a atorvastatin okhala ndi cytochrome CYP3A4 proteinase inhibitors (cyclosporine, clarithromycin, itraconazole), mlingo woyambira uyenera kuyambitsidwa ndi 10 mg, panjira yochepa ya mankhwala osokoneza bongo, atorvastatin iyenera kusiyidwa.

Ndikofunikira kuwunika pafupipafupi zizindikiro za chiwindi ntchito isanalandire chithandizo, masabata 6 ndi 12 pambuyo pa kuyamba kwa mankhwalawa kapena atakulitsa mlingo, komanso pafupipafupi (miyezi isanu ndi umodzi) panthawi yonseyi yogwiritsidwa ntchito (mpaka mtundu wa odwala omwe misempha ya transaminase ipambana ) Kuchulukitsidwa kwa transpase ya "hepatic" kumawonedwa makamaka m'miyezi itatu yoyambirira ya mankhwala. Ndikulimbikitsidwa kuti muchepetse mankhwalawo kapena muchepetse mlingo ndi kuwonjezeka kwa AST ndi ALT koposa katatu. Kugwiritsidwa ntchito kwa atorvastatin kuyenera kusiyidwa kwakanthawi kukulira kwa zizindikiro zamankhwala zosonyeza kukhalapo kwa myopathy pachimake, kapena pamaso pa zinthu zomwe zikuwonetsa kuyambika kwa kulephera kwa impso chifukwa cha rhabdomyolysis (matenda oopsa, kuchepa kwa magazi, opaleshoni yayikulu, kuvulala, metabolic, endocrine kapena kusokonezeka kwakukulu kwa ma electrolyte) . Odwala akuyenera kuchenjezedwa kuti ayenera kupita kwa dokotala ngati vuto lopanda kufooka kapena kufooka kwa minofu kumachitika, makamaka ngati akuphatikizidwa ndi malaise kapena fever.

Pali malipoti a kakulidwe ka atonic fasciitis ndi kugwiritsa ntchito atorvastatin, komabe, kulumikizana ndi kayendetsedwe ka mankhwalawa ndizotheka, koma sikunatsimikizidwe, etiology sichikudziwika.

Zotsatira pa minofu ya mafupa. Pogwiritsa ntchito atorvastatin, monga mankhwala ena a mkalasi iyi, zochitika zapadera za rhabdomyolysis ndi kulephera kwachiwiri kwaimpso chifukwa cha myoglobinuria zafotokozedwa. Mbiri yakulephera kwa impso imatha kukhala pachiwopsezo cha rhabdomyolysis. Mkhalidwe wa odwala oterowo uyenera kuyang'aniridwa mosamala kuti pakhale mawonekedwe a minofu ya fupa.

Atorvastatin, komanso ma statins ena, nthawi zina amatha kupititsa patsogolo myopathy, yowonetsedwa ndi kupweteka kwa minofu kapena kufooka kwa minofu kuphatikiza kuwonjezeka kwa mlingo wa creatine phosphokinase (CPK) kopitilira nthawi 10 kuchokera pamtengo wapamwamba. Kugwiritsa ntchito mitundu yayikulu ya atorvastatin okwera ndi mankhwala monga cyclosporine ndi potent inhibitors a CYP3A4 isoenzyme (mwachitsanzo, clearithromycin, itraconazole ndi HIV proteinase inhibitors) kumawonjezera chiopsezo cha myopathy / rhabdomyolysis. Mukamagwiritsa ntchito ma statins, kawirikawiri milandu ya immune-Mediated necrotizing myopathy (IONM), autoimmune myopathy, imanenedwapo. IONM imadziwika ndi kufooka m'magulu a minofu ya proximal komanso kuchuluka kwa serum creatine kinase, komwe kumapitilira ngakhale kuyimitsidwa kwa kutenga ma statins, necrotizing myopathy imadziwika panthawi ya minofu biopsy, yomwe siyimayendetsedwa ndi kutupa kwambiri, kusintha kumachitika pamene ma immunosuppressants atengedwa.

Kukula kwa myopathy kuyenera kuganiziridwa kwa odwala omwe ali ndi vuto la myalgia, kupweteka kwa minofu kapena kufooka komanso / kapena kuwonjezeka kwakukulu pamlingo wa CPK. Odwala ayenera kuchenjezedwa kuti ayenera kudziwitsa dokotala wawo za kuwonekera kosapweteka, kufooka kapena kufooka m'misempha, makamaka ngati atatsatana ndi malaise kapena kutentha thupi, komanso ngati minyewa ya minyewa ikupitilira atayima atorvastatin. Ndi kuwonjezeka kodziwika mu mulingo wa CPK, matenda a myopathy kapena akuganiza kuti myopathy, chithandizo ndi atorvastatin ziyenera kusiyidwa.

Chiwopsezo chotenga myopathy munthawi yamankhwala omwe mankhwalawa amapezeka amawonjezeka pamodzi ndi kugwiritsa ntchito cyclosporin, zotumphukira za fibric acid, erythromycin, clarithromycin, hepatitis C virusaseasease inhibitor, telaprevir, kugwiritsa ntchito kuphatikiza kwa HIV proteinase inhibitor (kuphatikizapo saquinavir + ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir. darunavir + ritonavir, fosamprenavir ndi fosamprenavir + ritonavir), nicotinic acid kapena wothandizira antifungal kuchokera ku gulu la azole. Poona funso motsatira osakaniza mankhwala ndi atorvastatin ndi fibric opangidwa kuchokera ku asidi, mankhwalawa, clarithromycin, saquinavir osakaniza ritonavir, lopinavir osakaniza ritonavir, darunavir osakaniza ritonavir, fosamprenavir, kapena fosamprenavir osakaniza ritonavir, wothandizila antifungal ku gulu la azoles kapena asidi nicotinic pa kumwa mankhwala ochepetsa lipid, madokotala ayenera kuganizira mozama za phindu lomwe lingachitike ndi zoopsa zomwe zingachitike ndikuwunika mosamala mkhalidwe wa odwala kuti mupeze chizindikiro chilichonse chazovuta za kupweteka kwa minofu, kuwonda kapena kufooka kwa minofu, makamaka m'miyezi yoyambirira ya chithandizo, komanso panthawi yowonjezereka ya gawo lililonse la mankhwalawa. Ngati mukufuna kugwiritsa ntchito atorvastatin ndi mankhwala omwe ali pamwambapa, muyenera kuganizira mwayi wogwiritsa ntchito atorvastatin pamiyeso yoyambirira komanso yokonza.

Muzochitika zotere, ndikofunikira kuti nthawi ndi nthawi muzindikire ntchito ya creatine phosphokinase (CPK), komabe, kuwongolera kotereku sikutsimikizira kupewa kwa myopathy yayikulu.

Odwala omwe ali ndi mbiri ya hemorrhagic stroke kapena lacunar infarction, kugwiritsa ntchito Atorvastatin ndikotheka pokhapokha poyerekeza chiopsezo / kupindula, chiwopsezo cha kubwereza kwa hemorrhagic stroke chiyenera kuganiziridwanso.

Amayi azaka zobereka azigwiritsa ntchito njira zodalirika zakulera. Popeza cholesterol ndi zinthu zopangidwa kuchokera ku cholesterol ndizofunikira pakukula kwa mwana wosabadwayo, chiwopsezo choteteza HMG-CoA reductase chimaposa phindu logwiritsa ntchito mankhwalawa panthawi yapakati. Amayi akamagwiritsa ntchito lovastatin (HMG-CoA reductase inhibitor) yokhala ndi dextroamphetamine mu trimester yoyamba ya kubereka, kubadwa kwa ana omwe ali ndi mafupa osakanikirana, tracheo-esophageal fistula, ndi anus atresia amadziwika. Ngati muli ndi pakati pamankhwala, mankhwalawa amayenera kuyimitsidwa nthawi yomweyo, ndipo odwala ayenera kuchenjezedwa za chiopsezo cha mwana wosabadwayo.

Umboni wina ukusonyeza kuti ma cellins monga gulu amawonjezera shuga wamagazi, ndipo mwa omwe ali pachiwopsezo chachikulu chotenga matenda a shuga, amatha kuyambitsa kuchuluka kwa shuga m'magazi, omwe amafunikira chithandizo choyenera. Komabe, maubwino a ma statins pakuchepetsa chiopsezo cha matenda amtima wopitilira patsogolo chiwopsezo chokhala ndi matenda ashuga, kotero ma statins sayenera kusiyidwa. Pali zifukwa zokuwunikira kwa nthawi yayitali glycemia mwa odwala omwe ali pachiwopsezo (kuthamanga kwa glucose a 5.6 - 6.9 mmol / l, index index ya thupi> 30 kg / m2, kuchuluka kwa triglycerides, matenda oopsa), malingana ndi kulimbikitsa kwaposachedwa.

Zambiri za momwe mankhwalawa amatha kuyendetsa magalimoto kapena njira zowopsa: Popeza zotsatira zoyipa za mankhwalawo, muyenera kusamala mukamayendetsa magalimoto kapena magalimoto ena oopsa.

Bongo

Zizindikiro Zizindikiro zopanga bongo sizinakhazikitsidwe. Zizindikiro zimatha kuphatikizira kupweteka m'chiwindi, kulephera kwaimpso, kugwiritsa ntchito nthawi yayitali kwa myopathy ndi rhabdomyolysis.

Chithandizo: Palibe mankhwala enieni, mankhwala oletsa kupangika komanso njira zopewera kuyamwa kwambiri. Atorvastatin imamangiriza mapuloteni a plasma; chifukwa, hemodialysis siyothandiza. Ndi chitukuko cha myopathy, chotsatira rhabdomyolysis ndi pachimake aimpso kulephera (kawirikawiri) - kusiya yomweyo mankhwala ndi kukhazikitsidwa kwa diuretic ndi sodium bicarbonate solution. Rhabdomyolysis ingayambitse kukula kwa hyperkalemia, komwe kumafunikira kulowetsedwa kwa calcium chloride kapena calcium gluconate, kulowetsedwa kwa shuga ndi insulin, kugwiritsidwa ntchito kwa ion osinthanitsa ndi ion ya potaziyamu kapena, ovuta kwambiri, hemodialysis.

Wopanga

RUE Belmedpreparaty, Republic of Belarus

Adilesi Yazamilandu ndi Adilesi Yamaudzulo:

220007, Minsk, Fabricius, 30,

t./f.: (+375 17) 220 37 16,

Dzinalo ndi dziko laomwe amalembetsa satifiketi

RUE Belmedpreparaty, Republic of Belarus

Adilesi ya bungweli yomwe imavomereza madandaulo kuchokera kwa ogula pamtundu wa zinthu zomwe zili mdera la Republic of Kazakhstan:

KazBelMedFarm LLP, 050028, Republic of Kazakhstan,

Almaty, St. Beysebaeva 151

+ 7 (727) 378-52-74, + 7 (727) 225-59-98

Imelo Adilesi: [email protected]

I.O. Wachiwiri kwa Director for Quality

Mlingo ndi makonzedwe

Asanayambe chithandizo ndi Atorvastatin, wodwalayo ayenera kusamutsira ku chakudya chomwe chimatsimikizira kuchepa kwa lipids yamagazi, yomwe iyenera kuchitika pakumwa mankhwala.

Mkati, tengani nthawi iliyonse masana (koma nthawi yomweyo), osasamala za chakudya.

Mlingo woyambira wabwino ndi 10 mg kamodzi patsiku. Kenako, mlingo umasankhidwa payekha kutengera zomwe zili mu cholesterol - LDL. Mlingo uyenera kusinthidwa pakapita milungu inayi. Pazipita tsiku lililonse 80 mg mu 1 mlingo.

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, zotsatira zoyenera zimawonedwa pogwiritsa ntchito mankhwala tsiku lililonse 80 mg (kamodzi).

Kuwonongeka kwa chiwindi

Odwala omwe ali ndi vuto la chiwindi, ayenera kusamala poyerekeza ndi kuchepetsa mankhwalawa. Magawo a chipatala ndi a labotale ayenera kuyang'aniridwa mosamala, ndipo ngati kusintha kwakukulu kwa matenda kwakapezeka, mulingo uyenera kuchepetsedwa kapena chithandizo chitha.

Kuchita ndi mankhwala ena

Maantacidids amachepetsa ndende ndi 35% (zotsatira za LDL cholesterol sizisintha).

Kugwiritsira ntchito kwofananira kwa atorvastatin ndi ma proteinase inhibitors omwe amadziwika kuti CYP3A4 cytochrome P450 inhibitors kumayendera limodzi ndi kuwonjezeka kwa plasma mozama kwa atorvastatin.

Mukamagwiritsa ntchito digoxin osakanikirana ndi atorvastatin pa mlingo wa 80 mg / tsiku, kuchuluka kwa digoxin kumawonjezera pafupifupi 20%.

Kuchulukitsa ndende ndi 20% (akafotokozera ndi atorvastatin pa mlingo wa 80 mg / tsiku) la mankhwala amkamwa okhala ndi norethindrone ndi ethinyl estradiol. Mphamvu yokhala ndi lipid yotsitsa kuphatikiza ndi colestipol imaposa izi kwa aliyense pamankhwala.

Ndi makonzedwe munthawi yomweyo ndi warfarin, nthawi ya prothrombin imachepa m'masiku oyamba, komabe, patatha masiku 15, chizindikirocho chimasintha. Pankhaniyi, odwala omwe atorvastatin omwe ali ndi warfarin ayenera kukhala ochulukirapo kuposa nthawi ya prothrombin kuti iwongoleredwe.

Kugwiritsa ntchito madzi a mphesa nthawi ya mankhwala ndi atorvastatin kungayambitse kuchuluka kwa mankhwalawa m'madzi a m'magazi. Mwakutero, odwala omwe amamwa mankhwalawa ayenera kupewa kumwa izi.

Zizindikiro zosokoneza bongo

Zizindikiro zapadera za bongo sizinakhazikitsidwe. Zizindikiro zake zimatha kuphatikizira kupweteka m'chiwindi, kuperewera kwaimpso, kugwiritsa ntchito nthawi yayitali kwa myopathy ndi rhabdomyolysis.

Palibe mankhwala enieni, mankhwala ochiritsira komanso njira zopewera kuyamwa (gastric lavage and in activated ula).Atorvastatin imamangiriza mapuloteni a plasma; chifukwa, hemodialysis siyothandiza. Ndi chitukuko cha myopathy, chotsatira rhabdomyolysis ndi pachimake aimpso kulephera (kawirikawiri) - kusiya yomweyo mankhwala ndi kukhazikitsidwa kwa diuretic ndi sodium bicarbonate solution. Rhabdomyolysis ingayambitse kukula kwa hyperkalemia, komwe kumafunikira kulowetsedwa kwa calcium chloride kapena calcium gluconate, kulowetsedwa kwa shuga ndi insulin, kugwiritsidwa ntchito kwa ion osinthanitsa ndi ion ya potaziyamu kapena, ovuta kwambiri, hemodialysis.