Momwe mungagwiritsire ntchito Atorvastatin 10?

Kufotokozera kogwirizana ndi 26.01.2015

Dzina lachi Latin: Atorvastatin
Code ya ATX: S10AA05
Chithandizo: Atorvastatin (Atorvastatin)
Wopanga: CJSC ALSI Pharma

Piritsi limodzi lili ndi ma milligram 21.70 kapena 10.85 atorvastatin calcium calcium, yomwe imagwirizana ndi mamilimita 20 kapena 10 a atorvastatin.

Monga zida zothandizira, Opadra II, magnesium stearate, aerosil, wowuma 1500, lactose, cellcrystalline cellulose, calcium carbonate.

Zotsatira za pharmacological

Mankhwalawa ndi hypocholesterolemic - imachita mpikisano komanso mwaulesi ma enzyme omwe amawongolera kusintha kwa HMG-CoA kukhala mevalonate, komwe kumapeto kwake kumalowa mu sterols, kuphatikiza cholesterol.

Kuchepa kwa plopma lipoproteins ndi cholesterol atatha kumwa mankhwalawa kumachitika chifukwa cha kuchepa kwa kapangidwe ka cholesterol m'chiwindi komanso ntchito ya HMG-CoA reductase, komanso kuchuluka kwa LDL receptors pamaselo a chiwindi, komwe kumawonjezera kukweza ndi kutsata kwa LDL.

Mu anthu omwe ali ndi homozygous komanso heterozygous Famer hypercholesterolemia, dyslipidemia, ndi nongenication hypercholesterolemia, kuchepa kwa apolipoprotein B, cholesterol yathunthu, ndi kachulukidwe kachulukidwe kolesterol-lipoproteins amawonedwa akamamwa mankhwalawa.

Mankhwalawa amachepetsa mwayi wakukula. ischemia ndi kufa mwa anthu azaka zonse kukhala nako myocardial infaration yopanda kusakhazikika kwa angina ndi mafunde a Q.Amachepetsa pafupipafupi matenda osapweteka ndi opha ziwopsezo, kuchuluka kwa matenda amtima komanso chiwopsezo chotenga matenda owopsa a mtima ndi mitsempha yamagazi.

Pharmacodynamics ndi pharmacokinetics

Imakhala ndi kuyamwa kwambiri, kuphatikiza kwakukulu m'magazi kumawonedwa pambuyo pa ola limodzi kapena awiri pambuyo pa kuperekedwa. The bioavailability ndi yochepa chifukwa chotsimikizika mwachangu cha yogwira thunthu mucosa ndi zotsatira za "gawo loyambira m'chiwindi" - 12 peresenti. Pafupifupi 98 peresenti ya mlingo wotengedwa umakhala ndi mapuloteni a plasma. Kupanga mapangidwe kumachitika m'chiwindi ndikupanga metabolites yogwira komanso zinthu zopanda ntchito. Hafu ya moyo ndi maola 14. Pa hemodialysis sikuwonetsedwa.

Contraindication

Mankhwala sayenera kumwedwa ndi:

wosakwana zaka 18
wa mimba ndi nthawi yoyamwitsa,
kulephera kwa chiwindi,
matenda a chiwindi kapena kuchuluka kwa michere ya "chiwindi" pazifukwa zosadziwika,
Hypersensitivity pazomwe zili pamankhwala.

Iyenera kutengedwa ndi matenda am'matumbo, kuvulalaopaleshoni yayikulu yosalamulirika khunyu, sepsis, ochepa hypotensionmetabolic ndi endocrine mavuto, kusokonezeka mu kuchuluka kwa electrolyte kwambiri, mbiri ya matenda a chiwindi ndi uchidakwa.

Zotsatira zoyipa

Mukamamwa mapiritsiwa, mutha kukumana ndi:

kuchuluka gout, mastodyniakunenepa kwambiri (osowa kwambiri)
albinuria hypoglycemiahyperglycemia (chosowa kwambiri)
petechiae, ecchymoses, seborrhea, chikangakutuluka thukuta, xeroderma, alopecia,
Matenda a Lyell, achulukane amakulitsa erythema, zithunzi, kutupa kwa nkhope, angioedema, urticaria, dermatitiszotupa pakhungu ndi kuyabwa (kawirikawiri),
kuphwanya kwamikizo, kusabala, kuchepa kwa libido, epididymitis, metrorrhagia, nephrourolithiasis, kutulutsa magazi mu maliseche, hematuria, yade, dysuria,
kuphatikiza mgwirizano, minofu hypertonicity, adamundarhabdomyolysis myalgiaarthralgia myopathy, anisitis, tendosynovitis, bursitismwendo kukokana nyamakazi,
tenesmus, magazi m`kamwa, melena, thumbo magazi, chiwindi ntchito. cholestatic jaundice, kapamba, zilonda zam'mimba, cheilitis, Biliary colic, chiwindigastroenteritis, zilonda zam'mimba zam'mimba, glossitis, esophagitis, stomatitis, kusanzadysphagia kubwatulakamwa yowuma, chilimbikitso kapena kuchepa, kupweteka kwam'mimba, gastralgia, chisangalalo, kutsegula m'mimba kapena kudzimbidwa, kutentha kwa mtima, nseru,
mphuno, kukokolola kwa mphumu ya bronchial, dyspnea, chibayo, rhinitis, bronchitis,
thrombocytopenia, lymphadenopathy, kuchepa magazi,
angina pectoris, arrhythmia, phlebitis, kuthamanga kwa magazi, orthostatic hypotension, palpitations, kupweteka pachifuwa,
kutaya kwa kukoma, parosmia, glaucoma, ugonthi, zotupa za m'mimba, kusokonezeka kwa malo okhala, kuwuma kwa conjunctival, tinnitus, amblyopia,
kulephera kudziwaHypesthesia kukhumudwa, migraineHyperkinesis, ziwalo ataxiakutengeka mtima amnesiazotumphukira neuropathy, paresthesia, zolota, kugona, malaise, asthenia, mutu, chizungulire, kusowa tulo.

Kuchita

Munthawi yomweyo makonzedwe a proteinase inhibitors amalimbikitsa kuchuluka kwa yogwira plasma ya magazi. Kugwiritsidwa ntchito mosiyanasiyana ndi mankhwala omwe amachepetsa kuchuluka kwa mahomoni amkati amkati (kuphatikizapo Spironolactone, Ketoconazole ndi Cimetidine) kumawonjezera mwayi wochepetsa mahomoni amkati mwa steroid.

Mukamamwa pamodzi ndi nicotinic acid, erythromycin, fibrate ndi cyclosporins, zimawonjezera mwayi wokhala ndi myopathy mukamathandizidwa ndi mankhwala ena a kalasi iyi.

Simvastatin ndi Atorvastatin - ndibwino?

Simvastatin Ndi statin yachilengedwe, ndipo Atorvastatin ndi nkhokwe yamakono yopanga zinthu. Ngakhale ali ndi mayendedwe osiyanasiyana a metabolic ndi mitundu yamaukadaulo, ali ndi mphamvu yofanana ya mankhwala. Amakhalanso ndi zotsatirapo zake, koma Simvastatin ndi wotsika mtengo kwambiri kuposa Atorvastatin, chifukwa chake pamtengo Simvastatin ndichabwino.

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 ndi nthawi 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 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%. 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.

Sichotsetsedwedwa pa hemodialysis.

Zizindikiro zogwiritsidwa ntchito

monga chowonjezera pakudya kuti muchepetse cholesterol yokwanira, LDL-C, apo-B, ndi triglycerides kwa achikulire, achinyamata, ndi ana azaka 10 kapena kuposerapo ndi hypercholesterolemia, kuphatikiza achibale a hypercholesterolemia (heterozygous version) kapena kuphatikiza (kusakaniza) Hyperlipidemia ( mitundu IIa ndi IIb malinga ndi gulu la Fredrickson), kuyankha pakudya ndi njira zina zosagwiritsa ntchito mankhwala sizili zokwanira,
Kuchepetsa cholesterol yokwanira, LDL-C mwa achikulire omwe ali ndi homozygous Famer hypercholesterolemia monga cholumikizira ku mitundu ina yotsatsira lipid-kupatula (mwachitsanzo LDL-apheresis) kapena, ngati chithandizo chotere sichikupezeka,

Kuteteza Matenda a Mtima:

kupewa zochitika zamtima mu mtima mwa odwala omwe ali pachiwopsezo chachikulu chokhala ndi zochitika zamkati pamtima, kuwonjezera pa kukonza ziwopsezo zina.
kupewa kwachiwiri kwamatenda amtima mwa odwala omwe ali ndi matenda amtima kuti achepetse chiwerengero cha anthu omwalira, matenda amitsempha yam'mimba, sitiroko, kuyambiranso kuchipatala kwa angina pectoris ndi kufunika kosinthanso.

Mlingo ndi makonzedwe

Mkati. Tengani nthawi iliyonse masana, ngakhale kudya kwambiri.

Musanayambe chithandizo ndi Atorvastatin, muyenera kuyesa kuthana ndi vuto la hypercholesterolemia pogwiritsa ntchito zakudya, masewera olimbitsa thupi komanso kuchepa thupi kwa odwala omwe ali ndi kunenepa kwambiri, komanso chithandizo cha matenda oyambitsidwa.

Popereka mankhwala, wodwalayo ayenera kuvomereza kuti azidya zakudya zaposachedwa za hypocholesterolemic, zomwe ayenera kutsatira nthawi yonse ya chithandizo.

Mlingo wa mankhwalawa umasiyana kuchokera ku 10 mg mpaka 80 mg kamodzi patsiku ndipo umapatsidwa gawo la mankhwala a LDL-Xc, cholinga cha mankhwalawo komanso momwe munthu amathandizira pa mankhwalawo. Mlingo wapamwamba tsiku lililonse wa mankhwala ndi 80 mg.

Kumayambiriro kwa mankhwalawa komanso / kapena pakuwonjezeka kwa mlingo wa Atorvastatin, ndikofunikira kuyang'anira kuchuluka kwa lipids m'magazi am'magazi aliwonse a 2-4 ndikusintha mlingo moyenerera.

Heterozygous achibale hypercholesterolemia

Mlingo woyambirira ndi 10 mg patsiku. Mlingo uyenera kusankhidwa payekhapayekha ndikuwunikira kufunikira kwake sabata iliyonse 4 ndikuwonjezereka kwa 40 mg patsiku. Ndiye kuti mankhwalawa atha kuwonjezeka mpaka kufika pa 80 mg patsiku, kapenanso kuphatikiza kwa mitundu ya asidi ya bile pogwiritsa ntchito atorvastatin muyezo wa 40 mg patsiku ndikotheka.

Gwiritsani ntchito ana ndi achinyamata kuyambira zaka 10 mpaka 18 ndi heterozygous achibale hypercholesterolemia

Mlingo woyambira wabwino 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. M'pofunika titrate mlingo wa mankhwalawa kutengera cholinga lipid-kutsitsa mankhwala. Kusintha kwa Mlingo kuyenera kuchitika mosiyanasiyana nthawi 1 m'milungu inayi kapena kupitilira.

Gwiritsani ntchito limodzi ndi mankhwala ena

Ngati ndi kotheka, munthawi yomweyo kugwiritsa ntchito cyclosporine, telaprevir kapena kuphatikiza kwa tipranavir / ritonavir, mlingo wa mankhwala Atorvastatin sayenera upambana 10 mg patsiku.

Muyenera kusamala ndikuwonetsetsa kuti mankhwala ochepetsa mphamvu ya atorvastatin azigwiritsidwa ntchito ngati agwiritsidwa ntchito ndi kachilombo ka HIV proteinase inhibitors, hepatitis C virusaseaseasease inhibitors (boceprevir), clarithromycin ndi itraconazole.

Zizindikiro zosokoneza bongo

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

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 kukula kwa myopathy, kutsatira rhabdomyolysis ndi pachimake aimpso kulephera, mankhwalawa ayenera kuthetsedwa ndipo kulowetsedwa kwa diuretic ndi sodium bicarbonate kunayamba. Rhabdomyolysis ikhoza kuyambitsa hyperkalemia, yomwe imafuna kukhazikika kwa njira ya calcium chloride kapena yankho la calcium gluconate, kulowetsedwa kwa 5% yankho la bingu (glucose) ndi insulin, komanso kugwiritsa ntchito ma resini a potaziyamu.

Popeza mankhwalawa amamangika kumapuloteni a plasma, hemodialysis siyothandiza.

Kuyanjana kwa mankhwala osokoneza bongo

Chiwopsezo chotenga myopathy ndi rhabdomyolysis ndi kulephera kwa aimpso pakumwa mankhwala a HMG-CoA reductase inhibitors kumawonjezereka ndikugwiritsa ntchito munthawi yomweyo cyclosporine, maantibayotiki (erythromycin, clearithromycin, hipupristine / dalphopristine), HIV proteinase inhibitors (indinavir, ritonoviraz, anti, ritonoviraz, anti, ritonoviraz, anti, ritonoviraz, anti, ritonoviraz, anti-ritonoviraz itraconazole, ketoconazole), nefazodone. Mankhwalawa amaletsa CYP3A4 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).

Pogwiritsa ntchito nthawi yomweyo ndi HIV protease zoletsa. hepatitis C virus proteinase inhibitors, clarithromycin ndi itraconazole ayenera kusamala ndikugwiritsa ntchito mlingo wotsika kwambiri wa atorvastatin.

CYP3A4 Isoenzyme Inhibitors

Popeza atorvastatin imapangidwa ndi isoenzyme CYP3A4, kugwiritsa ntchito kwa atorvastatin ndi zoletsa za isoenzyme CYP3A4 kungayambitse kuchuluka kwa plasma ndende ya atorvastatin. Kukula kwa kuyanjana ndi kuthekera kwa mphamvu kumatsimikizika ndi kusinthasintha kwa zotsatira pa CYP3A4 isoenzyme.

OATP1B1 zoyendetsa mapuloteni zotulutsa

Atorvastatin ndi ma metabolites ake ndi gawo lapansi la OATP1B1 protein protein. OATP1B1 inhibitors (mwachitsanzo, cyclosporine) angakulitse bioavailability wa atorvastatin. Kugwiritsa, kugwiritsa ntchito munthawi yomweyo mankhwala a atorvastatin pa 10 mg ndi cyclosporine pa mlingo wa 5.2 mg / kg / tsiku kumawonjezera kuchuluka kwa atorvastatin m'madzi a m'magazi nthawi 7.7. Kukula kwa hepatic uptake transporter ntchito pa ndende ya atorvastatin mu hepatocytes sikudziwika. Ngati sizotheka kupewa kugwiritsa ntchito nthawi yomweyo mankhwala ngati awa, tikulimbikitsidwa kuti muchepetse mlingo ndikuwongolera magwiridwe antchito.

Gemfibrozil / fibrate

Poyerekeza ndi kagwiritsidwe ntchito ka ma fibrate mu monotherapy, kusintha kosiyanasiyana kunadziwika nthawi zambiri, kuphatikizapo rhabdomyolysis yokhudzana ndi masculoskeletal system. Chiwopsezo chotere chimawonjezeka ndikugwiritsira ntchito munthawi yomweyo ma fibrate ndi atorvastatin. Ngati mankhwalawa agwiritsidwe ntchito munthawi yomweyo, ndiye kuti atorvastatin angagwiritsidwe ntchito moyenera. Kuwunika wodwalayo pafupipafupi kuyenera kuchitika.

Kutulutsa mafomu ndi kapangidwe kake

M'mafakitare mungapeze mankhwala amtundu umodzi wokha - mawonekedwe a mapiritsi. Chidacho chimanena za mankhwala amodzi. Atorvastatin imathandizira kuchepa kwa zam'mapid, ndipo chinthuchi chimaphatikizidwa pakukonzekera kwa mchere wa calcium (calcium trihydrate). Pamafotokozedwe a mankhwala omwe amafunsidwa, Mlingo wa gawo la yogwira umasungidwa - 10 mg. Ndalamayi ili ndi piritsi limodzi. Mankhwalawa sawonetsa zotsatira zoyipa chifukwa cha kupezeka kwa nembanemba wamafilimu.

Atorvastatin itha kugulidwa m'mapaketi amtundu. Iliyonse ili ndi mapiritsi 10. Chiwerengero chonse cha matuza m'bokosi lama katoni ndi 1, 2, 3, 4, 5, kapena 10 ma PC.

Atorvastatin 10 ndi enzyme inhibitor yomwe imakhudza mwachindunji njira yopanga cholesterol.

Kodi amatchulidwa?

Magawo ofunikira:

kuwonjezera mphamvu ya mankhwala omwe machitidwe awo akufuna kutsitsa cholesterol (Atorvastatin amatchulidwa kuti ndi gawo la chithandizo chovuta), kukwaniritsa zotsatira zofunika ndi mankhwala othandizira,
mankhwala a mtima dongosolo, kuteteza kukula kwa zovuta chifukwa cha kuchuluka magazi mamasukidwe, mafuta ambiri, kuchepa kwa mitsempha ya magazi.

Mlingo

Mapiritsi Ovomerezeka 10 mg, 20 mg ndi 40 mg

Piritsi limodzi lili:

ntchito yogwira - atorvastatin (monga calcium calcium ya trihydrate) 10 mg, 20 mg ndi 40 mg (10.85 mg, 21.70 mg ndi 43.40 mg),

zokopa: calcium carbonate, crospovidone, sodium lauryl sulfate, silicon dioxide, colloidal anhydrous, talc, microcrystalline cellulose,

kapangidwe ka chipolopolo: Opadry II pink (talc, polyethylene glycol, titanium dioxide (E171), mowa wa polyvinyl, chitsulo (III) oxide chikasu (E172), chitsulo (III) oxide ofiira (E172), iron (III) oxide wakuda (E172).

Mapiritsi okhala ndi pinki okhala ndi biconvex pamwamba

Mapuloteni oletsa

Mtengo wa AUC wa atorvastatin ukuwonjezeka kwambiri pogwiritsa ntchito munthawi yomweyo atorvastatin ndi kuphatikiza kwina kwa ma proteinase inhibitors, komanso atorvastatin ndi hepatitis C virusaseaseasehibase telaprevir. Chifukwa chake, kugwiritsa ntchito munthawi yomweyo mankhwala a atorvastatin mwa odwala omwe amapezeka ndi HIV proteinase inhibitors tipranavir ndi ritonavir kapena hepatitis C virus proteinase inhibitor telaprevir ayenera kupewedwa. Muyenera kusamala ndikugwiritsa ntchito munthawi yomweyo atorvastatin komanso kuphatikiza kwa HIV proteinase zoletsa lopinavir ndi ritonavir, ndikuchepetsa mlingo wa atorvastatin uyeneranso kukhazikitsidwa. Chenjezo liyenera kugwiritsidwa ntchito munthawi yomweyo kugwiritsa ntchito atorvastatin komanso kuphatikiza ma proteinase inhibitors, saquinavir ndi ritonavir, darunavir ndi ritonavir, fosamprenavir ndi ritonavir kapena fosamprenavir, pamene mlingo wa atorvastatin suyenera kupitilira 20 mg. Odwala omwe atenga kachilombo ka HIV proteinase inhibitor nelfinavir kapena hepatitis C virusase proteinhibulini ya inhibitor, mlingo wa atorvastatin sayenera kupitirira 40 mg;

Mankhwala

Pharmacokinetics

Atorvastatin imalowa mwachangu pambuyo pakukonzekera kwa pakamwa, ndende yake ya plasma imafika pamlingo wambiri kwa maola 1 - 2. Mgwirizano wa bioavailability wa atorvastatin ndi 95-99%, mtheradi - 12-14%, systemic (wopereka choletsa cha HMG-CoA reductase) - pafupifupi 30 % Kuphatikiza kwachilengedwe kwachilengedwe kumafotokozedwa ndi kutsimikizika kwachulukidwe kamkati ka mucous membrane wam'mimba ndi / kapena metabolism pakadutsa gawo loyambirira kudzera pachiwindi. Mafuta ndi plasma ndende ukuwonjezeka mogwirizana ndi mlingo wa mankhwalawa. Ngakhale kuti akudya ndi chakudya, mayamwidwe amachepetsa (kuchuluka kwa ndende ndi AUC kuli pafupifupi 25 ndi 9%, motero), kutsika kwa cholesterol LDL sikudalira atorvastatin wotengedwa ndi chakudya kapena ayi. Mukamamwa atorvastatin madzulo, ndende yake ya plasma inali yotsika (pafupifupi 30% chifukwa cha kuchuluka kwa ndende ndi AUC) kuposa m'mene mumamwa m'mawa. Komabe, kutsika kwa cholesterol ya LDL sikudalira nthawi yomwe mumwa mankhwalawa.

Kuposa 98% ya mankhwalawa amamangidwa kumapuloteni a plasma. Chiwerengero cha erythrocyte / plasma ndi pafupifupi 0,25, chomwe chimawonetsera kufooka kwa mankhwalawo m'maselo ofiira a magazi.

Atorvastatin imapangidwa kuti itulutsidwe kwa ortho- ndi para-hydroxylated ndi zinthu zosiyanasiyana za beta-oxidised. Mphamvu yoletsa mphamvu ya wachibale wa HMG-CoA reductase pafupifupi 70% imazindikira chifukwa cha zochita za metabolites. Atorvastatin anapezeka kuti ndi choletsa chofooka cha cytochrome P450 ZA4.

Atorvastatin ndi ma metabolites ake amachotsedwa makamaka ndi bile pambuyo pa hepatic ndi / kapena metabolism yowonjezera. Komabe, mankhwalawa sangatengeke pakuwonjezeranso kwina. Hafu yapakati ya moyo wa atorvastatin ndi pafupifupi maola 14, koma nthawi ya inhibitory zochita motsutsana ndi HMG-CoA reductase chifukwa chozungulira yogwira metabolites ndi maola 20-30. Pasanathe 2% ya mlingo wapakamwa wa atorvastatin amamuchotsa mkodzo.

Kuchulukitsidwa kwa plasma kwa atorvastatin mwa okalamba athanzi (wopitilira 65) ndiwokwera kwambiri (pafupifupi 40% ya ndende yayikulu ndi 30% kwa AUC) kuposa mwa achinyamata. Panalibe kusiyanasiyana pakuyenda bwino kwa mankhwalawa ndi atorvastatin mwa odwala okalamba komanso odwala a mibadwo ina.

Kuchulukitsidwa kwa atorvastatin m'madzi am'magazi mwa akazi kumasiyana ndi kuchuluka kwa madzi am'magazi mwa amuna (mwa akazi, kuchuluka kwakukulu kumakhala pafupifupi 20%, ndi AUC - 10% kutsika). Komabe, palibe kusiyana kwakukulu kachipatala komwe kumapezeka chifukwa cha kuchuluka kwa lipid mwa amuna ndi akazi.

Matenda a impso sasokoneza kukhudzana kwa mankhwalawa mu plasma kapena kuchuluka kwa atorvastatin pazambiri za lipid, motero palibe chifukwa chosinthira kwa odwala omwe ali ndi vuto la aimpso. Maphunzirowa sanakhudze odwala omwe amalephera-a-impso kulephera; mwina, hemodialysis sasintha kwambiri kuwonekera kwa atorvastatin, popeza mankhwalawa ali pafupifupi onse pama protein a plasma a magazi.

The kuchuluka kwa atorvastatin mu madzi am`magazi kumawonjezera kwambiri (pazipita ndende - pafupifupi 16 zina, AUC - 11 zina) mwa odwala cirrhosis chiwindi cha uchidakwa etiology.

Mankhwala

Atorvastatin ndi mpikisano wosankha wa HMG-CoA reductase-enzyme, yomwe imayang'anira kuchuluka kwa kusintha kwa HMG-CoA kukhala mevalonate - kalozera wa ma sterols (kuphatikiza cholesterol (cholesterol)). Odwala omwe ali ndi homozygous ndi heterozygous Famer hypercholesterolemia, cholowa monga hypercholesterolemia ndi dyslipidemia, atorvastatin amachepetsa kuchuluka kwa cholesterol, otsika kachulukidwe lipoproteins (LDL) ndi apolipoprotein B (Apo B). Atorvastatin amachepetsa ndende yotsika kwambiri ya lipoproteins (VLDL) ndi triglycerides (TG), komanso imachulukitsa pang'ono zomwe zimakhala ndi cholesterol high density lipoproteins (HDL).

Atorvastatin amachepetsa kuchuluka kwa cholesterol ndi lipoproteins m'magazi a magazi poletsa HMG-CoA reductase, kaphatikizidwe ka cholesterol m'chiwindi ndikuwonjezera kuchuluka kwa zolandilira za LDL pamtunda wa hepatocytes, womwe umatsatiridwa ndi kuwonjezeka ndi kutengera kwa LDL. Atorvastatin imachepetsa kupanga kwa LDL, imayambitsa kuwonjezeredwa kosatha ndi kosatha kwa ntchito ya LDL receptor. Atorvastatin bwino amachepetsa milingo ya LDL odwala omwe ali ndi homozygous Famer hypercholesterolemia, yomwe singagwiritsidwe ntchito moyenera ngati mankhwala a lipid amatsitsa.

Malo oyamba a atorvastatin ndi chiwindi, chomwe chimagwira gawo lalikulu pakuphatikizidwa kwa cholesterol ndi chilolezo cha LDL. Kutsika kwa cholesterol ya LDL kumalumikizana ndi mlingo wa mankhwalawo komanso kugwiritsidwa ntchito kwake mthupi.

Atorvastatin pa mlingo wa 10-80 mg adachepetsa cholesterol yathunthu (pofika 30-46%), LDL cholesterol (pofika 41-61%), Apo B (pofika 34-50%) ndi TG (mwa 14-33%). Zotsatira zake ndizokhazikika kwa odwala omwe ali ndi heterozygous Famer hypercholesterolemia, mtundu wopezeka wa hypercholesterolemia komanso mtundu wosakanikirana wa hyperlipidemia, kuphatikiza odwala omwe samadwala matenda a shuga.

Odwala omwe ali ndi hypertriglyceridemia yokhayokha, atorvastatin amachepetsa kuchuluka kwa cholesterol, LDL cholesterol, VLDL cholesterol, Apo B, TG ndipo kumawonjezera pang'ono mulingo wa cholesterol ya HDL. Odwala omwe ali ndi dysbetalipoproteinemia, atorvastatin amachepetsa chiwindi chomwe chimachepetsa chiwindi.

Odwala omwe ali ndi mtundu wa IIa ndi IIb hyperlipoproteinemia (malinga ndi gulu la Fredrickson), kuchuluka kwapakati pa HDL cholesterol mukamagwiritsa ntchito atorvastatin pa mlingo wa 10-80 mg anali 5.1-8.7% mosasamala. Kuphatikiza apo, panali kuchepa kwakukulu kwakukulu kokhazikika kwa kuchuluka kwa cholesterol / HDL cholesterol ndi HDL cholesterol. Kugwiritsidwa ntchito kwa atorvastatin kumachepetsa chiopsezo cha ischemia ndi kufa kwa odwala omwe ali ndi myocardial infarction popanda Q wave ndi osakhazikika a angina (mosaganizira jenda ndi zaka) ndizofanana molingana ndi mulingo wa cholesterol ya LDL.

Heterozygous zokhudzana ndi hypercholesterolemia mu ana. Mwa anyamata ndi atsikana azaka zapakati pa 10 mpaka 17 ndi heterozygous Famer hypercholesterolemia, kapena hypercholesterolemia, atorvastatin pa mlingo wa 10-20 mg kamodzi patsiku anachepetsa kwambiri cholesterol, LDL cholesterol, TG ndi Apo B m'madzi am'magazi. Komabe, sizinakhudze kwambiri kukula ndi kutha kwa anyamata kapena kutalika kwa msambo kwa atsikana. Chitetezo ndi mphamvu ya Mlingo pamwambapa 20 mg pa mankhwala a ana sichinaphunzire. Mphamvu ya kutalika kwa mankhwala a atorvastatin muubwana pakuchepetsa kuchepa kwa thupi ndi kufa muukalamba sichinakhazikitsidwe.

Mlingo ndi makonzedwe

Musanayambe mankhwala a Atorvastatin, ndikofunikira kudziwa kuchuluka kwa cholesterol m'magazi motsutsana ndi zakudya zoyenera, perekani mankhwala olimbitsa thupi ndikuchita zinthu zofunikira kuchepetsa thupi mwa odwala omwe ali ndi kunenepa kwambiri, komanso kuchitira chithandizo chamatenda oyamba. Pa mankhwala ndi atorvastatin, odwala ayenera kutsatira muyezo hypocholesterolemic zakudya. Mankhwala ndi mankhwala 10 mg wa 80 patsiku kamodzi, tsiku lililonse, koma nthawi yomweyo patsiku, kaya kudya. Mlingo woyambira ndi wokonza ukhoza kupangidwa molingana ndi gawo loyambirira la cholesterol ya LDL, zolinga ndi magwiridwe antchito. Pambuyo pa masabata 2-4 kuyambira pa chiyambi cha chithandizo ndi / kapena kusintha kwa mankhwala ndi Atorvastatin, mbiri ya lipid iyenera kutengedwa ndi kusintha kwa mankhwalawo.

Hypercholesterolemia yoyamba komanso yophatikiza (yophatikizika) hyperlipidemia. Nthawi zambiri, ndikokwanira kupereka mankhwala mu 10 mg kamodzi patsiku. Mphamvu ya mankhwalawa imayamba pambuyo pa masabata awiri, ndipo zotsatira zake zimakhala - pambuyo pa masabata anayi. Kusintha koyenera kumathandizidwa ndi kugwiritsa ntchito mankhwalawa kwa nthawi yayitali.

Homozygous achibale hypercholesterolemia. Mankhwala ndi mankhwala 10 mg mpaka 80 pa tsiku tsiku lililonse, nthawi iliyonse, ngakhale kudya zakudya. Mlingo woyambira ndi kukonza umayikidwa payekhapayekha. Nthawi zambiri, odwala omwe ali ndi homozygous Famer hypercholesterolemia, zotsatira zake zimachitika pogwiritsa ntchito Atorvastatin pa mlingo wa 80 mg kamodzi patsiku.

Heterozygous achibale hypercholesterolemia mu ana (odwala a zaka 10 mpaka 17). Atorvastatin tikulimbikitsidwa koyamba mlingo.

10 mg kamodzi pa tsiku tsiku lililonse. Mlingo woyenera kwambiri ndi 20 mg kamodzi patsiku tsiku lililonse (Mlingo wopitilira 20 mg usanaphunzire mwa odwala a m'badwo uno). Mlingo umayikidwa payekhapayekha, poganizira cholinga cha mankhwala, mankhwalawa amatha kusintha pakadutsa milungu inayi kapena kupitirira apo.

Gwiritsani ntchito odwala omwe ali ndi matenda a impso komanso aimpso kulephera. Matenda a impso sasokoneza kukhudzana kwa atorvastatin kapena kuchepa kwa plasma LDL cholesterol, motero palibe chifukwa chosinthira mlingo.

Gwiritsani ntchito odwala okalamba. Palibe kusiyana pakukhwimitsa chitetezo ndikugwiritsidwa ntchito kwa mankhwalawa pochiza hypercholesterolemia mwa odwala okalamba komanso odwala omwe ali ndi zaka 60.

Odwala omwe ali ndi vuto la chiwindi Mankhwala amakonzedwa mosamala pokhudzana ndi kutsika kwake pakuchotsa mankhwalawa m'thupi. Kuwongolera kwa magawo azachipatala ndi a labotale akuwonetsedwa, ndipo ngati kusintha kwakukuru m'maganizo kwapezeka, mlingo uyenera kuchepetsedwa kapena chithandizo chikuyenera kuyimitsidwa.

Ngati lingaliro lipangidwe pa mgwirizano wa Atorvastatin ndi CYP3A4 zoletsa, ndiye:

Nthawi zonse yambani kulandira mankhwala osachepera 10 mg, onetsetsani kuti mumayang'anira ma seramu lipids musanayambe kumwa mankhwala.

Mutha kusiya kwakanthawi kumwa Atorvastatin ngati zoletsa za CYP3A4 zikupangidwira nthawi yochepa (mwachitsanzo, kanthawi kochepa ka mankhwala othandizira monga clarithromycin).

Malangizo okhudza mlingo waukulu wa Atorvastatin mukamagwiritsa ntchito:

ndi cyclosporine - mlingo sayenera upambana 10 mg,

ndi clarithromycin - mlingo sayenera upambana 20 mg,

ndi itraconazole - mlingo sayenera upambana 40 mg.

Azithromycin

Ndi munthawi yomweyo kugwiritsa ntchito atorvastatin pa mlingo wa 10 mg kamodzi patsiku ndipo azithromycin pa mlingo wa 500 mg patsiku, kuchuluka kwa azithromycin mu plasma ya magazi sikunasinthe.

Kuphatikizidwa kwa atorvastatin pa 40 mg ndi diltiazem pa 240 mg kumabweretsa kuwonjezeka kwa ndende ya atorvastatin m'madzi a m'magazi.

CYP3A4 Isoenzyme Inductors

Kugwiritsidwa ntchito kwa atorvastatin ndi ma inducers a CYP3A4 isoenzyme (mwachitsanzo, efavirenz, phenytoin, rifampicin, kukonzekera kwa wort kwa St. John) kungayambitse kuchepa kwa kuchuluka kwa atorvastatin m'magazi a m'magazi. Chifukwa cha magawo awiri oyanjana ndi rifampicin (inducer ya CYP3A4 isoenzyme ndi hepatocyte transport protein inhibitor OATP1B1), kugwiritsa ntchito pamodzi kwa atorvastatin ndi rifampicin ndikulimbikitsidwa, popeza kuchepetsedwa kuyang'anira atorvastatin pambuyo poti kudwala kwakukulu. Komabe, mphamvu ya rifampicin pakukhudzidwa kwa atorvastatin mu hepatocytes sichikudziwika ndipo ngati kugwiritsidwa ntchito kwakanthawi imodzi sikungapeweke, kugwiritsa ntchito kosakaniza koteroko kuyenera kuyang'aniridwa mosamala pakumwa.

Ndi kuyambitsa munthawi yomweyo kwa atorvastatin ndi kuyimitsidwa komwe kumakhala ndi magnesium ndi aluminium hydroxides, kuchuluka kwa atorvastatin m'madzi am'magazi kumatsika pafupifupi 35%, komabe, kuchepa kwa LDL-C sikusintha.

Atorvastatin sichikhudza pharmacokinetics ya phenazone, motero, kuyanjana ndi mankhwala ena omwe amapangidwa ndi ma enzymes omwewo a dongosolo la cytochrome P 450 sikuyembekezeredwa.

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.

Pogwiritsa ntchito mobwerezabwereza digoxin ndi atorvastatin pa mlingo wa 10 mg patsiku, kuchuluka kwa 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%, chifukwa chake, odwala otere ayenera kuyang'aniridwa.

Kulera kwamlomo

Pogwiritsa ntchito munthawi yomweyo atorvastatin komanso kulera kwapakamwa komwe kumakhala ndi norethisterone ndi ethinyl estradiol, kuwonjezeka kwakukulu mu AUC ya norethisterone ndi ethinyl estradiol kumawonedwa ndi pafupifupi 30% ndi 20%, motero. Izi ziyenera kuganiziridwa posankha njira yakulera yolerera ya pakamwa ya mayi yemwe akutenga atorvastatin.

Terfenadine

Atorvastatin wogwiritsidwa ntchito munthawi yomweyo analibe vuto lililonse pa pharmacokinetics ya terfenadine.

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 pa mlingo wa 80 mg ndi amlodipine pa 10 mg, ma pharmacokinetics a atorvastatin m'chigawo chofanana sanasinthe.

Fusidic acid

Pa maphunziro atatsatsa malonda, milandu ya rhabdomyolysis mwa odwala omwe amatenga ma statins, kuphatikizapo atorvastatin ndi fusidic acid, adadziwika.Odwala omwe kugwiritsa ntchito fusidic acid amafunika, mankhwala okhala ndi ma statins ayenera kusiyidwa panthawi yonse yogwiritsa ntchito fusidic acid. Mankhwala a Statin amatha kuyambiridwanso patatha masiku 7 atatha mlingo womaliza wa fusidic acid. Mu zochitika zapadera, ngati chithandizo chautali wa mankhwala a fusidic acid ndichofunikira, mwachitsanzo, pochiza matenda opatsirana, kufunika kogwiritsira ntchito nthawi yomweyo kwa atorvastatin ndi fusidic acid kuyenera kuganiziridwa paliponse ndikuyang'aniridwa ndi dokotala. Wodwalayo ayenera kufunsa dokotala nthawi yomweyo ngati kufooka kwa minofu, kumva, kapena kupweteka kumawonekera.

Kugwiritsa ntchito kwa ezetimibe kumalumikizidwa ndi kukula kwa zoyipa, kuphatikiza rhabdomyolysis, kuchokera ku dongosolo la musculoskeletal. Chiwopsezo chotere chimawonjezeka ndikugwiritsa ntchito munthawi yomweyo atorvastatin ndi ezetimibe. Kuyang'anira bwino ndikofunika kwa odwalawa.

Milandu ya myopathy yanenedwapo za kugwiritsidwa ntchito kofanana kwa atorvastatin ndi colchicine. Mankhwala ophatikizidwa pamodzi ndi mankhwalawa, muyenera kusamala.

Mukamaphunzira mayendedwe a atorvastatin ndi cimetidine, palibe machitidwe apamtundu wofunika omwe adapezeka.

Mankhwala ena ophatikizika

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

M'maphunziro a kachipatala, atorvastatin adagwiritsidwa ntchito limodzi ndi mankhwala a antihypertensive ndi estrogens, omwe adalembedwa kuti ndi othandizira olowa m'malo mwake, palibe zofunikira zazidziwitso zosafunikira zapakati. Kafukufuku wochita mogwirizana ndi mankhwala enaake sanachitike.

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 woyambirira uyenera kuyambitsidwa ndi 10 mg, panjira yochepa ya mankhwala osokoneza bongo, atorvastatin iyenera kusiyidwa.

Ndikofunikira kuwunika pafupipafupi zizindikiro za chiwindi chisanagwire ntchito mankhwala, pakadutsa milungu 6 ndi 12 atatha kumwa mankhwalawa kapena atakulitsa mlingo, komanso pafupipafupi (miyezi isanu ndi umodzi) munthawi yonse yogwiritsira ntchito (mpaka mtundu wa odwala omwe kuchuluka kwake kwa transaminase upambana ) 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. Kugwiritsa ntchito atorvastatin kuyenera kusiyidwa kwakanthawi ngati kungachitike kukula kwa matenda azachipatala omwe akuwonetsa kukhalapo kwa myopathy yacute, kapena pamaso pa zinthu zomwe zikuwonetsa kukonzekera 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 malungo.

Zochita zamankhwala

Chiwopsezo cha myopathy chikuwonjezereka panthawi yamankhwala ndimankhwala ena a gululi pomwe ntchito cyclosporine, zotumphukira za fibric acid, erythromycin, antifungals zokhudzana ndi azoles, ndi nicotinic acid.

Maantacid okhala: munthawi yomweyo kuyamwa kwa kuyimitsidwa komwe kuli ndi magnesium ndi aluminium hydroxide kunachepetsa kuchuluka kwa atorvastatin m'madzi am'magazi ndi pafupifupi 35%, komabe, kuchepa kwa cholesterol ya LDL sikunasinthe.

Antipyrine: Atorvastatin sichikhudza pharmacokinetics ya antipyrine, chifukwa chake, kulumikizana ndi mankhwala ena omwe amapangidwa ndi cytochrome isoenzymes yomweyo sayembekezereka.

Amlodipine: mu kuphunzira kwa kuyanjana kwa mankhwala kwa anthu athanzi, munthawi yomweyo makonzedwe a atorvastatin pa mlingo wa 80 mg ndi amlodipine pa 10 mg kunapangitsa kuwonjezeka kwa zotsatira za atorvastatin ndi 18%, zomwe sizinali zofunikira kwambiri pakuchipatala.

Gemfibrozil: chifukwa chowonjezera chiopsezo chotenga myopathy / rhabdomyolysis ndi kugwiritsa ntchito pamodzi kwa HMG-CoA reductase inhibitors ndi gemfibrozil, makonzedwe omwewo a mankhwalawa ayenera kupewedwa.

Ma fiber ena: chifukwa cha chiwopsezo chowonjezereka cha myopathy / rhabdomyolysis ndi kugwiritsa ntchito pamodzi kwa HMG-CoA reductase inhibitors ndi ma fibrate, atorvastatin iyenera kuyikidwa mosamala mukamayamwa mafupa.

Nicotinic acid (niacin): chiopsezo chotenga myopathy / rhabdomyolysis chitha kuwonjezeka mukamagwiritsa ntchito atorvastatin molumikizana ndi nicotinic acid, chifukwa chake, munthawi imeneyi, kuganiziridwa kuyenera kuperekedwa pakuchepetsa mlingo wa atorvastatin.

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

Colchicine: ndi munthawi yomweyo kugwiritsa ntchito atorvastatin ndi colchicine, milandu ya myopathy imanenedwa, kuphatikizapo rhabdomyolysis, chifukwa chake, kusamala kuyenera kuchitika pofotokoza atorvastatin ndi colchicine.

Digoxin: 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.

Erythromycin / clarithromycin: ndi munthawi yomweyo kugwiritsa ntchito atorvastatin ndi erythromycin (500 mg kanayi patsiku) kapena clarithromycin (500 mg kawiri patsiku), zomwe zimalepheretsa cytochrome P450 ZA4, kuwonjezeka kwa kuchuluka kwa atorvastatin m'magazi a magazi kumawonedwa.

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

Terfenadine: ndi munthawi yomweyo kugwiritsa ntchito atorvastatin ndi terfenadine, kusintha kwakukulu mu pharmacokinetics ya terfenadine sikunapezeke.

Njira zakulera: mukugwiritsa ntchito atorvastatin ndi kulera kwapakamwa komwe kumakhala ndi norethindrone ndi ethinyl estradiol, panali kuwonjezeka kwakukulu mu AUC ya norethindrone ndi ethinyl estradiol ndi 30% ndi 20%, motsatana. Izi ziyenera kuganiziridwa posankha njira yakulera yolerera ya pakamwa ya mayi yemwe akutenga atorvastatin.

Warfarin: pophunzira mogwirizana kwa atorvastatin ndi warfarin, palibe zizindikiro zakugwirizana kwakukulu pamankhwala komwe kunapezeka.

Cimetidine: pophunzira mogwirizana ndi atorvastatin ndi cimetidine, palibe zizindikiro zakugwirizana kwakukulu pamankhwala komwe kunapezeka.

Protease Inhibitors: kugwiritsa ntchito munthawi yomweyo mankhwala a atorvastatin okhala ndi mapuloteni ena otchedwa cytochrome P450 ZA4 inhibitors limodzi ndi kuwonjezeka kwa plasma mozama kwa atorvastatin.

Malangizo pakugwiritsira ntchito mankhwala a atorvastatin ndi HIV proteinase zoletsa: