Momwe mungagwiritsire ntchito Atorvastatin Teva?

Fomu ya Mlingo - mapiritsi okhala ndi filimu: pafupifupi oyera kapena oyera, okhala ndi chifanizo, omwe adalemba mbali zonse: mbali imodzi - "93", mbali ina "7310", "7311", "7312" kapena "7313" (10 ma PC mu chithuza, pamatafulidwe amtundu wa matuza atatu kapena 9).

Piritsi limodzi lili:

• yogwira mankhwala: atorvastatin calcium - 10,36 mg, 20,72 mg, 41.44 mg kapena 82.88 mg, womwe ndi wofanana ndi 10 mg, 20 mg, 40 mg kapena 80 mg wa atorvastatin, motero.
• othandizira zigawo: eudragit (E100) (copolymer wa dimethylaminoethyl methacrylate, butyl methacrylate, methyl methacrylate), lactose monohydrate, alpha-tocopherol macrogol supplement, povidone, croscarmellose sodium, sodium stearyl fumarate,
• makanema ophatikizira makanema: opadry YS-1R-7003 (polysorbate 80, hypromellose 2910 3cP (E464), titanium dioxide, hypromellose 2910 5cP (E464), macrogol 400).

Zizindikiro zogwiritsidwa ntchito

• heterozygous achibale komanso osakhala achibale a hypercholesterolemia, hypercholesterolemia osakanikirana (ophatikizidwa) hyperlipidemia (mitundu IIa ndi IIb malinga ndi gulu la Fredrickson) pophatikiza zakudya zomwe zimapangitsa kutsika kwa lipid kotsitsa kuchuluka kwa cholesterol yokwanira, otsika-ululu wa lipoprotein cholesterol highensene lipoprotein cholesterol (HDL),
• dysbetalipoproteinemia (mtundu wa III malinga ndi gulu la Fredrickson), serum triglycerides (mtundu IV malinga ndi gulu la Fredrickson) - mothandizidwa ndi zakudya sizothandiza,
• homozygous Famer hypercholesterolemia - kuchepetsa LDL cholesterol ndi cholesterol yathunthu yopanda mphamvu ya zakudya zochiritsira komanso zina zopanda mankhwala.

Contraindication

• kulephera kwa chiwindi (Makasi a ana-Pugh A ndi B),
• yogwira pathologies a chiwindi, kuchuluka kwa hepatic michere (yochulukirapo katatu kuposa malire apamwamba) achikhalidwe osadziwika,
• nthawi ya pakati komanso yoyamwitsa,
• wazaka 18
• Hypersensitivity pamagawo a mankhwala.

Mochenjera, tikulimbikitsidwa kuti Atorvastatin-Teva akhazikike ndi mbiri ya matenda amchiwindi, odwala omwe ali ndi vuto lotiwotcha, kudalira mowa, kusokonezeka kwa metabolic ndi endocrine, matenda osokoneza bongo apakati, matenda opweteka kwambiri a pachimake (sepsis), matenda a minofu kuvulala.

Mlingo ndi makonzedwe

Mapiritsi amatengedwa pakamwa nthawi imodzi patsiku, mosasamala kanthu za kudya nthawi iliyonse ya tsiku.

Dokotala amamulembera aliyense payekha, poganizira kuchuluka kwa cholesterol ya LDL, cholinga cha mankhwala ndi momwe wodwalayo amayankhira mankhwalawo.

Makonzedwe a Atorvastatin-Teva akuyenera kutsagana ndi pafupipafupi (1 nthawi iliyonse masabata awiri ndi awiri) kuwunika kwa lipids m'magazi am'magazi, kutengera ndi zomwe zapezedwa, sinthani mlingo.

Kusintha kwa dose sikuyenera kupitilizidwa nthawi 1 m'milungu inayi.

Mlingo wapamwamba tsiku lililonse ndi 80 mg.

Mlingo wovomerezeka watsiku ndi tsiku:

• heterozygous Famer hypercholesterolemia: mlingo woyambirira ndi 10 mg, ndikupanga kusintha kwa masabata 4 aliwonse, uyenera kubwera pang'onopang'ono mpaka 40 mg. Mankhwalawa akamalandira mankhwala a 40 mg, mankhwalawa amatengedwa limodzi ndi asidi a bile, omwe amakhala ndi monotherapy, mlingo umakulitsidwa mpaka 80 mg,
• chachikulu hypercholesterolemia ndi kuphatikiza (kuphatikiza) hyperlipidemia: 10 mg, monga lamulo, mlingo umapereka kuyenera koyenera kwa milingo ya lipid. Zotsatira zazikulu zamankhwala zimachitika pakatha milungu 4 ndipo zimapitiliza ntchito kwa nthawi yayitali.
• homozygous achibale hypercholesterolemia: 80 mg.

Kwa matenda a mtima ndi chiwopsezo chachikulu cha zovuta zamtima, chithandizo chimalimbikitsidwa ndi zotsatirazi zakukonzekera kwa lipid: cholesterol yonse yotsika ndi 5 mmol / l (kapena pansi pa 190 mg / dl) ndi LDL cholesterol yochepera 3 mmol / l (kapena pansi pa 115 mg / dl).

Ngati vuto la chiwindi likulephera, wodwalayo angafunike kupereka mankhwala ochepa kapena kusiya kumwa mankhwalawo.

Ndi kulephera kwa aimpso, kusintha kwa mlingo sikofunikira, chifukwa mankhwalawa sasintha ndende ya m'magazi.

Zotsatira zoyipa

• Kuchokera kwamankhwala amanjenje: pafupipafupi - kupweteka mutu, kusowa - kulakwa kwa zotsekemera, chizungulire, kusowa tulo, paresthesia, amnesia, malodza, kukhumudwa, kusowa - kuperewera kwa mitsempha, kusadziwika pafupipafupi - kukhumudwa, kukumbukira kapena kutayika, kusokonezeka kwa kugona,
• kuchokera ku chitetezo chamthupi: Nthawi zambiri - thupi siligwirizana, kawirikawiri - anaphylactic mantha, angioedema,
• Kuchokera m'mimba thirakiti: Nthawi zambiri - nseru, kukomoka, kutsegula m'mimba, kudzimbidwa, kudzimbidwa, kusowa - kupweteka kwam'mimba, kupindika, chamba, kusanza,
• Kuchokera kwamankhwala am'mimba ndi minofu yolumikizika: Nthawi zambiri - kupweteka kwa miyendo, kutupa, mafupa, minyewa yam'mimba, kupweteka kwam'mimba, kuphipha kwa minofu, kuperewera - minofu kufooka, kupweteka khosi, kawirikawiri - rhabdomyolysis, myopathy, myositis, tendonopathy ndi kupindika kwa tendon, pafupipafupi sikudziwika - immuno-mediated necrotizing myopathy,
• kuchokera ku hepatobiliary system: pafupipafupi - hepatitis, kawirikawiri - cholestasis, kawirikawiri - kulephera kwa chiwindi,
• Kuchokera kumitsempha yamagazi ndi kayendedwe ka magazi: kawirikawiri - thrombocytopenia,
• Kuchokera kupuma dongosolo, chifuwa ndi zam'mimba ziwalo: nthawi zambiri - nosebleeds, kupweteka kwa pharyngeal-laryngeal dera, nasopharyngitis, pafupipafupi osadziwika - interstitial m'mapapo pathologies,
• zikuwonetsa zasayansi: pafupipafupi - kuchuluka kwa ntchito ya serum creatine kinase, hyperglycemia, pafupipafupi - hypoglycemia, leukocyturia, kuchuluka kwa michere ya chiwindi, kuchuluka kwake sikudziwika - kuchuluka kwa ndende ya glycosylated hemoglobin,
• mbali ya chiwalo chothandizira kumva, mavuto a labyrinth: pafupipafupi - tinnitus, osowa kwambiri - kutaya kwa makutu,
• mbali ya gawo la masomphenya: pafupipafupi - kuchepa kwa kumveka bwino kwa masomphenya, kawirikawiri - kuphwanya kwamawonedwe owoneka,
• dermatological zimachitika: pafupipafupi - khungu kuyabwa, zotupa, alopecia, urticaria, kawirikawiri - erythema multiforme, oxous dermatitis, kawirikawiri - poizoni epermermal necrolysis, Stevens-Johnson syndrome,
• Kuchokera pakubala: kawirikawiri - gynecomastia, pafupipafupi - kusokonezeka kwa kugonana,
• Matenda ochitika pafupipafupi: pafupipafupi - kufooka, asthenia, kutentha thupi, kupweteka pachifuwa, zotupa zam'mimba, kulemera kwa thupi, kuperewera kwa magazi, matenda a anorexia.

Malangizo apadera

M'mbuyomu, hypercholesterolemia iyenera kuyesedwa kuti ichotse mankhwalawa, kudya zolimbitsa thupi, komanso odwala omwe ali ndi kunenepa kwambiri, kuchepa thupi komanso kuchiza matenda ena.

Kugwiritsidwa ntchito kwa Atorvastatin-Teva kumapereka chizindikiritso cha zakudya zapamwamba za hypocholesterol, zomwe zimayikidwa ndi adokotala nthawi yomweyo ndi mankhwalawa.

HMG-CoA reductase inhibitors imatha kusintha kusintha kwa magawo amomwe ammagazi a chiwindi ntchito nthawi yonse yamankhwala. Chifukwa chake, mankhwalawa amayenera kutsatiridwa ndikuwunika ntchito ya chiwindi limodzi ndi ma frequency otsatirawa: musanayambe mankhwala, mutatha kuchuluka kulikonse, kenako pakatha masabata 6 ndi 12 mutangoyamba kumwa, ndiye kuti pakatha miyezi isanu ndi umodzi. Odwala omwe ali ndi ma enzymes okwera ayenera kuyang'aniridwa ndi dokotala mpaka mlingo ubwerere mwakale. Ngati ma ratotate aminotransferase (AST) ndi alanine aminotransferase (ALT) achulukitsa katatu pakuwonjeza malire, muyezo uyenera kuchepetsedwa kapena kuthetsedwa.

Kukula kwa myopathy kumatha kukhala kosakomera chifukwa chotenga atorvastatin, zizindikiro zake zimaphatikizapo kuwonjezeka kwa creatine phosphokinase (CPK) ka 10 kapena kuposanso poyerekeza ndi malire apamwamba a chizolowezi kuphatikiza ndi kupweteka komanso kufooka m'misempha. Odwala ayenera kudziwitsidwa zakufunika kofunsa dokotala ngati akumva kupweteka komanso kufooka m'misempha, limodzi ndi malungo. Therapy iyenera kutha pomwe akusungabe kuwonjezereka kwa ntchito za KFK kapena kukhalapo kwa akutsimikiza kapena kutsimikizira myopathy.

Poyerekeza ndi kagwiritsidwe ntchito ka atorvastatin, kukulitsa kwa rhabdomyolysis ndi kulephera kwaimpso chifukwa cha myoglobinuria ndikotheka. Ngati muli ndi matenda owopsa, ma hypotension ochepa, opaleshoni yayikulu, kuvulala kwambiri, kupweteka kwa endocrine ndi ma electrolyte, kusokonekera kosagwirizana kapena kuwoneka kwa zinthu zina zomwe zingayambitse matenda a impso kulephera kwa rhabdomyolysis, tikulimbikitsidwa kusiya chithandizo cha Atorvastatin-Teva.

Kumwa mankhwalawa sikukhudza kudwala kwa wodwala kuyendetsa magalimoto ndi zida.

Kuyanjana kwa mankhwala osokoneza bongo

Kuphatikiza kwa HMG-CoA reductase inhibitors okhala ndi ma fibrate, cyclosporine, macrolide maantibayotiki (kuphatikiza erythromycin), nicotinic acid, azole antifungal othandizira amawonjezera chiopsezo cha myopathy kapena kungayambitse rhabdomyolysis, limodzi ndi kulephera kwa myoglobinuria. Chifukwa chake, tikulimbikitsidwa kuti mosamala, kuyerekeza maubwino ndi zoopsa zomwe zingachitike pochizira, chisankho pakuika kwa atorvastatin nthawi yomweyo ndimankhwala awa.

Ndi kusamala kwakukulu, tikulimbikitsidwa kuti apereke mankhwala osakanikirana ndi cyclosporine, HIV proteinase inhibitors, ma macrolide anti-virus (kuphatikizapo erythromycin, clarithromycin), azole antifungal mankhwala, nefazodone ndi zoletsa zina za CYP3A4 isoenzyme, popeza ndizotheka kuonjezera kuchuluka kwa atorvastatin ndi plasma yamagazi. .

Ndi kugwiritsa ntchito pamodzi kwa Atorvastatin-Teva:

• cimetidine, ketoconazole, spironolactone ndi mankhwala ena omwe amachepetsa kuchuluka kwa mahomoni amtundu wa antioxidic, kumawonjezera kuchepa kwa kuchuluka kwa mahomoni amkati mwathunthu,
• kulera kwapakamwa kokhala ndi ethinyl estradiol ndi norethisterone kumachulukitsa kuchuluka kwa zinthu zomwe zimagwira m'magazi a magazi,
• kuyimitsidwa komwe kuli ndi aluminium hydroxide ndi magnesium kumachepetsa (pafupifupi 35%) kuchuluka kwa atorvastatin mu plasma, osasintha kuchuluka kwa kuchepa kwa LDL,
• digoxin imatha kuwonjezera plasma ndende yake,
• warfarin imayambitsa kuchepa pang'ono kwa nthawi ya prothrombin kumayambiriro kwa zamankhwala, m'masiku 15 otsatira, chizindikiro chimabwezeretseka,
• cyclosporin ndi zoletsa zina za P-glycoprotein zitha kukulitsa bioavailability wa atorvastatin,
• terfenadine sasintha ndende mu madzi am'magazi.

Kuphatikiza mankhwala omwe ali ndi colestipol kumakhudzanso kutulutsa kwa lipids kuposa kumwa mankhwalawa mosiyana, ngakhale mlingo wa atorvastatin m'magazi a magazi amatsika pafupifupi 25%.

Kugwiritsa ntchito madzi a mphesa nthawi ya mankhwalawa kuyenera kukhala kochepa, popeza kuchuluka kwa madzi kumawonjezera ndende ya atorvastatin mu plasma.

Mankhwalawa sasokoneza pharmacokinetics a phenazone ndi mankhwala ena omwe amapangidwa ndi cytochrome isoenzymes yomweyo.

Zotsatira za rifampicin, phenazone, ndi zina za CYP3A4 zolimbikitsa isoenzyme pa Atorvastatin-Teva sizinakhazikitsidwe.

Kuthekera kwa kulumikizana kwakukulu pakugwiritsira ntchito mankhwala ochepetsa mphamvu ya kalasi III (kuphatikizapo amiodarone) kuyenera kuganiziridwanso.

Kafukufuku sanawonetse mgwirizano wa atorvastatin ndi cimetidine, amlodipine, antihypertensive mankhwala.

Pharmacological zochita za atorvastatin teva

Mankhwala ndi a osankha mpikisano wa enzyme HMG-CoA reductase, amene amathandizira kaphatikizidwe ka mevalonic acid, yemwe amatsogolera cholesterol ndi zina sterols.

Triacylglycerides (mafuta) ndi cholesterol m'chiwindi chimamangiriza kwambiri osachulukana kwambiri lipoprotein, kuchokera komwe amawatumiza ndi magazi kupita nawo ku minofu ndi minofu ya adipose. Awa, mkati mwa lipolysis, otsika osalimba lipoproteins (LDL) amapangidwa, omwe amasungunuka ndi kuyanjana ndi LDL receptors.

Kuchita kwa mankhwalawa kumathandizira kuchepetsa kuchuluka kwa mafuta ndi cholesterol m'magazi poletsa ntchito ya HMG-CoA reductase enzyme, cholesterol biosynthesis mu chiwindi ndikuwonjezera kuchuluka kwa zolandilira za LDL zomwe zimathandizira kuthana ndi katangale wa lipoproteins otsika.

Zotsatira za mankhwalawa zimatengera mlingo womwe umatengedwa ndipo umachepetsa kuchepa kwa lipoprotein wochepa kwambiri mwa odwala omwe ali ndi kuphwanya kwa cholesterol metabolism (hypercholesterolemia), yomwe singasinthidwe ndi mankhwala ena kuti muchepetse lipids.

Kumwa mankhwalawa kumabweretsa kutsika kwa:

• cholesterol yathunthu (30-46%),
• cholesterol in LDL (41-61%),
• apolipoprotein B (34-50%),
• triacylglycerides (14-33%).

Nthawi yomweyo, mulingo wa cholesterol popanga matenda osachulukitsa lipoproteins (HDL) ndi apolipoprotein A.Zotsatira zake zimawonedwa mwa odwala omwe ali ndi cholowa ndipo amatenga mitundu ya hypercholesterolemia, dyslipidemia wosakanikirana, kuphatikizapo mtundu 2 shuga. The pharmacological zotsatira za mankhwalawa amachepetsa kuopsa kwa mtima ndi zomwe zimawopseza kuti aphedwa chifukwa cha iwo.

Malinga ndi kafukufuku wazachipatala, zotsatira za kugwiritsa ntchito mankhwalawa kwa odwala okalamba sizinatchule mosatetezeka komanso mosagwirizana ndi zotsatira zoyipa za odwala azaka zina.

Mankhwala amapezeka mwachangu pakamwa. Kuzindikira kwambiri m'magazi kumajambulidwa pambuyo pa maola 1-2. Kudya pang'onopang'ono kumachepetsa kuyamwa kwa zinthu zomwe zimagwira, koma sizikuwakhudza mayendedwe ake. Zothandiza kugaya chakudya ndi 12%. The bioavailability wa inhibitory zochita wachibale wa enzyme HMG-CoA reductase ndi 30%, amene amayamba ndi kagayidwe kagayidwe kamakomedwe ka chakudya ndi chiwindi. Amakhala m'mapuloteni a magazi ndi 98%.

Zinthu zomwe zimagawika zimagawika mu metabolites (ortho- ndi para-hydroxylated derivatives, mankhwala a beta-oxidation) gawo lalikulu m'chiwindi. Ndi biotransformed machitidwe a isoenzymes CYP3A4, CYP3A5 ndi CYP3A7 a cytochrome P450. Ntchito zoletsa zamankhwala othandizira omwe amaphatikizana ndi enzyme HMG-CoA reductase ndi 70% kutengera zochita za metabolites.

Kupukusa kwa metabolites komaliza kumachitika makamaka kudzera mu bile, gawo laling'ono chabe (Zizindikiro zogwiritsira ntchito atorvastatin teva

Kupewa matenda a mtima dongosolo (matenda a mtima, kukhumudwa, myocardial infarction), komanso mavuto awo:

• Akuluakulu m'magulu amodzi omwe ali pachiwopsezo chimodzi: okalamba, oopsa, osuta, anthu omwe ali ndi HDL yochepetsedwa kapena cholowa champhamvu cha matenda amtima ndi mtima.
• Odwala omwe ali ndi matenda a shuga 2 omwe amakhala ndi proteinuria, retinopathy, matenda oopsa,
• Odwala odwala matenda a mtima (kupewa misempha).

Chithandizo cha hyperlipidemia:

• ndi hypercholesterolemia yoyamba (yotenga komanso cholowa, kuphatikizapo homo- ndi heterozygous mitundu ya mabanja hypercholesterolemia) - mankhwalawa amagwiritsidwa ntchito ngati chida chodziyimira komanso monga gawo la zovuta ndi njira zina zotsatsira lipid-kuchepetsa (LDL apheresis),
• ndi dyslipidemia,
• Odwala omwe ali ndi ma triglycerides okwera m'magazi (mtundu IV malinga ndi Fredrickson),
• Odwala odwala matenda a pulayimale dysbetalipoproteinemia (Fredrickson mtundu wachitatu) omwe amamwa mankhwala osokoneza bongo.

Momwe angatenge

Mlingo wa tsiku ndi tsiku umatengera muyeso woyamba wa cholesterol ndipo uli pamtunda wa 10-80 mg. Poyamba, 10 mg imakhazikitsidwa kamodzi patsiku nthawi ina iliyonse patsiku, osatengera kudya. Kusintha kwa magazi kumatengera ma cholesterol am'magazi, omwe amayenera kuwunikidwa kawiri aliyense, kenako milungu 4 iliyonse.

Mlingo watsiku ndi tsiku wa akulu:

• ndi hypercholesterolemia ndi hyperlipidemia yosakanikirana: 10 mg kamodzi patsiku (njira yodziwika bwino yolembedwa pambuyo pa masiku 28 kuyambira pa chiyambi cha chithandizo, ndi chithandizo chanthawi yayitali chotulukapo chake
• ndi heterozygous cholowa hypercholesterolemia: 10 mg kamodzi patsiku (koyamba mlingo wowonjezera ndikubweretsa 40 mg patsiku),
• ndi homozygous cholowa hypercholesterolemia: 80 mg 1 nthawi patsiku.

Matenda amkati samhudza kukhudzidwa kwa zinthu zomwe zimagwira m'magazi kapena mphamvu ya Atorvastatin-Teva. Palibe chifukwa chosinthira Mlingo chifukwa cha matenda a impso. Ngati chiwindi chalephera kugwira ntchito, kusintha kwa mankhwalawa ndikofunikira malinga ndi momwe gawo limagwirira ntchito. Woopsa milandu, mankhwalawa amathetsedwa.