Mankhwala a Atorvastatin: malangizo ogwiritsira ntchito, mavuto ndi kuwunika

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.

Kutulutsa mawonekedwe ndi kapangidwe kake

Atorvastatin imapezeka mu mawonekedwe a mapiritsi okhala ndi mafilimu okhala ndi zida zazikulu za atorvastatin calcium trihydrate.

Zinthu zotsatirazi zidagwiritsidwa ntchito ngati zothandiza pakukonzekera: microcrystalline cellulose, calcium carbonate, lactose, colloidal silicon dioxide, starch 1500, Opadry II, magnesium stearate, titanium dioxide, talc.

Ndemanga zoyipa

Sindinawonenso kusintha, koma mutu, chizungulire komanso kugona. Kodi "Botany" wathu azibwera ndi chiyani kuti athandize anthu, osati motsatana))

Anayikidwa kumwa atorvastine ndi cholesterol 6. 5. Ndimamwa 10 mg patsiku - sindikuwona ntchito yapadera, koma pali zovuta zingapo. Ndikuyesa kusinthana ndi chakudya.

Sindinganene kuti mankhwalawa ndi odabwitsa. Adalembera bambo anga pamtengo wa 60 mg / tsiku, chifukwa cholesterol yayikulu ndi chibadwa chathu.

mwayi wolandila (mosasamala kanthu za chakudya).

Sindinazindikire kusintha kulikonse kwaumoyo kumapeto kwa maphunziro. Momwe cholesterol imaposa 7 mmol / l, idakhalabe.Ndiye miyezi isanu ndi umodzi, cholesterol ya abambo ake adatseka mtsempha wamagazi, womwe unayambitsa necrosis ya chala chachikulucho. Tsopano, pofuna kupewa kudulidwa kawiri pachaka, abambo amapangidwa ndi mankhwala okwera mtengo kwambiri.

Malingaliro anga, atorvastatin ndi mankhwala osagwira ntchito konse, ndipo sindikudziwa zomwe madokotala amatiuza.

Amayi Atorvastatin adawerengedwa pambuyo pa stroko. Izi zisanachitike, amayi anga nthawi zambiri ankamwa mapiritsi a cholesterol okwera, koma onse anali okwera mtengo, opitilira 1000r. Pankhaniyi, mtengo unakondwera. Koma iyi ndiye kuphatikiza kokha kwa amayi.

Pambuyo pa miyezi itatu ya kumwa Atorvastatin, cholesterol sinachepe. Potengera maziko akumwa mapiritsi, mutu ndi mseru ukupitilira. Ndizofunikira kudziwa kuti malangizowa ali ndi zotsatira zoyipa zingapo, kuphatikiza mankhwalawa osavomerezeka kwa okalamba. Ndipo amayi anga ndi okalamba basi. Inde, ndipo cholesterol yayikulu imakhudza gulu la anthu.

Adafunsa adotolo kuti aletse mankhwalawo, sanatilolere, anati ayenera kumwa mankhwalawo nthawi yonse, ndipo sakunena kuti. Chifukwa chake musokoneze naye. Mankhwalawa sakhala omasuka konse, ndipo palibe malingaliro kuti mankhwalawo amabweretsa kuchira.

mavuto ambiri

Ndikufuna kukambirana za chinthu chimodzi chosasangalatsa, chokumana nacho cha cholesterol changa m'mwazi. Zinachitika kuti cholesterol yanga inali yokwera kuposa yachilendo, ndinali ndisanayesepo, ndipo amangondipeza kuchipatala.

Mwachidule, adotolo adalimbikitsa kuti achepetse, chifukwa mafuta ambiri a cholesterol, amakhala oopsa. Kutsitsa, kudya. Kusanthula kukapita, kunapezeka kuti kotsika kwambiri kuposa momwe kanakhalira. Kuti muwonjezere izi, dokotalayo adandipatsa mankhwala "Aorvastatin". Chabwino, ndikuvomereza, nthawi yamadzulo. Pambuyo pa masiku angapo atandilandira, ndimakhala ngati chinjoka chopumira moto mkati mwanga. Kupweteka kwamtima kosatha, chinthu chosamveka m'mimba.

Pambuyo pa sabata lozunzidwa, ndinali wanzeru kuti nditha kuwerengera ndemanga osati pa Otzovik wathu, nditazindikira kuti izi zikuchitika kwa ine. Inathetsa mwachangu zonse ndipo moyo unayamba kuyenda bwino. Sindinakhalepo ndi mavuto m'mimba, chifukwa chake sindingaganizire momwe mankhwalawa amalembera anthu omwe ali ndi mavuto awa.

Inde, tonse ndife osiyana, "kuti kufa ndi kwabwino kwa Russia-Germany," koma ndikuganiza kuti ngati muyenera kukhazikitsa china chake mthupi mwachilengedwe, chonde, pitani mukadye, idyani masamba ndi zipatso, sewera masewera.

Sindilangiza abwenzi, mapiritsi ndi "achabe".

Sindikulangizira kuti atembenukire kwa iwo

Atorvastatin ndimatenga zaka 1, 5. Cholesterol kwenikweni sikuchepetsedwa. Zinali 4, 6 zinakhala 4, 4. Kodi ndizoyenera kulimbitsa chiwindi chanu ngati mankhwalawo sagwira ntchito. Poyamba ndidatenga 20 mg, kenako adotolo adakulitsa mlingo mpaka 30 mg.

Chiwerengero chachikulu cha zoyipa. Ndinali kugona, kulemera m'mutu mwanga, nditatha sabata kuvomereza, tsoka lidachitika: chizungulire chinakulirakulira mpaka ndinayitanira ambulansi, yomwe ndinali ndisanachitepo. Kunali kusanza, kukhathamira kwa mphamvu (ndipo sindimavutika ndi izi konse), pafupifupi kutaya chikumbumtima. Ananditengera ku 1st Gradskaya, ndikupanga ma Sc scan, mtima, komanso kuyezetsa magazi. Sanapeze cholakwika chilichonse, adazindikira kuti ali ndi matenda am'mimba ndipo anawatumiza kunyumba. Tsopano ndimawerenga malangizowo ndikupeza zizindikilo zanga mu ZIVUTSO ZAKUTI. Kodi ndingalandirebe chiyani?

Werengani buku lonse. Madokotala amachenjeza za zovuta zomwe zingachitike.

Anayesedwa ndipo adawulula cholesterol yokwera - 7, 6. Dokotala adalemba piritsi la atorvastatin 1. Patatha piritsi lachinayi, kupanikizika kunakulirakulira, ngakhale kupanikizika kwanga kumakhala koyenera. Ndidayitanitsa ambulansi. Tsopano ndidaganiza kuti ndisamwe mapiritsi awa. Ndiona ndikupita kwa dokotala kuti ndikaonane.

Mwina akuti mwatsutsa.

Ndimatenga atorvastatin masiku 5. Mutu. Phokoso m'mutu. Panali kukokana mwendo usikuuno. Mankhwala oopsa. koma cholesterol 9, 3. Dotolo adalembera. Zopanda chakudya zonse zopangidwa ndi nyama. Kumanzere nkhuku yophika yokha. Ndiona zotsatira mwezi umodzi.

Ndidakwanitsa kutenga Atorvastatin tsiku limodzi lokha, ndipo ndidakakamizidwa kukana. Mankhwalawa siali a ine, chifukwa ndili ndi matenda am'mimba komanso matenda opunduka a msana. Ndakhala ndikugwiritsa ntchito mankhwala osokoneza bongo kwa nthawi yayitali. Ndili ndi mantha kuti chithandizo ichi sichiyenera kusakanikirana ndi mankhwala anga. Tsiku lotsatira, khutu langa lakumanja linali litatsekedwa, ndinadwala mutu. Zofooka ngati izi zidandigwira mpaka tsiku limodzi ndikubwerera, ndimagona tsiku lonse.

Anandiika 40 mg wa Atorvastatin chifukwa cha ululu wamtima. Ndidapitilira

Anandiika 40 mg wa Atorvastatin chifukwa cha ululu wamtima. Ndakhala pa miyezi 9. Zidachepetsa kwenikweni cholesterol yanga, koma zidakhala ndi zoyipa zambiri zosafunikira! Nthawi yomweyo ndinazindikira kuti ndili ndi vuto lokumbukira, ndinayamba kuyiwala chilichonse, chifunga changa m'mutu mwanga. Ululu wam'mimba nawonso unayamba kuvuta. Ndipo mkazi wanga adayamba kulabadira kuti nkhawa yanga ikusokonekera, ndidakwiya kuchokera kunja, popanda chifukwa.

Mawonekedwe ndi kipimo

Atorvastatin (m'Chilatini - Atorvastatin) imapezeka pokha piritsi. Pofuna kupewa zovuta za chilengedwe (chinyezi, kuwala, kutentha) pazinthu zomwe zimagwiritsidwa ntchito ndi mankhwalawo, komanso kuyamwa kwa mankhwalawa m'magawo am'mimba ndi gawo loyambirira la matumbo, amakutidwa ndi membrane wamafilimu. Mtundu wa filimuyo umatengera wopanga. Nthawi zambiri chimakhala choyera, koma nthawi zina chimakhala chikaso, chofiirira kapena chofiirira. Maonekedwe ndi mawonekedwe a mapiritsiwo ndi osiyana: ndiwazungulira kapena wozungulira kapangidwe kake, wokhala ndi mawonekedwe osalala kapena wolemba manambala mbali zosiyanasiyana.

Koma chinthu chachikulu mu mankhwalawa si mawonekedwe, koma ntchito yogwira. Ichi ndi atorvastatin calcium calcium. Koma popeza zomwe atorvastatin imachita imakhala ndi gawo lalikulu pokwaniritsa njira yothandizira achire, mlingo wa mankhwalawo umayang'aniridwa makamaka kwa iwo. Chifukwa chake mu internet network mungapeze Atorvastatin wokhala ndi 10, 20, 30, 40, 60 ndi 80 mg pazomwe zimagwira. Mlingo wake wocheperako (1 kapena 5 mg), ngakhale m'magulu ophatikiza a hypolipidemic, mulibe.

Mu cell imodzi yopanga masamba, mapiritsi 10 kapena 15 amayikidwa. Phale imodzi imatha kukhala mu phukusi, kapena mwina - mpaka 10. Mapiritsi ambiri amapezeka mumatumba a polymer. Pali mitundu yina ya mankhwala a gulu ili, yomwe ndi atorvastatin. Koma ali ndi zina, osati zapadziko lonse (INN), koma mayina amalonda (Atoris, Liprimar, Novostat, Tulip, etc.).

Mankhwala oyamba a Atorvastatin opangidwa ku Russia ali m'ndalama zotsatirazi:

makina a anatomical and achire mankhwala gulu (ATX) ndi C10AA,
nambala molingana ndi gulu la ku Russia lochita bwino OKPD2-20.10.149,
malinga ndi kaundula wa mankhwala ku Russia (RLS), mankhwalawo ndi a gulu la mankhwala "statins".

Atorvastatin sichinthu chokhacho chomwe amapangira mankhwalawa. Muli zotuluka: calcium carbonate, cellulose, mkaka, wowuma, silicon dioxide, magnesium stearate, polyvinyl mowa, titanium dioxide, polyethylene glycol ndi talc. Odwala matendawa ayenera kudziwa za iwowa, chifukwa momwe mankhwalawa angapangidwire.

Atorvastatin amapezeka pamankhwala omwe adotolo amauza Latin. Ndipo ngakhale azamankhwala osavomerezeka ali okonzeka kugulitsa mankhwalawo, simuyenera kumwa popanda kufunsa dokotala. Inde, musanalandire chithandizo komanso munthawi yake ndikuyenera kuwongolera chiwindi.

Zizindikiro zogwiritsidwa ntchito

Zomwe zimakhazikitsidwa ndi ma statins zimatchedwa dyslipidemia. Omasuliridwa chilankhulo chosavuta, ichi mafuta kagayidwe. Siziwonekera kwa nthawi yayitali kwambiri, ndipo pokhapokha ndi kuyika kwambiri kwa cholesterol "yoyipa" m'mitsempha ya mtima kumayambitsa zizindikiro za atherosulinotic. Mu gawo loyambirira, kusakhazikika kwa lipid kumapezeka mu labotale. Kuwunikaku kumatchedwa mbiri ya lipid, imaphatikizapo zofunikira zazikulu za metabolism yamafuta - triglycerides, cholesterol, ponseponse komanso gawo lama protein-protein, cholesterol transporter mapuloteni, komanso coheleffic ya atherogenic.

Popanda kudziwa mbiri ya lipid (dzina lachiwiri la mbiri ya lipid), ndizosatheka kukhazikitsa mtundu ndi mtundu wa statin, womwe udzatengedwe ndi wodwala kwanthawi yayitali (ndipo mwina, moyo wake wonse). Kuphatikiza apo, mbiri ya lipid ndiyofunikira pakuwongolera chithandizo chomwe chayamba kale. Magazi a Venous amaperekedwa kuti awunike pambuyo pokonzekera kosavuta: popanda icho, zotsatira zake zitha kupotozedwa.

Ubwino wa atorvastatin ndiwothandiza pa mankhwalawa amitundu yonse ya hypercholesterolemia (cholowa komanso cholowa). Amachepetsa cholesterol "yoyipa" komanso mapuloteni onyamula omwe angayikidwe mumakoma a mitsempha. Nthawi yomweyo, imakulitsa kuchuluka kwa lipoprotein "zabwino" ndikukulitsa kuchuluka kwa zolandila zomwe zimagwira cholesterol pakugwiritsa ntchito kapena kugwiritsa ntchito. Kuphatikiza apo, atorvastatin imachepetsa triglycerides m'mwazi, koma sizitanthauza kuti imatha kutengedwa kuti muchepetse kunenepa.

Mphamvu ya zochita za yogwira zimatengera kukakamiza kwa puloteni yayikulu yomwe imathandizira mapangidwe a cholesterol ndi maselo a chiwindi. Enzyme imatchedwa hydroxymethylglutaryl coenzyme A reductase, ndipo Atorvastatin, motsatana, ndi choletsa wa HMG CoA reductase. Ndilo mtundu wa mankhwalawa womwe umalola kuti usangoletsa kukula kwa malo omwe alipo kale atherosulinotic, komanso kuteteza mawonekedwe awo mwa anthu omwe ali pachiwopsezo chotenga atherosulinosis. Chifukwa chake, atha kutumizidwa kuti akhale ndi vuto la majini ku hypercholesterolemia adakali aang'ono kapena kwa osuta kwambiri ndi odwala matenda oopsa pambuyo zaka 55.

Statin samachiza mitsempha yamagazi, koma ndi matenda amtima kapena matenda a mtima zimaletsa zovuta monga kugunda kwa mtima kapena sitiroko. Zisonyezero zagwiritsidwa ntchito ndi mitundu yayikulu ya matenda a mtima, pambuyo pawo, ngozi zapamtima. Atorvastatin amadziwikanso mu postoperative nthawi mu mtima sayansi ndi mtima. Ndipo zotsatira zabwino zimapezeka ndikugwiritsa ntchito zovuta kwa mankhwalawa ndi mankhwala ena otsitsa a lipid komanso kuphatikiza njira zina zowongolera mafuta kagayidwe (zakudya, masewera olimbitsa thupi, kusiya zizolowezi zoyipa).

Ndemanga zopanda ndale

Sindinathandizenso ndipo panali zovuta zina. Sungunulani zakudya zowonjezera: Kukana soseji, mazira, tchizi ndi batala. Komanso kuphika. Pambuyo pa miyezi iwiri sindinachepetse thupi, koma cholesterol idakula bwinobwino

Inali 7.1, atatenga kukhala 7.2

Mankhwalawa ndi abwino, ngakhale m'masabata awiri oyambapo panali mseru pang'ono, kenako adadutsa. Atakhutira ndi mankhwalawo, cholesterol imabwerera mwachangu 10.3-5.1. Posachedwa, mnzake ngozi (atherosulinosis) adati adamulembera rosuvastatin-sz, komanso statin, koma zikuwoneka kuti yatsopano yamakono ili ndi zotsatirapo zochepa. Sindikudziwa ngati pakufunika kusintha mankhwalawa, chifukwa nseru sichidanso nkhawa.

Atorvastatin ndi mankhwala othandiza omwe agwiritsidwa ntchito kwa nthawi yayitali. Chokhacho chomwe chikufotokozedwa tsopano ndi m'badwo watsopano wama statins. Zikuwoneka kuti amakhulupirira kuti zoyipa zoyambira ndizochepa. Atorvastatin amafananizidwa pamtengo ndi rosuvastatin-sz, koma chomaliza ndi chamakono kwambiri.

Moona mtima sindinazindikire kusiyana pakati pa atorvastatin ndi rosuvastatin. Ndidatenga atorvastatin kwa miyezi 4, cholesterol yabwerera mwachizolowezi, pomwepo dotolo adati rosuvastatin-sz - cholesterol imakhalanso, ndimamva bwino. Ndikukhulupirira kuti mankhwala atsopano akadali abwino.

Ndinatenga maphunziro a atorvastatin 2, amatsitsa cholesterol bwino, ndinali wopanda vuto ndi chizungulire, apo ayi zonse zinali zodabwitsa. Kenako, mogwirizana ndi dokotala, anasinthana ndi rosuvastatin-sz, uno ndi m'badwo wotsatira wama statins. Palibe zoyipa, komanso zoyenera.

Ubwino: Mankhwalawa amatha kugwiritsidwa ntchito kwa nthawi yayitali, pamtengo wotsika.

Zoyipa: Mankhwalawa amayenera kugwiritsidwa ntchito ndi analgesic, popeza atatha kutenga mutu umawoneka.

Ndakhala ndikugwiritsa ntchito mankhwalawa kwa nthawi yayitali, mumtengo wotsika, chifukwa zomwe mafuta amafuta a cholesterol amachepetsa pang'onopang'ono. Muyenera kutenga ndi analgesic, chifukwa mutatha kutenga, mutu umatuluka. Dokotala adalamulira kuti amwe mankhwalawo usiku. Chifukwa chake, kupita kukagona, ndimatenga ndi analgesic.

Atorvastatin - mankhwala ochepetsa cholesterol

Chapakatikati, ndikadali tchuthi chodwala ndi matenda opatsirana pachimake, ndidakumana ndi mayeso a kuchipatala, momwe, monga odwala onse azaka zanga zobadwa, ndimayenera kukayezetsa (FLG, mayeso, ultrasound, mammography, ndi zina). Wochiritsayo adapereka chiyembekezo pazotsatira zonse. Mu mayeso anga a biochemical magazi adawonetsa kuchuluka kwa cholesterol, triglycerides ndi china chake pamenepo. Amayi anga anali ndi myocardial infarction, ndili ndi matenda oopsa, motero adotolo, akuti ndili m'gulu lowopsa lachitukuko cha IHD ndi vuto la mtima, adandiwuza mapiritsi a Atorvastatin 20 mg 1/2 t. kamodzi patsiku. Kuphatikiza apo, adotolo adandiuza mosamala kuti ndizitsatira zakudya. Patatha mwezi kuchokera chiyambi cha chithandizo, ndidapimanso kuyesanso magazi. Dokotala sanakhutire ndi izi ndikuwonjezera pa piritsi limodzi. Anandichitira mwezi wina. Pomaliza, chithandizo chomwe chimapereka zotsatira, cholesterol inachepa kwambiri. Ndikupitilizabe kumwa Atorvastatin mtsogolo.

Ndinawerenga malangizowo - Mulungu wanga, mankhwalawa angathe kukhala ndi mavuto ambiri bwanji! Ndipo adotolo adati ndichitenga pano kwa nthawi yayitali, sindingapewe zotsatirapo zake. Koma pakali pano sindikuwoneka kuti ndikuzindikira chilichonse.

Mankhwala abwino. Koma akatswiri odziwa za mtima akuwalangizidwa kuti azisanthula pamaziko a zopweteka. Zosokoneza chiwindi. Musaiwale kuti ma statins amachotsa cholesterol yoyipa komanso yabwino m'thupi.

Palibe vuto kwa chiwindi. Musanayambe kumwa ma statins (mankhwala omwe amachepetsa cholesterol yamagazi) muyenera kusintha moyo wanu, kusinkhasinkhanso zakudya zanu, ndipo pokhapokha ngati theka la chaka, cholesterol siyibwerera mwakale, ndiye kuti muyambe kumwa Atorvastatin.

Mwamuna wake adalembetsa kale hypercholesterolemia ndi hyperlipidemia poyesa magazi kwa biochemical kwazaka zingapo. Zakudyazo sizipereka phindu lililonse, ngakhale pakusala, tikakana nyama, cholesterol sikucheperachepera. Dokotala adamupatsa mankhwala Atorvastatin 10 mg kamodzi patsiku. Amayamba kudya, patatha milungu iwiri panali kusinthaku, patatha mwezi umodzi cholesterol idalowa malire apamwamba.

Mphamvu yogwiritsira ntchito mankhwalawa ndi yovuta kwambiri, choyamba imasokoneza kaphatikizidwe ka cholesterol, ndipo chachiwiri chimakulitsa mulingo wa zolandilira cell kupita ku cholesterol, zomwe zimapangitsa kuti zigwiritsidwe mwachangu kwambiri mu cell.

Mankhwalawa ndi otsika mtengo kwa maphunziro a pamwezi - pafupifupi ma ruble 350. Mutha kumwa piritsi mosasamala chakudyacho, ndiye chosavuta, popeza mumayiwala kumwa mankhwala ambiri pamimba yopanda kanthu kenako kudikirira theka la tsiku mukatha kumwa. Mankhwala atayamba, mwamunayo adakhala ndi mavuto. Kupanga kwake kwasintha, michere ya hepatic yadumpha pang'ono, ali ndi kufooka, mutu. Pambuyo pake zonse zidapita, ngakhale mafutawo a chiwindi sanachepe mpaka mankhwala atatheratu. Anamwa atorvastatin kwa miyezi iwiri.

Pazonse, mankhwalawa ndiabwino, samathandiza, ngakhale kuti sangachite popanda mavuto.

Mayankho abwino

Ndikuwerenga ndemanga ndipo ndangosokonezeka, ndimamva kuti ndili ndi nkhawa. Ndakhala ndamwa mankhwalawa kwa miyezi 1.5 ndipo sindinakhalepo ndi mavuto azachipatala. Popeza panali kuthamanga kwa magazi komanso kugunda kwa mtima, palibe. Nusea, etc., monga amanenera NO. kuyezetsa magazi kuyenera kutengedwa ndi cholystyrin kuti mudziwe, anali 6.2.. Ndipo kotero palibe mavuto azaumoyo

Mankhwala onse awiri amalimbana ndi ntchitoyo - kutsitsa cholesterol. Ine ndekha ndinatenga atorvastatin-sz, tsopano ndimatenga rosuvastatin-sz. Mwambiri, ndili ndi "chidziwitso" cha 10 pobata ma statins, mu 2009 adayika zovuta za hypercholesterolemia + zotsutsana ndi matenda a shuga. Atorvastatin-sz inatenga zaka 7, kuyambira mwezi wachiwiri wa kutenga 5.8-6.2 mavuto sanawone. Kenako, mu 2016, adandivomera rosuvastatin-sz, mankhwala a statin m'badwo wotsatira. Ndidapitilira, sindimamva kusintha kulikonse, cholesterol yanga idakhala yabwinobwino. Chifukwa chake ndikuganiza - kukoma ndi mtundu .. mwina zamakono kwambiri, mwina njira zina sizimamvetseka.

Ndimalimbikitsa kwambiri mankhwalawa. Abambo anga adatenga zaka 7, amakumbukira za cholesterol kamodzi miyezi isanu ndi umodzi, pomwe amapanga mbiri ya lipid. Tsopano akutenga rosuvastatin-sz, monga mankhwala atsopano, motero ndikusangalala kwambiri ndi izi. Inde, ndikothekera kwambiri kutero chifukwa Piritsi limodzi patsiku

Mankhwala abwino. Iyenso adatenga nthawi yayitali ndipo amuna awo nawonso adakhala bwino. Cholesterol yakhala yachilendo kwa zaka zambiri, ndizachisoni kuti mumangofunika kutenga ma statins moyo wanu wonse. mwezi wapitalo, adotolo adamuwuza kuti mwamuna wake asinthe pier yamakono rosuvastatin-sz. Wowoloka, cholesterol idakhala yokhazikika. Tsopano ndikuganiza, nditha kusintha mankhwalawo kapena kukhalabe pa atorvastatin?

Kodi ma statin a m'badwo woyamba komanso wachiwiri amagwiritsidwabe ntchito? Ndidangoona mibadwo itatu mu mankhwala atorvastatin - pomwe ndidamwa, ndi mankhwala abwino. Pachokha pachaka amavomereza bwino rosuvastatin-sz 4 mibadwo. Cholesterol 4.5, panalibe zotsatira zoyipa.

Mankhwala ndiwotsimikizika, adatenga zaka 5. Cholesterol sizinapite kupitilira momwe zinalili. Zaka 2 zapitazo, adasinthanitsa (chilichonse monga momwe adanenera dokotala) ndi rosuvastatin-sz, akuwoneka ngati achatsopano, zotsatira zake ndi zofanana - sindinazindikire kusiyana, koma zikugwira ntchito.

Atorvastatin aledzera ndi abambo anga, adamupatsa ntchito kuti amwe kwa moyo wonse. Cholesterol inachepa bwino, vuto linali ndi triglycerides. Dibicor adalembedwanso, ndipo triglycerides idayambanso kuchepa ndipo chiwindi chimasiya kusewera pranks, dibicor ikuwoneka kuti ikuteteza.

adatenga atorvastatin wa cholesterol yayikulu, idamuthandiza, koma mwatsoka idadwalitsa. Adafunsa adotolo kuti asankhe china, adalangiza kuyesa rosuvastatin-sz - izi zili ngati m'badwo watsopano. Ndimatenga mwezi, zonse zili mu dongosolo.

Ndikumwa atorvastatin-sz mchaka chachiwiri, cholesterol ndiyabwino, ndipo ndikuganiza kuti idandithandizira kutaya makilogalamu ochepa. Adandithandiza kwambiri, pachakudya chimodzi sindimakhala nthawi yayitali.

Atorvastatin ss adandiuza kuti ndichepetse cholesterol. Tili ndi vuto labanja ndipo ndimadziwa za izi. Ndimamwa pafupipafupi m'maphunziro, cholesterol sikumuka, sindinapeze vuto lililonse ku thanzi langa.

Aliyense amalemba kuti zakudya zimathandiza ndi cholesterol, koma sizili choncho - zidatsimikiziridwa kale kuti cholesterol yayikulu imapangidwa m'thupi lokha. Atorvastatin ndi piritsi labwino ndipo amathandizira ndi chithandizo, koma uku ndi m'badwo wam'mbuyomu wama statins, tsopano atsopano ambiri apangidwa. Ndimatenga rosuvastatin-sz - zotsatira zake ndizabwino, koma zotsatira zoyipa ndizochepa.

Sindikudziwa kuti ndinali ndi vuto la cholesterol mpaka, mwangozi, adokotala adazindikira izi. Ndinkamwa maphunziro a Atorvastatin sz ndikutsatira chakudya. Cholesterol yafupika, chifukwa chake, ndikupangira.

Pamene cholesterol yapamwamba idapezeka mu kusanthula, ndidalembedwa Atorvastatin cz. Ndinavutika kwambiri ndikamadya. Koma zidapezeka kuti ndikuchepera. Ndipo mankhwalawa ndiabwino, amasangalatsidwa nawo.

Atorvastatin sz waledzera ndi amayi anga. Ali ndi mavuto a cholesterol komanso matenda oopsa 2. Cholesterol imabweranso ngati yachilendo, timamwa maphunziro. Pali zotsatira zoyipa zambiri mu malangizowo, koma amayi anga sanaone chilichonse.

Imathandizira Pansi Cholesterol

Ndili ndi chizungulire, kulumpha mu magazi ndipo ndimayamba kukomoka. ndipo ndinapita kwa adotolo, ndinadutsa mayeso onse, ndinachita ma ultrasound a mitsempha yaubongo ndipo adotolo anandiuza mapiritsi a otorvostatin. Ndinayamba kumwa piritsi limodzi la mamilimita 20 kamodzi patsiku nthawi yomweyo, mkhalidwe wanga unayamba kuyenda bwino, magazi anga ankadumphadumpha, ndi zina zotero. Mwezi uliwonse ndimayesa kuyang'ana kolesterol yanga ndipo ndimamwa mapiritsi awa zonse ndizabwino, Posachedwa ndidasinthira mapiritsiwa kukhala ndi mabizinesi ambiri, koma zidapezeka kuti ndikukulira, ndiye ndidabwerera ku atorvostatin ndipo ndikumva bwino

Mapiritsi abwino kwambiri omwe amachepetsa cholesterol yamagazi

Atorvastatin anathandiza kwambiri, cholesterol kuyambira 6, 4 yatsika mpaka 3, 8, ndimamwa koposa chaka, ndimachepetsa pang'onopang'ono mlingo kuchokera 40 mg mpaka 10. Mwezi uliwonse, ndimapereka magazi kuti akandipime. Tsopano ndikotheka kumwa mlingo wokonza, osati tsiku ndi tsiku, monga kale, koma mwachitsanzo 2 pa sabata. Momwe ndimamwa ndikadumwa sitiroko ndili ndi mankhwalawa kwa moyo wonse!

Mayi anga amamwa, adachotsedwa moyo. Anali ndi cholesterol 9, ndipo ndizambiri. Nditayamba kugwiritsa ntchito Atorvastatin, ndiye mwezi umodzi pambuyo pake zidapezeka: cholesterol idayamba kukhala yabwinobwino. Koma iye, kamodzi chinthu choterechi, amakhala ataledzera nthawi zonse, chifukwa thupi palokha silimayendetsa mulingo wake chifukwa cha kuperewera kwa metabolic. Palibe mavuto omwe adawonedwa.

Atorvastatin anabwezeretsa cholesterol yanga mwachizolowezi. Ngakhale zidakwezedwa kale komanso zakudya zopanda mchere komanso zopanda mafuta sizinathandize, koma mankhwalawa adathandiza. Ndimatsata minofu, popeza ma statins amatha kuwawononga ndikuyambitsa kufooka. Ndikukulangizani kuti muchite izi kwa onse omwe amamwa mankhwala a gululi.

Zosagwirizana ndi mankhwala ambiri.

Mankhwalawa adawerengedwa kwa agogo anga, popeza iye, kuwonjezera pa matenda oopsa, ali ndi cholesterol yayikulu. Koma, mwamwayi, mankhwalawa amayenda bwino ndi mankhwala ambiri a antihypertensive.

Pa gawo loyambirira, mankhwalawa amayenera kumwedwa kamodzi patsiku, koma ndikofunikira kwambiri kuwunika kuchuluka kwa cholesterol m'magazi, ndiko kuti, kukayezetsa. Pambuyo poyesedwa kuti athandizidwe kuti mankhwalawo amagwira ntchito popanda kuwonetsa kwa pathological, mlingo ungathe kuchuluka. Ndikofunikira kuyang'anitsitsa mosamala kuti munthawi yamankhwala musagwiritse ntchito mankhwala ena omwe angakulitse chinthu yogwira ntchito m'magazi am'magazi, zomwe zingayambitse zotsatira zosasangalatsa. Mankhwalawa amaphatikizapo maantibayotiki, mankhwala antifungal, nicotinic acid.

Pakutha kwa mwezi woyamba kumwa kolesterol yanga, agogo anga anali atatsika ndipo anali osadalirika.

Tsoka ilo, vuto la cholesterol yayikulu lero limakhudza ambiri. Ngati mudakali aang'ono thupi limatha kuthana ndi cholesterol yowopsa, ndiye kuti patatha zaka 35 ndikofunikira kuyang'anitsitsa thanzi ndi kuchuluka konse kwa magazi. Ndikwabwino kudziwa kolesterol yomweyo osalola kuwonjezeka pamwamba pazovomerezeka. Ngati mutha kuyesa chaka chilichonse, ndipo nthawi zambiri, ndiye kuti mutha kudziwa kayendedwe ka cholesterol m'magazi.

Koma zitachitika kuti cholesterol imapitilira zomwe sizinachitike, ndiye kuti simuyenera kuyika mankhwala mu bokosi lalitali, muyenera kumwa mankhwala oyenera. Atorvastatin ndi mankhwala odziwika bwino ochepetsa cholesterol.

Mankhwalawa ndiokwera mtengo, amagula ma ruble pafupifupi 160-180, amagulitsidwa pa mankhwala aliwonse, mtengo wake umadalira malire amtundu wa mankhwala ena.

Atorvastatin imakhala yothandiza pokhapokha pazakudya zoyenera, zalembedwa m'malangizo, adotolo adabwereza izi atalembera mapiritsi a Atorvastatin.

Ndikofunikira kwambiri kuyesedwa musanayambe chithandizo kuti mutsimikizire kuchuluka kwa cholesterol yomwe yakwera, izi ndizofunikira kuti muwerenge molondola kuchuluka kwa mankhwalawa. M'malo mwanga, anali piritsi limodzi katatu pa tsiku kwa mwezi umodzi. Mlingo umatha kukhala wosiyana, mpaka mapiritsi 8, koma zonsezi zimayikidwa ndikuyang'aniridwa ndi katswiri.

Patatha mwezi umodzi, kuyezetsa magazi adakonzekera kuti adziwe ngati mankhwalawo alimbana kapena ayi. Pambuyo pa nthawi iyi, ndinaperekanso magazi, monga momwe zotsatira zake zinawonekera, zotsatira zake zinali ndipo panali kuchepa kwakukulu kwa cholesterol, koma komabe mulingo wake udali kunja kwa chizolowezi, adasankha kumwa Atorvastatin kwa masabata ena a 2 omwe ali ndi mlingo womwewo ndikumwa nthawi yomweyo mkaka waminyewa ya chiwindi. Zakudya izi zimathandizanso kutsitsa cholesterol.

Pambuyo pa masabata ena awiri, mayesowo adabwezeretsa, ndinapumira modekha, koma ichi sichifukwa kupumula. Inde, mankhwala Atorvastatin adathetsedwa, koma kudya kokha ndikuwunikira nthawi zonse zaumoyo.

Mankhwalawa adandithandizira, ndidabweretsa cholesterol yokhazikika, ndimangofunika kudya zakudya zowonjezera, apo ayi padzakhala zovuta zina: cholesterol - Atorvastatin ndi mosemphanitsa, ndipo pali zovuta ndi chiwindi (kuwerenga zotsatira zoyipa). Mankhwalawa ndiokwera mtengo, zochita zake sizoyipa kuposa zomwe zimatengedwera kunja, koma anyamata, muyenera kuchoka pamapangidwe am'mimba ndikumangirira ndi batala, soseji ndi maswiti ndi zina zosangalatsa. Eya ..

Zakudya zomwe zili ndi cholesterol yambiri ndizofunikira kwambiri. Agogo anga aakazi anali ndi cholesterol yokwanira 10 mmol / L. Dotolo adalangiza kuti azitsatira kadyedwe kena: mafuta ochepa a nyama (ngati nyama, ndiye nkhuku yonenepa kwambiri, nkhuku), masamba ambiri, zipatso (makamaka zipatso zosapezekanso), samalani mankhwalawa akumwa madzi. Atorvastatin adapangidwa kuchokera ku mankhwala. Agogo aakazi ankamwa mankhwalawa kamodzi patsiku. Pambuyo pa miyezi isanu ndi umodzi, zotsatirazi zidakwaniritsidwa: kulemera kunachepetsedwa ndi 14 makilogalamu (zakudya zoyenera zidachita mbali), cholesterol idakhala yabwinobwino. Tsopano chiwopsezo cha atherosulinosis chatha.

Pharmacokinetics

Pambuyo potenga atorvastatin, imalowa mwachangu m'matumbo am'mimba, ndende yayikulu mu plasma (C_m_Ah) imatheka pambuyo pa maola 1-2. Kuchuluka kwa mayamwidwe kumawonjezeka molingana ndi mlingo womwe umamwa. The bioavailability wachibale wa atorvastatin ndi 95-99%, mtheradi - 12-14%, mwatsatanetsatane zoletsa za HMG-CoA reductase zochita - pafupifupi 30%.

Kugawa kwapakati pa atorvastatin ndi 381 L, kuchuluka kwa mapuloteni a plasma kuli pafupifupi 98%.

Atorvastatin imapangidwa ndi gawo la cytochrome CYP3A4 kupita ku ortho- ndi para-hydroxylated, komanso beta-oxidation. Pafupifupi 70% ya zoletsa zamtundu wa mankhwalawa zimachitika chifukwa cha ortho- ndi para-hydroxylated metabolites.

Atorvastatin ndi ma metabolites ake ndi magawo a P-glycoprotein. Atorvastatin ndi metabolites ake amachotsedwa makamaka ndi bile. Pafupifupi theka moyo wa atorvastatin ndi pafupifupi 14-15 maola. Chifukwa cha kukhalapo kwa zochita za pharmacological mu metabolites, nthawi ya inhibitory zochita motsutsana ndi HMG-CoA reductase ndi maola 20-30.

Magulu apadera a odwala

Odwala okalamba: kuchuluka kwa plasma kwa atorvastatin kunali kokulirapo okalamba (zaka> 65 zaka) poyerekeza ndi achinyamata odzipereka,_, momwe kuponderera kwa lipid kunali kufananirana ndi magulu azaka ziwiri.

Ana: maphunziro pa pharmacokinetics a ana sanachitike.

Jenda: plasma wozungulira atorvastatin mwa akazi amasiyana ndi amuna (pafupifupi 20% kuposa C_m_Ah ndi 10% otsika kwa AUC). Komabe, palibe kusiyana kwakukulu mwakuthupi pankhani yokhudza ma lipids mwa amuna ndi akazi.

Odwala aimpso kulephera: matenda a impso sizinakhudze plasma woipa wa atorvastatin ndi lipid-kutsitsa kwenikweni.

Odwala omwe ali ndi vuto la chiwindi: Odwala omwe ali ndi matenda osokoneza bongo a chiwindi, kuwonjezereka kwa plasma wozungulira atorvastatin kunadziwika (C_max) pafupifupi nthawi 16 ndi AUC pafupifupi nthawi 11.

Mimba komanso kuyamwa

Kugwiritsa ntchito atorvastatin kumapangidwa panthawi yapakati (onani gawo "Contraindication"). Pakhala pali malipoti a kubadwa kwa kubadwa pambuyo pakuwonekera kwa intrauterine ku HMG-CoA reductase inhibitors. Kafukufuku wazinyama adawonetsa poyipa pakubala. Mayi woyembekezera atatenga atorvastatin, mwana wosabadwayo amatha kuchepa mphamvu, zomwe zimayambitsa cholesterol biosynthesis. Atherosulinosis ndi njira yovuta, ndipo, monga lamulo, kuthetsedwa kwa mankhwala ochepetsa mphamvu ya lipid pa nthawi yoyembekezera sikukhudza kwambiri chiopsezo cha nthawi yayitali chokhudzana ndi hypercholesterolemia yoyamba. Pankhaniyi, atorvastatin sayenera kulembedwa kwa amayi apakati, amayi omwe akukonzekera kutenga pakati kapena ngati ali ndi pakati. Ndikofunikira kusiya kumwa atorvastatin panthawi yapakati.

Sizikudziwika ngati atorvastatin kapena ma metabolites ake amachotsedwa mkaka wa munthu. M'maphunziro a nyama, plasma mozama wa atorvastatin ndi metabolites yake yogwira ntchito ndi yofanana ndi mkaka. Kugwiritsa ntchito atorvastatin pa nthawi yoyamwitsa kumayesedwa, azimayi omwe amatenga atorvastatin ayenera kusiya kuyamwitsa (onani gawo "Contraindication").

Mlingo ndi makonzedwe

Asanayambe chithandizo ndi atorvastatin, wodwalayo ayenera kusamutsidwira ku chakudya chomwe chimatsimikizira kuchepa kwa magazi lipids, omwe amayenera kuonedwa pakumwa mankhwala.

Mlingo woyambira wabwino ndi 10 mg tsiku lililonse. Kutengera ndi momwe mungafunikire, mlingo wa tsiku ndi tsiku utha kuwonjezereka osapitirira 80 mg. Wodwala ayenera kumwa atorvastatin nthawi ina iliyonse patsiku, koma nthawi yomweyo tsiku lililonse. Mankhwalawa amatengedwa mosasamala chakudya. Zotsatira zake zochizira nthawi zambiri zimawonedwa pakatha milungu iwiri, ndipo zotsatira zake zimakhala pambuyo pa milungu inayi. Chifukwa chake, mankhwalawa sayenera kusinthidwa kale kuposa masabata anayi pambuyo pa kuyamba kwa mankhwalawo m'mbuyomu.

Hyperlipidemia(cholowawosangandiosalandira cholowahypercholesterolemia) komanso kuphatikiza (wosakanikirana) dyslipidemia (Fredricksonovsky

Mlingo woyambira wabwino ndi 10 mg tsiku lililonse. Kutengera zofunika

Mphamvu ya tsiku ndi tsiku mlingo akhoza kuchuluka osapitirira 80 mg.

Homozygous achibale hypercholesterolemia

Mulingo wa mlingo ndi 10-80 mg. Odwala omwe ali ndi homozygous cholowa hypercholesterolemia, atorvastatin ayenera kugwiritsidwa ntchito ngati mankhwala olumikizana ndi njira zina zamankhwala kapena ngati chithandizo cha njira zina sichingatheke.

Heterozygous cholowa hypercholesterolemia mwa ana (wazaka 10 mpaka 17)

Mlingo woyambira wa atorvastatin ndi 10 mg / tsiku. Mlingo woyenera kwambiri ndi 20 mg / tsiku (Mlingo pamwambapa 20 mg sunafotokozedwe mu maphunziro awa odwala). Mlingo uyenera kusankhidwa payekha malinga ndi cholinga chamankhwala. Kusintha kwa Mlingo kuyenera kuchitika pakadutsa milungu inayi kapena kupitilira apo.

Kupewa matenda a mtima

Mu maphunziro popewa matenda amtima, kugwiritsidwa ntchito kwa 10 mg patsiku. Mlingo wapamwamba ungafunike kuti mukwaniritse kuchuluka kwa cholesterol.

Magulu apadera a odwala

Odwala omwe ali ndi vuto la impso

Matenda a impso sasokoneza kukhudzana kwa atorvastatin kapena kuchepa kwa plasma LDL cholesterol. Chifukwa chake, palibe kufunika kwa kusintha kwa mlingo wa atorvastatin mwa odwala omwe ali ndi matenda a impso.

Odwala omwe ali ndi vuto la chiwindi

Kusamala ndikofunikira pokhudzana ndi kutsika pang'ono pothana ndi mankhwalawa m'thupi (onani zigawo za "Contraindication" ndi "Precautions").

Kugwiritsa ntchito mankhwalawa odwala okalamba

Mukamamwa mankhwalawa muyezo Mlingo wake, mphamvu yake ndi chitetezo chake kwa odwala okulirapo zaka 70 sizisiyana ndi kuchuluka kwa anthu onse.

Kuphatikizika kwa kugwiritsa ntchito mankhwala ochepetsa lipid

Atorvastatin imatha kutumizidwa ndi sequestrants ya bile acid. Kuphatikizidwa kwa HMG-CoA reductase inhibitors ndi ma fibrate kumafuna kusamala kwambiri (onani zigawo "Precautions" ndi "Kuchita ndi mankhwala ena").

Mlingo wa odwala amatenga cyclosporine, clarithromycin, itraconazole kapena ma proteinase zoletsa.

Odwala omwe amatenga cyclosporine kapena HIV proteinase inhibitors (tipranavir + ritonavir) kapena hepatitis C virus (telaprevir) ayenera kupewa chithandizo ndi atorvastatin. Odwala omwe ali ndi kachilombo ka HIV amatenga lopinavir kuphatikiza ndi ritonavir, ayenera kusamala popereka mankhwala a atorvastatin, ndipo chithandizo chikuyenera kuchitika ndi mlingo wochepa kwambiri. Odwala omwe amatenga clearithromycin, itraconazole, komanso odwala omwe ali ndi kachilombo ka HIV amatenga kuphatikiza kwa saquinavir ndi ritonavir, darunavir ndi ritonavir, fosamprenavir kapena fosamprenavir ndi ritonavir, mlingo wa atorvastatin uyenera kutsimikiziridwa 20 mg, ndipo tikulimbikitsidwa kuti kuyezetsa koyenera kuchipatala kuyenera kutsimikizira mphamvu ya otsika Mlingo wa atorvastatin.

Odwala omwe atenga kachilombo ka HIV proteinase inhibitor nelfinavir kapena hepatitis C proteinase inhibitor boceprevir, mlingo wa atorvastatin uyenera kuchepetsedwa ndi 40 mg, ndipo kuyesedwa koyenera kachipatala kumalimbikitsidwanso kuti atsimikizire kugwira ntchito kwapadera kwa atorvastatin (onani "Precautions" ndi "Kugwirizana ndi mankhwala ena").

Njira zopewera kupewa ngozi

Kuwonongeka kwa chiwindi

Ndikulimbikitsidwa kuwunika ntchito ya chiwindi (ntchito za ma enzymes a chiwindi) musanayambe chithandizo ndi atorvastatin, komanso mobwerezabwereza malinga ndi mawonekedwe a matenda. Pakhala pali kawirikawiri nkhani zotsatsa zotsatsa za chiwindi chakupha ndi chosafa m'magazi omwe amatenga ma statins, kuphatikizapo atorvastatin. Ngati mukumwa mankhwalawa atorvastatin kuwonongeka kwa chiwindi ndi zizindikiro za matenda kapena / kapena hyperbilirubinemia kapena jaundice, ndiye kuti chithandizo ziyenera kuyimitsidwa nthawi yomweyo. Ngati zifukwa zina za vuto la chiwindi sizinakhazikitsidwe, ndiye kuti atorvastatin sayambiranso.

Atorvastatin iyenera kulembedwa mosamala kwa odwala omwe amamwa mowa komanso / kapena omwe ali ndi mbiri ya matenda a chiwindi. Matenda a chiwindi mu gawo yogwira, kapena kuwonjezeka kwa zochitika za transaminases popanda chifukwa chosadziwika, ndikutsutsana kwa makonzedwe a atorvastatin.

Kuteteza kwa Stroko kudzera Mukuchepetsa Kwambiri Cholesterol

M'maphunzirowa, zidapezeka kuti pakati pa odwala omwe alibe matenda am'mitima ya coronary omwe amangodwala kumene kapena akuvutika kwambiri chifukwa chodwala matenda a hemorrhagic, nthawi zambiri amawona odwala omwe amalandira 80 mg ya atorvastatin kuposa odwala omwe akulandira placebo. Makamaka, chiwopsezo chowonjezereka chinawonedwa mwa odwala omwe anali ndi vuto la hemorrhagic kapena infarction ya lacunar panthawi yomwe phunzirolo limayamba. Kwa odwala omwe ali ndi hemorrhagic sitiroko kapena_, lacunar infarction, muyeso wa chiwopsezo / phindu la kuchuluka kwa atorvastatin 80 mg sichidziwikiratu, chiwopsezo cha hemorrhagic stroke chikuyenera kuwunikira mosamala asanayambe chithandizo.

Zotsatira pa minofu ya mafupa

Mankhwalawa atorvastatin, monga momwe amagwiritsidwira ntchito ndi gulu lofananalo, milandu ya rhabdomyolysis siinawoneke kwambiri, yomwe inkayenda limodzi ndi kulephera kwaimpso chifukwa cha myoglobinuria. Mbiri yakulephera kwa impso imatha kukhala pachiwopsezo cha kukula kwa rhabdomyolysis. Odwala oterowo, kuyang'anira mosamala mafupa am'mimba ndikofunikira.

Kuchiza ndi atorvastatin, monga ma statin ena, kumatha kuyambitsa myopathy, komwe kumawonetsedwa ndi kupweteka komanso kufooka mu minofu, ndikuphatikizidwa ndi kuwonjezeka kwa ntchito ya creatine phosphokinase (CPK) nthawi zopitilira 10 poyerekeza ndi malire apamwamba. Kugwiritsira ntchito kophatikizana kwa Mlingo wambiri wa atorvastatin ndi mankhwala ena, monga cyclosporine ndi potent CYP3A4 inhibitors (mwachitsanzo, ecithromycin, itraconazole ndi HIV proteinase inhibitors), kumawonjezera chiopsezo cha myopathy / rhabdomyolysis.

Pali malipoti osowa pakukula kwa chitetezo cha necrotic myopathy, autoimmune myopathy yogwirizana ndi kutenga ma statins. Matenda a neopotic myopathy amadziwika ndi kufooka kwa minofu ndikuwonjezereka kwa kuchuluka kwa metaboline kinase, komwe kumapitiliza ngakhale pambuyo poti chithandizo cha statins sichitha, minofu biopsy imawululira necrotic myopathy popanda kutupa kwakukulu, kusintha kumachitika ngati mankhwala a immunosuppressive atengedwa.

Myopathy iyenera kuganiziridwa kwa wodwala aliyense wokhala ndi myalgia, kufinya kwa minofu kapena kufooka, komanso / kapena kuwonjezeka kodziwika ka zochitika za CPK. Odwala ayenera kuchenjezedwa kuti ayenera kudziwitsa dokotala nthawi yomweyo za kuwoneka kosapweteka kapena kufooka m'misempha, ngati atsagana ndi malaise kapena malungo. Mankhwala a Atorvastatin ayenera kusiyidwa ngati pakuwoneka kuwonjezeka kwazomwe zikuchitika mu ntchito za CPK kapena pamaso pa myopathy yotsimikizika.

Chiwopsezo cha myopathy akamagwiritsidwa ntchito ndi mankhwala ena a mkalasiyi chikuwonjezeka ndi kugwiritsa ntchito nthawi yomweyo cyclosporine, fibrate, erythromycin ,cacithromycin, hepatitis C proteinase inhibitor telaprevir, kuphatikiza kwa ma protein a protease inhibitor, kuphatikizapo saquinavir ndi ritonavir, lopinavir, ritonavir ndi ritonaviramprenren ndi ritonavir, nikotini acid, kapena azole antifungal agents. Mukamapereka mankhwala a atorvastatin osakanikirana ndi michere, erythromycin ,cacithromycin, kuphatikiza kwa saquinavir ndi ritonavir, lopinavir ndi ritonavir, darunavir ndi ritonavir, fosamprenavir, fosamprenavir ndi ritonavir, mankhwala a azole antifungal kapena asidi wa nicotinic. kuwunikira odwala pafupipafupi kuti azindikire ngati pali chizindikiro chilichonse chazomwe zimapangitsa kupweteka kwa minofu kapena kufooka, makamaka m'miyezi yoyambirira ya chithandizo komanso nthawi yowonjezereka eskers mankhwala aliwonse. Mlingo woyambirira komanso wowonjezera wa atorvastatin uyenera kutumikiridwa mukamamwa pamodzi ndi mankhwalawa. Muzochitika zotere, kutsimikiza kwa ntchito za KFK kungalimbikitsidwe, ngakhale kuti chiwongolero chotere sichimalepheretsa kukula kwa myopathy.

Malangizo poika mankhwala olumikizirana amaperekedwa pagome 1.

Gome 1. Kuyanjana kwa Mankhwala Osakanizidwa ndi Chiwopsezo cha Kukula
myopathies / rhabdomyolysis________________________________________________________

Zochita Zamankhwalaamatanthauza

Malangizo Olembedwera,.

Cyclosporin, HIV proteinase inhibitors (tipranavir + ritonavir), hepatitis C proteinase inhibitor (telaprevir)

Atorvastatin iyenera kupewa

HIV protease inhibitor (lopinavir + ritonavir)

Gwiritsani ntchito mosamala, pa mlingo wotsika kwambiri wogwira.

Clarithromycin, itraconazole, HIV protease inhibitors (saquinavir + ritonavir *, darunavir + ritonavir, fosamprenavir, fosamprenavir + ritonavir)

Osapitilira tsiku lililonse 20 mg

HIV proteinase inhibitor (nelfinavir), hepatitis C proteinase inhibitor (boceprevir)

Osapitilira mlingo wa 40 mg wa tsiku lililonse

* Gwiritsani ntchito mosamala pa mlingo wotsikitsitsa.

Milandu ya myopathy, kuphatikizapo rhabdomyolysis, idanenedwa ndi mgwirizano wa atorvastatin ndi colchicine, choncho tiyenera kusamala pankhaniyi.

Odwala akuyenera kuchenjezedwa kuti ayenera kupita kwa dokotala ngati vuto lopanda kufooka kapena kufooka kwa minofu kumachitika, makamaka ngati akuphatikizidwa ndi malaise kapena malungo.

Musanayambe mankhwala

Atorvastatin ayenera kuikidwa mosamala kwa odwala omwe ali ndi vuto la rhabdomyolysis. Mulingo wa CPK uyenera kutsimikizika musanayambe chithandizo chotsatira:

- matenda obadwa nawo a minofu m'modzi kapena banja,

- kuwopsa kwa minofu chifukwa cha kugwiritsa ntchito ma statins kapena ma fiber,

- matenda a chiwindi akale komanso / kapena kumwa mowa kwambiri,

- odwala okalamba (zaka zopitilira 70) - kufunikira kwa zowerengera zasayansi pamilandu iyi kumayambitsidwanso ndi kukhalapo kwa zinthu zina zomwe zimayambitsa rhabdomyolysis,

- milandu ya kuchuluka kwa ndende ya plasma (mwachitsanzo, milandu yolumikizana ndi kugwiritsidwa ntchito kwapadera, kuphatikiza majini).

Muzochitika pamwambapa, ubale pakati pa chiwopsezo ndi phindu lomwe lingakhalepo uyenera kuyesedwa, kuyang'ana kwamankhwala ndikofunikira.

Ndi chiwonjezeko chachikulu cha ndende ya KFK (chopitilira malire opitilira muyeso koposa nthawi 5) pamlingo woyamba, chithandizo sichiyenera kuyamba.

Kuyeza milingo ya CPK

Simuyenera kuyeza mulingo wa CPK mutatha kuchita masewera olimbitsa thupi kwambiri kapena pamaso pa zinthu zina zomwe zikuwonjezera kuchuluka kwa CPK, chifukwa izi zimapangitsa kuti matanthauzidwe akuwunika asinthe. Ngati milingo yoyambirira ya CPK iwonjezeka kwambiri (nthawi zopitilira 5 poyerekeza ndi malire apamwamba), ndikofunikira kuti mupendenso pambuyo pa masiku 5-7 kuti mutsimikizire zotsatira.

Kuwonjezeka kwa kusala kudya kwa HbAlc ndi shuga wa seramu mofulumira kumanenedwa ndi zoletsa za HMG-CoA reductase, kuphatikizapo atorvastatin. Matenda amakhudza kaphatikizidwe ka cholesterol ndipo mwanjira yake akhoza kulepheretsa kupanga kwa mahomoni a adrenal cortex ndi / kapena mahomoni a steroid. Kafukufuku wachipatala awonetsa kuti atorvastatin sichepetsa plasma cortisol ndende yake ndipo sikuti imawononga malo osungira a adrenal gland. Mphamvu ya ma statins pa chonde chachimuna sichinaphunzire kuchuluka kokwanira kwa odwala. Zotsatira zake, ngati zilipo, pa pituitary-gonadal system mwa akazi panthawi ya premenopause sizikudziwika. Chisamaliro chimayenera kuthandizidwa popereka mankhwala okhala ndi mankhwala omwe amatha kutsitsa kapena kuchuluka kwa mahomoni amkati monga ketoconazole, spironolactone ndi cimetidine.

Statin, monga kalasi, imatha kuwonjezera kuchuluka kwa magazi, ndipo mwa odwala ena omwe ali ndi chiopsezo chachikulu chotenga matenda a shuga, amatha kuyambitsa matenda a hyperglycemia, omwe amafunika njira zochizira matenda ashuga. Nthawi yomweyo, kuchepa kwa chiwopsezo cha matenda amtima wamtundu wamthupi ndi ma statins amapambana pachiwopsezo cha matenda a shuga, kotero kuyimitsa mankhwala a statin sikofunikira. Odwala omwe ali pachiwopsezo cha kukhala ndi matenda ashuga (glucose ofulumira a 5.6-6.9 mmol / L, index mass body> 30 kg / m 2, triglycerides okwera, matenda oopsa) amafunikira kuwunika kachipatala komanso kusanthula kwamankhwala osokoneza bongo.

Matenda am'mapapo

Pochita mankhwala pogwiritsa ntchito ma statin ena, makamaka pakanthawi yayitali, vuto la matenda am'mapapo lomwe limachitika kawirikawiri kwambiri. Kuwonetsedwa kwa matendawa kumaphatikizapo zizindikiro monga dyspnea, chifuwa chowuma, komanso thanzi lofooka (kutopa, kuchepa thupi, komanso kutentha thupi). Panthawi yomwe akuganiza kuti matenda am'mapapo omwe akuwaganizira, mankhwala a statin ayenera kusiyidwa.

Zidziwitso Zapadera Zaiwo

Atorvastatin ili ndi lactose. Mankhwalawa sioyenera odwala omwe ali ndi chibadwa chochepa cha galactose, kuperewera kwa lactase enzyme, kapena glucose ndi galactose malabsorption.

Gwiritsani ntchito odwala okalamba

Ukalamba (zaka 65 ndi kupitirira) ndi chinthu chomwe chimapangitsa chidwi cha myopathy, chifukwa chake atorvastatin iyenera kuperekedwa kwa odwala okalamba mosamala.

Gwiritsani ntchito pa nthawi yoyembekezera

Akazi azaka zaubala

Amayi azaka zobereka azigwiritsa ntchito njira zabwino zolerera panthawi ya mankhwala.

Mu maphunziro a nyama, atorvastatin sizinawononge chonde chachimuna kapena chachikazi.

Zowonongera mphamvu yakuyendetsa magalimoto ndi makina owopsa: Palibe malipoti azotsatira zoyipa za atorvastatin pa ndende.

Pa mimba ndi mkaka wa m`mawere

Kufufuza komwe kunachitika motere sikunachitike, ndipo palibe amene amadziwa momwe Atorvastatin amakhudzira mwana wosabadwayo komanso ngati amadutsa mkaka wa m'mawere. Chifukwa chake, samaperekedwa kwa amayi apakati, ndipo ngati kuli kofunikira kutenga mkaka wotsekera, mwanayo amasinthidwa kuti adyetse maupa. Pankhaniyi, amayi omwe ali ndi zaka zobereka, pamene akutenga statin, tikulimbikitsidwa kugwiritsa ntchito njira zoyenera za kulera kuti zithetse mwayi wokhala ndi pakati pa zero.

Atorvastatin amalembera okhawo akuluakulu, ndipo adapangidwira zochizira matenda a lipid metabolism komanso kupewa mtima wamavuto osagwirizana ndi maziko a mtima opangidwa ndi mtima. Zokhudza kuchuluka kwa ana ndi achinyamata sizimamveka bwino, chifukwa chake madokotala sakhala pachiwopsezo chogwiritsa ntchito odwala omwe ali ndi zaka 18.

Zotsatira zoyipa

Kuopsa kwa zovuta kumakhala kotsika: zotsatira zoyipa zimachitika mu 1-3% ya anthu omwe amagwiritsa ntchito nthawi yayitali a Atorvastatin.

Nthawi zambiri, izi ndi zizindikiro zamitsempha m'mimba.
Chifukwa chakuti chinthu chogwira ntchito chimakhudza chiwindi, dyspepsia imatha kukhala - kutulutsa, mseru, kutsegula m'mimba kapena kudzimbidwa, kupweteka pamimba.
Nthawi zina pamakhala kupweteka kwakanthawi.
Malangizowo amatcha ziwengo (kuyambira pakulowerera pakhungu mpaka anaphylaxis), kuchepa kwa potency, kuphwanya mphamvu ya zotumphukira zamitsempha, kukokana, ndi kupweteka kwapawiri ngati zotsatira zoyipa.
Ndizachilendo kwambiri kukhala ndi hepatitis ya mankhwala osokoneza bongo kapena kapamba, kusintha kwa magazi kumachitika: kuchepa kwa maselo ambiri, kuwonjezeka kwa michere ya chiwindi.
Pazokha, rhabdomyolysis inalembedwa - kuwonongeka kwa minofu minofu yomwe idatsekeka pambuyo pake pamatupa a impso chifukwa cha zinthu zawo zowola, zomwe zimapangitsa kuti pakhale kulephera kwaimpso.

Chisamaliro chapadera chikuyenera kuperekedwa kwa odwala matenda ashuga mitundu yonse iwiri. Matenda a shuga ndi chiwonetsero chovomerezeka cha matendawa. Ndipo izi sizanthu koma kupititsa patsogolo kwa zotupa zamatenda am'mimba. Atorvastatin amalembedwa kwa odwala matenda ashuga pamene dyslipidemia yapezeka. Kodi imakweza shuga? Yankho ndi losamveka: chilichonse ndi chokhacho; mankhwalawa sangakhudze kuchuluka kwa shuga, koma angayambitse hypo- kapena hyperglycemia. Kugwiritsa ntchito mankhwala a statin a mtundu 1 ndi matenda amtundu wa 2 kumaphatikizapo kuwunika kawirikawiri shuga.

Zolemba ntchito

Asanapereke Atorvastatin, madokotala akuyesera kuti akwaniritse kubwezeretsa kwa lipid moyenera ndi zakudya, zolimbitsa thupi, kuchepa thupi. M'malo mwake, malingaliro awa amapitilira nthawi yonse ya chithandizo cha statin. Nthawi yomweyo musanadye yoyamba ya mankhwala ntchito ya chiwindi. Kenako imakhala yokhazikika: masabata 1.5 pambuyo poyambira mankhwalawa, pambuyo pa miyezi itatu, kenako - miyezi isanu ndi umodzi iliyonse komanso pambuyo pa kusintha kulikonse.

Kuphatikiza apo, mankhwalawa amathandizira odwala matenda obwereza amawunikiranso asanayambe chithandizo. Ndi kuthamanga kwa magazi, hypothyroidism, kunenepa kwambiri, matenda amchiwindi, mankhwala omwe amagwirizana amasankhidwa kapena mlingo womwe umagwiritsidwa ntchito, malingana ndi kufotokozera. Komanso, odwala amachenjezedwa za kuthekera kwa myopathy, chifukwa chake ayenera kudziwitsa dokotala za kupweteka kwa minofu iliyonse.

Maphunziro ochepera Chithandizo sichinapangidwe kwa masiku angapo, ndipo chikhala bola ngati katswiri wanena. Nthawi zambiri ochepera amakhala miyezi ingapo. Kupatula apo, kusagwirizana kwa lipid kunayamba zaka zambiri kapena zaka zambiri. Ndipo zimatengera nthawi yayitali kukonza. Chifukwa chake, funso loti mungathe kupumira panokha siliyenera kukhala: mapiritsi ayenera kuledzera nthawi zonse. Popanda yopuma, Atorvastatin imatha kutengedwa zaka zambiri, ndipo zimatenga nthawi yayitali bwanji kuti achite izi - lipid mbiri imati.

Ndi chiwindi ntchito

Atorvastatin amaloledwa pokhapokha ngati pali chiwindi matenda kapena kufooka kwa chiwindi. Komabe, imawunika kufunika kogwiritsa ntchito kwake komanso kuthekera kwina kusintha njira zina zomwe sizikhudza chiwindi. Kuwunikira magwiridwe antchito a hepatocytes ngati vuto la chiwindi ndilofunikira kwambiri. Kusanthula kuyenera kuchitika pa nthawi komanso mukatha kukonzekera.

Mtengo wa mankhwala

Mankhwala a gulu lama pharmacological amapangidwa m'maiko ambiri, ndipo mtengo wa Atorvastatin umatengera wopanga. Komabe, komanso pamtundu wa milligram, komanso kuchuluka kwa mapiritsi a phukusi. Ma analogues pamtengo akukonzekera kupanga kwa Chiyukireniya, Russia, India ndi Chingerezi.

Mtengo wa maphunziro a pamwezi ndi tsiku lililonse 20 mg m'masamba athu amapangira 90 ± 20 UAH. kapena 250 ± 80 ma ruble. Mapiritsi a Israeli ndi okwera mtengo 1.5, owonjezera ku Spain ndi okwera mtengo kawiri, Amereka ndi aku Germany amakhala okwera mtengo katatu.

Zomwe atorvastatin-based statin ndizabwinoko

Phukusi lachipatala, nthawi zambiri pafupi ndi dzina loyambirira limakhala ndi chidule kapena mawu ena, mwachitsanzo, Atorvastatin SZ kapena Atorvastatin MS. Izi tinthu timene timapanga opanga osiyanasiyana. Izi, tikulankhula za makampani opanga mankhwala ku Russia Severnaya Zvezda ndi Medisorb. Pazosanjikiza zina mutha kuwona mawu owonjezera "Pranapharm", "Ozone", "LEXVM", "Vertex", "Canonfarm", "Akrikhin", "Actavis", "Biocom", "ALSI Pharma".

Mwa zina zomwe mungapeze mu Atorvastatin Alkaloid (Macedonia), Atorvastatin Teva (Israel), Ananta (India), Pfizer (USA), Blufish (Sweden), Ratiopharm (Germany), " Aveksima "(kampani yapadziko lonse lapansi) ... Ndizosatheka kunena motsimikiza kuti ndi mankhwala ati omwe kampani ndiyabwino. M'malo mwake, izi ndizofananira, fanizo mwachindunji. Madera otchedwa Atorvastatin ali ndi zinthu zomwezo. Amasiyana m'magawo othandizira: mapiritsi amatha kuthandizidwa ndikugwiritsira ntchito omwe alibe zotsatira zoyipa mu regimen yothandizira. Komabe, ngati mankhwala atorvastatin okhala ndi mayina ena ogulitsa.

Izi zikuwonetsedwa ndi kuwunika kwa akatswiri ndi odwala: Mankhwala ololeredwa bwino omwe amachokera pa atorvastatin amasankhidwa chifukwa cha odwalawo, ndipo m'malo mwake sizinakhudze zotsatira za mbiri ya lipid. Koma palibe amene wakwanitsa kusinthiratu mankhwala opanga mankhwala ndi wowerengeka.

Kugwiritsa Ntchito

Anthu ambiri, asanayambe chithandizo, amafuna kudziwa lingaliro loyima pawokha la madokotala (akatswiri azachipatala), komanso kudziwa za ndemanga za odwala omwe adamwa mankhwalawa. Pambuyo pa kafukufuku wa akatswiri ndi odwala, wina atha kuona mfundo zazikuluzikulu motere:

Atorvastatin ndi mankhwala osankha madokotala ambiri chifukwa chothandiza kwambiri komanso samakumana ndi mavuto ambiri,
odwala ambiri omwe amamwa mapiritsi a cholesterol "yoyipa" adazindikira kuti akukhala bwino, makamaka omwe adasinthitsa mbadwo watsopano wa statin ndi rosuvastatin ndi atorvastatin chifukwa cha zovuta zoyipa.
ochepa mwa odwala omwe amamwa mankhwalawa adadandaula za chizungulire, kufooka ndi mutu, koma awa anali achikulire omwe adalandira mankhwala okwanira.