Atorvastatin 20 mg - cov lus qhia rau kev siv > Kev khomob thiab kev tiv thaiv

Cov ntsiav tshuaj-yeeb yaj kiab, 20 mg.

Ib ntsiav tshuaj muaj

cov tshuaj nquag - atorvastatin (nyob rau hauv daim ntawv ntawm atorvastatin calcium ntsev) - 20 mg
excipients - lactose monohydrate, microcrystalline cellulose, croscarmellose sodium, hypromellose 2910, polysorbate 80, calcium stearate, calcium carbonate
lub plhaub sib xyaw - hypromellose 2910, polysorbate 80, titanium dioxide (E 171), talc

Dawb puag ncig biconvex zaj duab xis-coated ntsiav tshuaj. Thaum lub sijhawm so, cov ntsiav tshuaj muaj xim dawb lossis yuav luag dawb.

Cov Tshuaj Hauv Tshuaj

Hypolipidemic tus neeg sawv cev los ntawm pawg statins. Lub tshuab tseem ceeb ntawm kev ua ntawm atorvastatin yog qhov inhibition ntawm kev ua ntawm 3-hydroxy-3-methylglutarylcoenzyme A- (HMG-CoA) reductase, ib qho enzyme uas catalyzes hloov dua siab tshiab ntawm HMG-CoA rau mevalonic acid. Qhov kev hloov pauv no yog ib qho ntawm thawj kauj ruam ntawm kev sib tshooj hauv cov roj (cholesterol) coj los ua ke hauv lub cev. Kev tsuj ntawm atorvastatin roj synthesis ua rau cov tshuaj tiv thaiv muaj zog ntawm LDL receptors (lipoproteins tsawg ntom) hauv lub siab, zoo li hauv cov ntaub so ntswg tshwj xeeb. Cov receptors khi LDL cov roj ntsha thiab tshem tawm cov ntshav ntshav, uas ua rau cov roj cholesterol LDL tsawg hauv cov ntshav.

Cov nyhuv antisclerotic ntawm atorvastatin yog lub txiaj ntsig ntawm cov nyhuv ntawm cov tshuaj rau ntawm phab ntsa ntawm cov hlab ntsha thiab cov ntshav sib xyaw ua ke. Cov tshuaj inhibits lub synthesis ntawm isoprenoids, uas yog yam loj hlob ntawm cov cell ntawm lub puab ntawm cov hlab ntsha. Nyob hauv kev cuam tshuam ntawm atorvastatin, endothelium-ywj pheej nthuav cov hlab ntshav txhim kho. Atorvastatin txo qis cov roj cholesterol, cov lipoproteins tsawg ntom, apolipoprotein B, triglycerides. Ua rau muaj cov HDL cov cholesterol (cov lipoproteins ntau ntom) thiab apolipoprotein A.

Kev txiav txim ntawm cov tshuaj, raws li txoj cai, txhim kho tom qab 2 lub lis piam ntawm kev tswj hwm, thiab cov txiaj ntsig siab tshaj plaws tau tiav tom qab plaub lub lis piam.

Cov Tshuaj Pharmacokinetics

Kev tshem tawm yog qhov siab. Lub sijhawm kom mus txog qhov siab tshaj plaws yog 1-2 teev, qhov siab tshaj plaws hauv cov poj niam yog 20% siab dua, AUC (thaj chaw hauv qab txoj kab nkhaus) yog 10% qis dua, qhov siab tshaj plaws hauv cov neeg mob haus cawv ntau yog 16 zaug, AUC yog 11 zaug siab dua li ib txwm. Khoom noj khoom haus me ntsis txo qhov nrawm thiab ncua sijhawm ntawm kev nqus ntawm cov tshuaj (los ntawm 25% thiab 9%, feem), tab sis qhov txo qis hauv LDL cov roj (cholesterol) zoo ib yam li cov kev siv atorvastatin tsis muaj zaub mov. Qhov kev nkag siab ntawm atorvastatin thaum thov thaum yav tsaus ntuj yog qis dua thaum sawv ntxov (kwv yees li 30%). Txoj kab sib txuas ntawm qhov txheeb ze ntawm cov neeg nqus ntawm cov tshuaj thiab cov koob tshuaj tau qhia tawm.

Bioavailability - 14%, lub cev tsis muaj zog ntawm cov kev txwv tsis pub tiv thaiv HMG-CoA reductase - 30%. Kev siv lub cev tsis tshua muaj txiaj ntsig zoo yog vim muaj cov kab mob presystemic hauv lub plab zom mov thiab txoj hnyuv "thaum pib tso" los ntawm lub siab.

Qhov nruab nrab ntawm kev faib tawm yog 381 l, qhov sib txuas nrog cov ntshav plasma protein yog 98%. Nws yog metabolized feem ntau hauv daim siab nyob rau hauv kev ua ntawm cytochrome P450 CYP3A4, CYP3A5 thiab CYP3A7 nrog kev tsim cov tshuaj pharmacologically nquag metabolites (ortho- thiab parahydroxylated derivatives, beta-oxidation khoom). Qhov cuam tshuam ntawm cov tshuaj tawm tsam HMG-CoA reductase yog kwv yees li 70% txiav txim siab los ntawm kev ua si ntawm cov roj ntsha hloov mus.

Nws yog cov kua hauv cov kua tsib tom qab cov kab mob hepatic thiab / lossis extrahepatic metabolism (tsis ua mob hnyav nkag mus hauv qhov hnyav).

Ib nrab-lub neej yog 14 teev .Tes kev tiv thaiv kev ua si tiv thaiv HMG-CoA reductase tseem muaj txog li 20-30 teev, vim muaj cov metabolites nquag. Tsawg dua 2% ntawm kev noj tshuaj hauv qhov ncauj yog txiav txim siab nyob rau hauv cov zis.

Nws tsis yog nyob hauv tus kab mob hemodialysis.

Kev ntsuas rau siv

Cov lus qhia rau kev siv atorvastatin yog:

hypercholesterolemia, yog ib qho kev txhawb ntxiv rau kev noj haus rau kev kho mob ntawm cov neeg mob uas nce qib ntawm cov roj (cholesterol) tag nrho, LDL cov roj (cov lipoproteins tsawg ntom), apolipoprotein B thiab triglycerides, ntxiv rau cov roj HDL (cov lipoprotein ntau ntau) rau cov neeg mob thawj chib txiv ntshav tsis muaj kab mob hypercholesterolemia), kev sib xyaw (sib xyaw) hyperlipidemia (Fredrickson yam IIa thiab IIb), ntshav ntau ntshav qib triglyceride (Fredrickson hom III), nyob rau hauv cov teeb meem thaum kev noj zaub mov tsis muaj kev ua kom txaus.
kom txo qis tag nrho cov roj (cholesterol) thiab cov roj (cholesterol) LDL hauv cov neeg mob homozygous kab mob hypercholesterolemia nyob rau hauv cov mob uas tsis muaj tshuaj tiv thaiv txaus rau kev noj zaub mov noj lossis lwm yam tshuaj tsis raug.
rau prophylaxis hauv cov neeg mob uas tsis muaj kev soj ntsuam cov kab mob plawv, nrog lossis tsis muaj dyslipidemia, tab sis muaj ntau yam kev pheej hmoo rau cov mob plawv xws li haus luam yeeb, kub siab, ntshav qab zib mellitus, muaj roj tsawg HDL (HDL-C), lossis nrog rau thaum ntxov kev mob plawv hauv tsev neeg keeb kwm (los txo qis kev pheej hmoo ntawm kev tuag nyob rau ntawm cov hlab ntshav plawv thiab tsis mob ntshav siab ntshav qab zib, txo kev pheej hmoo ntawm mob hlab ntsha tawg).

Pharmacological kev txiav txim

Cov nyhuv pharmacological yog hypolipidemic.

Cov tshuaj muaj zog ua rau cov enzyme HMG-CoA reductase, uas koom nrog cov tshuaj tua kab mob roj thiab atherogenic lipoproteins hauv daim siab, thiab tseem ua rau cov tshuaj hepatic cell membrane receptors uas ntes LDL. Noj cov tshuaj ntawm ib koob ntawm 20 mg ua rau txo qis cov roj (cholesterol) tag nrho los ntawm 30-46%, cov lipoproteins tsawg kawg yog 41-61%, triglycerides los ntawm 14-33%, thiab kev nce siab hauv cov tshuaj lipoproteins ntau ntau.

Tshaj tawm cov tshuaj hauv qhov siab tshaj plaws ntawm 80 mg txo cov kev pheej hmoo ntawm kev ua tsis zoo hauv cov hlab plawv, kev tuag thiab cov zaus mus pw hauv tsev kho mob plawv, suav nrog cov neeg mob siab.

Cov tshuaj ntawm cov tshuaj raug kho raws qib ntawm LDL.

Qhov siab tshaj plaws ua tiav tau tiav 1 hlis tom qab pib kho mob.

Pharmacokinetics: nqus tau los ntawm kev mob plab, ncav lub siab plasma ntau tshaj plaws tom qab 1-2 teev. Noj thiab lub sijhawm nruab hnub tsis cuam tshuam rau qhov ua tau zoo. Thauj nyob rau hauv ntshav protein ntau cuam tshuam lub xeev. Nws yog oxidized hauv lub siab nrog kev tsim cov tshuaj metabolites nquag kho mob. Nws yog dhau los nrog bile.

Hauv cov neeg mob uas muaj hnub nyoog 65 xyoos, hauv kev sib piv nrog cov tub ntxhais hluas cov neeg mob, qhov ua tau zoo thiab kev nyab xeeb ntawm cov tshuaj yog qhov zoo sib xws.

Txo lub raum tsis ua haujlwm tsis cuam tshuam rau cov tshuaj metabolism thiab cov tshuaj tawm thiab tsis tas yuav hloov cov tshuaj.

Kev mob siab hauv lub siab yog qhov ua tsis ncaj rau kev siv tshuaj atorvastatin.

Vim li cas cov ntsiav tshuaj Atorvastatin 20

Kev taw qhia rau kev siv:

metabolic ntshawv siab ntawm lipoproteins thiab lwm yam lipidemia,
ntshiab hypercholesterolemia,
ntshiab hypertriglyceridemia,
sib xyaw thiab tsis tau lees paub txog hyperlipidemia,
kev tiv thaiv kev mob plawv hauv cov neeg mob uas muaj kev pheej hmoo siab,
mob plawv rau lub plawv (angina pectoris, myocardial infarction),
raug mob stroke.

Cov chaw muag tshuaj

Cov Tshuaj Pharmacokinetics

Kev tshem tawm yog qhov siab. Kev tshem tawm ib nrab-lub neej yog 1-2 teev, Cmax hauv cov poj niam yog 20% siab dua, AUC yog 10% qis dua, Cmax hauv cov neeg mob uas muaj cawv qog mob ntshav siab yog 16 zaug, AUC yog 11 zaug siab dua li ib txwm. Khoom noj khoom haus me ntsis txo qhov nrawm thiab ncua sijhawm ntawm kev nqus ntawm cov tshuaj (los ntawm 25 thiab 9%, feem), tab sis qhov txo qis hauv LDL cov roj (cholesterol) zoo ib yam li cov kev siv atorvastatin tsis muaj zaub mov. Qhov kev nkag siab ntawm atorvastatin thaum thov thaum yav tsaus ntuj yog qis dua thaum sawv ntxov (kwv yees li 30%). Txoj kab sib txuas ntawm qhov txheeb ze ntawm cov neeg nqus ntawm cov tshuaj thiab cov koob tshuaj tau qhia tawm. Bioavailability - 14%, lub cev tsis muaj zog ntawm cov kev txwv tsis pub tiv thaiv HMG-CoA reductase - 30%. Qes tsawg lub cev kev noj qab haus huv yog vim muaj cov kab mob presystemic metabolism hauv txoj hnyuv plab thiab thaum "thawj hla" los ntawm lub siab. Qhov nruab nrab ntawm kev faib tawm yog 381 l, kev sib txuas nrog cov ntshav plasma ntau dua 98%. Nws yog metabolized feem ntau hauv daim siab nyob rau hauv kev ua ntawm cytochrome CYP3A4, CYP3A5 thiab CYP3A7 nrog kev tsim cov pharmacologically nquag metabolites (ortho thiab parahydroxylated derivatives, cov khoom ntawm beta oxidation). Hauv cov tshuaj vitro, ortho- thiab para-hydroxylated metabolites muaj qhov cuam tshuam rau HMG-CoA reductase, piv nrog ntawm atorvastatin. Qhov cuam tshuam ntawm cov tshuaj tawm tsam HMG-CoA reductase yog kwv yees li 70% txiav txim los ntawm cov kev ua ntawm lub cev hloov roj thiab ua mob ntev li 20-30 teev vim lawv muaj. Kev tshem tawm ib nrab-lub neej yog 14 teev. Nws yog cov kua hauv cov kua tsib tom qab cov kab mob hepatic thiab / lossis extrahepatic metabolism (tsis ua mob hnyav nkag mus hauv qhov hnyav). Tsawg dua 2% ntawm kev noj tshuaj hauv qhov ncauj yog txiav txim siab nyob rau hauv cov zis. Nws tsis yog tawm thaum lub sij hawm hemodialysis vim kev ua kom nruj rau cov ntshav protein. Nrog lub siab ua tsis tau rau hauv cov neeg mob uas muaj cawv cawv (Me Nyuam-Pyug B), Cmax thiab AUC nce ntxiv (16 thiab 11 zaug, feem ntau). Cmax thiab AUC ntawm cov tshuaj hauv cov neeg laus (65 xyoo rov hauv) yog 40 thiab 30%, feem ntau, ntau dua li cov neeg mob hauv cov neeg laus cov hluas (tsis muaj kev kuaj mob tseem ceeb). Cmax hauv cov poj niam yog 20% siab dua, thiab AUC yog 10% qis dua tus txiv neej (nws tsis muaj nqi kuaj mob). Cov hlaws tsis ua haujlwm tsis cuam tshuam rau cov ntshav plasma concentration ntawm cov tshuaj.

Cov Tshuaj Hauv Tshuaj

Atorvastatin yog tus neeg saib xyuas hypolipidemic los ntawm pab pawg ntawm statins. Nws yog cov xaiv sib tw inhibitor ntawm HMG-CoA reductase, ib qho enzyme uas hloov 3-hydroxy-3-methylglutaryl coenzyme A rau mevalonic acid, uas yog qhov ua ntej ntawm sterols, suav nrog cov roj (cholesterol). Triglycerides thiab cov roj (cholesterol) hauv lub siab yog suav nrog qhov sib xyaw ntawm lipoproteins tsawg heev (VLDL), nkag mus rau hauv cov ntshav thiab thauj mus rau cov ntaub so ntswg. Tsawg lipoproteins tsawg (LDL) yog tsim los ntawm VLDL thaum muaj kev sib cuam tshuam nrog LDL receptors. Kev ua kom cov ntshav plasma tsawg thiab lipoprotein tsawg dua vim tias tsis muaj HMG-CoA reductase, cov roj (cholesterol) nyob hauv daim siab ua haujlwm ntau ntxiv thiab muaj cov LDL receptors ntau nyob rau hauv lub cell, uas ua rau muaj kev nce siab thiab catabolism ntawm LDL. Txo qhov tsim ntawm LDL, ua rau muaj suab tshaj tawm thiab pheej ua kom nce ntxiv hauv cov dej num ntawm LDL receptors. Kev txo qis LDL hauv cov neeg mob homozygous tsev neeg hypercholesterolemia, uas feem ntau tsis yog tuaj yeem kho nrog lipid-txo tshuaj. Nws txo cov theem ntawm cov roj (cholesterol) tag nrho los ntawm 30-46%, LDL - los ntawm 41-61%, apolipoprotein B - los ntawm 34-50% thiab triglycerides - los ntawm 14-33%, ua rau muaj kev nce qib ntawm cov ntshav siab roj-lipoproteins thiab apolipoprotein A. Dose-dependently txo qib LDL hauv cov neeg mob homozygous cov kab mob hypercholesterolemia, tiv thaiv kev kho mob nrog lwm cov lipid-txo cov tshuaj. Tseem ceeb txo txoj kev pheej hmoo ntawm kev tsim ischemic muaj teeb meem (suav nrog kev loj hlob ntawm kev tuag los ntawm myocardial infarction) los ntawm 16%, kev pheej hmoo rov qab pw hauv tsev kho mob rau angina pectoris, nrog cov cim ntawm myocardial ischemia, los ntawm 26%. Nws tsis muaj carcinogenic thiab mutagenic teebmeem. Kev ua rau txoj kev kho tau tiav 2 lub lis piam tom qab pib kho, mus txog qhov siab kawg tom qab 4 lub lis piam thiab kav ntev hauv lub sijhawm kho.

Tsuas tshuaj thiab tswj hwm

Sab hauv, siv sijhawm txhua lub sijhawm ntawm hnub, tsis hais noj zaub mov. Ua ntej pib kev kho mob, koj yuav tsum hloov mus rau kev noj haus kom ntseeg tau tias cov lipids hauv cov ntshav tsawg dua, thiab saib nws thaum lub sijhawm tag nrho kev kho mob.

Hauv kev tiv thaiv kab mob plawv Thawj koob tshuaj rau cov neeg laus yog 10 mg ib hnub ib zaug. Cov koob tshuaj yuav tsum tau hloov nrog lub caij nyoog ntawm tsawg kawg 2-4 lub lis piam nyob rau hauv kev tswj hwm ntawm lipid tsis nyob hauv ntshav. Qhov tshuaj ntau tshaj txhua hnub yog 80 mg hauv 1 koob tshuaj. Nrog rau kev tswj hwm tib lub sijhawm nrog cyclosporine, qhov siab tshaj plaws txhua hnub ntawm atorvastatin yog 10 mg, nrog clarithromycin - 20 mg, nrog itraconazole - 40 mg.

Ntawmthawj hypercholesterolemia thiab ua ke (sib xyaw) hyperlipidemia 10 mg ib hnub ib zaug. Cov nyhuv manifests nws tus kheej tsis pub dhau 2 lub lis piam, cov siab tshaj plaws pom tau hauv 4 lub lis piam.

Ntawmhomozygous tsev neeg hypercholesterolemia cov koob tshuaj thawj zaug yog 10 mg ib hnub ib zaug, tom qab ntawd nce mus txog 80 mg ib hnub ib zaug (ib qho zuj zus hauv LDL los ntawm 18-45%). Ua ntej pib txoj kev kho, tus neeg mob yuav tsum yog tus kws kho mob hypocholesterolemic noj, uas nws yuav tsum ua raws thaum lub sijhawm kho. Nrog lub siab tsis ua haujlwm, qhov tshuaj yuav tsum tau ua kom tsawg. Rau cov menyuam yaus txij li 10 txog 17 xyoo (tsuas yog cov tub thiab tus ntxhais coj khaub ncaws) nrog kev tiv thaiv kabmob heterozygous tsev neeg hypercholesterolemia, thawj koob tshuaj yog 10 mg 1 zaug nyob rau ib hnub. Qhov koob tshuaj yuav tsum tau nce ntxiv tsis pub dhau 4 lub lis piam lossis ntau dua. Qhov koob tshuaj ntau tshaj plaws txhua hnub yog 20 mg (kev siv cov koob tshuaj ntau tshaj 20 mg tsis tau kawm).

Cov neeg laus thiab cov neeg mob raum hloov cov tshuaj rau noj yog tsis tas yuav tsum tau ua.

Cov neeg mob uas muaj lub siab ua haujlwm tsis zoo kev saib xyuas yuav tsum tau ua nyob rau hauv kev txuas nrog qeeb qeeb ntawm kev tshem tawm cov tshuaj ntawm lub cev. Cov chaw kuaj mob thiab kuaj pom ntawm lub siab ua haujlwm yuav tsum tau ua tib zoo saib xyuas, thiab nrog cov kab mob hloov pauv tseem ceeb, cov koob tshuaj yuav tsum raug txo lossis txiav tawm.

Siv hauv kev sib xyaw nrog lwm cov tshuaj sib xyaw. Yog tias siv cov atorvastatin thiab cyclosporine tsim nyog, koob tshuaj atorvastatin yuav tsum tsis pub tshaj 10 mg.

Sab sij huam

Los ntawm lub paj hlwb: insomnia, mob taub hau, asthenic syndrome, malaise, kiv taub hau, peripheral neuropathy, amnesia, paresthesia, hypesthesia, kev nyuaj siab.

Los ntawm lub plab zom mov: xeev siab, raws plab, mob plab, dyspepsia, flatulence, cem quav, ntuav, tsis nco qab, mob siab, mob caj pas, mob caj dab, mob daj ntseg.

Los ntawm cov leeg musculoskeletal: myalgia, mob nraub qaum, mob caj dab, mob leeg, mob leeg, mob myopathy, rhabdomyolysis.

Kev tsis haum tshuaj: urticaria, mob pruritus, tawv nqaij ua pob, xoo pob liab vog, anaphylaxis, polymorphic exudative erythema (suav nrog Stevens-Johnson syndrome), Laille syndrome.

Los ntawm cov kabmob hemopoietic: thrombocytopenia.

Los ntawm ib sab ntawm cov metabolism: hypo- lossis hyperglycemia, nce kev ua si ntawm ntshiab CPK.

Endocrine system: mob ntshav qab zib mellitus - qhov ntau zaus ntawm kev txhim kho yuav nyob ntawm qhov muaj lossis tsis muaj kev phom sij (yoo cov kua nplaum ≥ 5.6, qhov ntsuas lub cev ua kom hnyav> 30 kg / m2, nce triglycerides, keeb kwm kev kub siab).

Lwm yam: tinnitus, qaug zog, kev sib daj sib deev, peripheral edema, qhov hnyav ntxiv, mob hauv siab, alopecia, cov xwm txheej ntawm kev txhim kho ntawm cov kabmob interstitial, tshwj xeeb tshaj yog siv sijhawm ntev, mob hemorrhagic mob stroke (thaum noj loj dua nrog CYP3A4 inhibitors), mob raum tsis ua haujlwm. Cov.

Cov Yuav Tsum Muaj

hypersensitivity rau ib feem twg ntawm cov tshuaj

nquag ua mob rau daim siab, nce kev ua haujlwm ntawm "daim siab" hloov ntshav (ntau dua 3 zaug) uas tsis paub keeb kwm

Cov poj niam muaj hnub nyoog yug me nyuam uas tsis siv txoj kev ua kom muaj txiaj ntsig txaus

cov me nyuam qis dua 18 xyoo (qhov ua tau zoo thiab kev nyab xeeb)

tuav tswj hwm nrog HIV protease inhibitors (telaprevir, tipranavir + ritonavir)

cov kab mob tsis haum rau galactose tsis haum, lactase deficiency lossis impaired glucose-galactose haum

Atorvastatin tuaj yeem siv tshuaj rau tus poj niam ntawm kev muaj me nyuam tsuas yog tias nws paub tseeb tias nws tsis tau xeeb tub thiab paub txog kev pheej hmoo ntawm cov tshuaj rau cov menyuam hauv plab.

keeb kwm txog kab mob siab

electrolyte tsis txaus

endocrine thiab metabolic ntshawv siab

mob hnyav ua mob (sepsis)

dav hlais tawm

Cov tshuaj sib cuam tshuam

Nrog rau kev tswj hwm tib lub sijhawm ntawm cyclosporine, fibrates, erythromycin, clarithromycin, immunosuppressive, antifungal tshuaj (cuam tshuam nrog azoles) thiab nicotinamide, cov tshuaj atorvastatin hauv plasma thiab txoj kev pheej hmoo ntawm myopathy nrog rhabdomyolysis thiab lub raum tsis ua haujlwm nce.

Antacids txo qhov tshuaj nyob ntawm 35% (cov nyhuv ntawm LDL cov cholesterol tsis hloov).

Qhov kev siv ua ke ntawm atorvastatin nrog warfarin tuaj yeem txhim kho cov nyhuv ntawm warfarin ntawm cov ntshav coagulation tsis dhau thawj hnub (txo sij hawm prothrombin). Cov nyhuv no ploj mus tom qab 15 hnub ntawm kev sib koom ua ke ntawm cov tshuaj no.

Kev siv cov ntsiab lus ntawm atorvastatin nrog protease inhibitors hu ua CYP3A4 inhibitors yog nrog los ntawm kev nce plasma ntau dua ntawm atorvastatin (thaum siv tshuaj erythromycin nrog Cmax, atorvastatin nce 40%). HIV protease inhibitors yog CYP3A4 inhibitors. Kev siv tshuaj tiv thaiv kab mob HIV protease inhibitors thiab statins nce qib ntawm statins nyob rau hauv cov ntshav, uas nyob rau hauv cov xwm txheej tsis tshua muaj ua rau kev txhim kho ntawm myalgia, thiab tshwj xeeb rau mob rhabdomyolysis, mob o thiab mob ntawm cov nqaij striated, ua rau myoglobulinuria thiab mob raum tsis ua haujlwm. Qhov mob kawg ntawm ib feem peb ntawm cov neeg mob yuav tas sim neej.

Siv atorvastatin nrog kev ceev faj thiab qhov tsawg kawg yog siv tau zoo nrog tus kab mob HIV protease inhibitors: lopinavir + ritonavir. Cov koob tshuaj atorvastatin yuav tsum tsis pub ntau tshaj 20 mg rau ib hnub thaum noj ua ke nrog HIV protease inhibitors: fosamprenavir, darunavir + ritonavir, fosamprenavir + ritonavir, saquinavir + ritonavir. Qhov tshuaj ntawm atorvastatin yuav tsum tsis pub tshaj 40 mg ib hnub twg thaum noj ua ke nrog cov kab mob HIV protease inhibitor nelfinavir.

Thaum siv digoxin sib xyaw nrog atorvastatin ntawm ib koob ntawm 80 mg / hnub, kev ua haujlwm ntawm digoxin nce ntxiv txog li 20%.

Tsub kom lub siab ntxiv (thaum kho nrog atorvastatin ntawm ib koob ntawm 80 mg / hnub) ntawm qhov ncauj txwv tsis pub muaj norethisterone los ntawm 30% thiab ethinyl estradiol los ntawm 20%.

Cov lipid-txo cov nyhuv ntawm kev sib xyaw nrog colestipol yog qhov zoo dua rau qhov tshuaj rau txhua qhov sib cais, txawm hais tias 25% txo qis ntawm cov tshuaj atorvastatin thaum siv concomitantly nrog colestipol.

Kev siv ib txhij nrog cov tshuaj uas txo cov kev ua kom zoo ntawm cov tshuaj hormones endogenous steroid (suav nrog ketoconazole, spironolactone) muaj kev pheej hmoo ntawm txo cov tshuaj endogenous steroid (ceev faj yuav tsum tau siv).

Kev siv cov kua txiv kab ntxwv qaub thaum kho mob tuaj yeem ua rau nce ntshav ntau ntxiv ntawm atorvastatin. Yog li, thaum kho, kua txiv kab ntxwv qaub yuav tsum zam.

Cov lus qhia tshwj xeeb

Atorvastatin tuaj yeem ua rau muaj kev nce siab ntau ntxiv ntawm CPK, uas yuav tsum raug coj mus rau hauv qhov kev ntsuas txawv txav ntawm lub hauv siab. Nws yuav tsum tau yug los hauv lub siab tias qhov nce hauv KFK los ntawm 10 zaug piv nrog cov cai, nrog rau cov mob myalgia thiab cov leeg tsis muaj zog tuaj yeem cuam tshuam nrog myopathy, kev kho mob yuav tsum tau tsum tsis ua ntxiv.

Nrog rau kev siv tib txhij ntawm atorvastatin nrog cytochrome CYP3A4 protease inhibitors (cyclosporine, clarithromycin, itraconazole), thawj koob tshuaj yuav tsum tau pib nrog 10 mg, nrog lub sijhawm luv luv ntawm kev siv tshuaj tua kab mob, atorvastatin yuav tsum tau txiav tawm.

Nws yog ib qho tsim nyog yuav tsum tau soj ntsuam qhov ntsuas tsis tu ncua ntawm lub siab ua haujlwm ua ntej kev kho mob, 6 thiab 12 lub lis piam tom qab pib siv tshuaj lossis tom qab nce qhov koob tshuaj, thiab tsis tseg (txhua 6 lub hlis) thaum lub sijhawm tag nrho ntawm kev siv (txog thaum qhov ib txwm ua tiav ntawm cov mob ntawm cov neeg mob uas muaj kev hloov siab ntau dua li ib txwm ) Kev nce ntxiv ntawm tus kab mob "hepatic" transaminases yog pom feem ntau hauv thawj 3 lub hlis ntawm kev tswj hwm tshuaj. Nws raug nquahu kom thim cov tshuaj lossis txo cov koob tshuaj nrog kev nce hauv AST thiab ALT ntau dua 3 zaug. Kev siv cov tshuaj atorvastatin yuav tsum tau txiav tawm ib ntus hauv kev txhim kho cov kev tshawb fawb pom tias muaj qhov mob myopathy zoo, lossis nyob rau ntawm qhov muaj kev cuam tshuam rau kev txhim kho ntawm lub raum tsis ua haujlwm vim rhabdomyolysis (mob hnyav, txo ntshav siab, kev phais loj, kev poob plig, mob plab, endocrine lossis mob ntshav qab zib cuam tshuam loj) Cov. Cov neeg mob yuav tsum tau ceeb toom tias lawv yuav tsum tau sab laj nrog kws kho mob sai sai yog tias tsis hnov qhov mob lossis cov leeg tsis muaj zog, tshwj xeeb tshaj yog tias lawv nrog mob tshwm sim lossis kub taub hau.

Muaj cov ntawv tshaj tawm txog kev txhim kho ntawm atonic fasciitis nrog kev siv atorvastatin, txawm li cas los xij, kev sib txuas nrog kev tswj hwm ntawm cov tshuaj yog ua tau, tab sis tseem tsis tau muaj pov thawj, cov etiology tseem tsis tau paub.

Ntxim rau cov leeg pob txha. Thaum siv atorvastatin, zoo li lwm yam tshuaj ntawm cov chav kawm no, muaj tsawg yam tshwm sim ntawm rhabdomyolysis nrog mob raum tsis ua haujlwm los ntawm myoglobinuria tau piav qhia. Keeb kwm ntawm lub raum tsis ua haujlwm tuaj yeem yog qhov kev pheej hmoo rau rhabdomyolysis. Cov mob ntawm cov neeg mob yuav tsum tau ua tib zoo saib xyuas kev txhim kho kev ua kom pom ntawm cov leeg nqaij pob txha.

Atorvastatin, zoo li lwm yam statins, hauv cov xwm txheej tsis tshua muaj peev xwm ua rau kev txhim kho myopathy, tshwm sim los ntawm cov leeg mob los yog cov leeg tsis muaj zog ua ke nrog kev nce qib ntawm creatine phosphokinase (CPK) ntau dua 10 zaug los ntawm qhov muaj nqi tshaj saud. Kev sib xyaw ua ke ntawm kev siv tshuaj ntau dua ntawm atorvastatin nrog cov tshuaj xws li cyclosporine thiab hwj chim inhibitors ntawm CYP3A4 isoenzyme (piv txwv li, clarithromycin, itraconazole thiab HIV protease inhibitors) nce qhov kev pheej hmoo ntawm myopathy / rhabdomyolysis. Thaum siv cov tshuaj statins, muaj tsawg kis ntawm kev tiv thaiv kab mob-tiv thaiv necrotizing myopathy (IONM), autoimmune myopathy, tau tshaj tawm. IONM yog tus cwj pwm los ntawm qhov tsis muaj zog ntawm qhov sib thooj ntawm cov leeg ua ke thiab kev nce ntxiv ntawm cov ntshav dej muaj txiaj ntsig ntau ntau ntxiv, uas mob siab txawm hais tias nres ntawm kev siv statins, necrotizing myopathy raug pom thaum mob me, uas tsis nrog kev mob hnyav, txhim kho tshwm sim thaum txhaj tshuaj tiv thaiv kab mob.

Kev txhim kho ntawm myopathy yuav tsum xav tias tsam nyob hauv cov neeg mob uas mob myalgia, mob nqaij los yog tsis muaj zog thiab / lossis cov cim nce siab hauv qib ntawm CPK. Cov neeg mob yuav tsum tau ceeb toom tias lawv yuav tsum ceeb toom rau lawv tus kws kho mob tam sim ntawd txog qhov tshwm sim ntawm qhov tsis hnov mob, mob lossis tsis muaj zog hauv cov leeg, tshwj xeeb yog tias lawv nrog mob lossis kub taub hau, nrog rau yog tias cov leeg mob mus ntev tom qab txiav tawm atorvastatin. Nrog lub cim nce siab hauv qib ntawm CPK, kuaj mob myopathy lossis xav tias tsam myopathy, kev kho mob nrog atorvastatin yuav tsum tsis ua ntxiv.

Txoj kev pheej hmoo ntawm kev txhim kho myopathy thaum kho nrog cov tshuaj ntawm cov chav kawm no nce nrog kev siv cyclosporin, tib lub sijhawm ntawm fibric acid, erythromycin, clarithromycin, kab mob siab C virus protease inhibitor, telaprevir, kev siv tshuaj tiv thaiv HIV tiv thaiv inhibitors (suav nrog saquinavir + ritonavir, ritinavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, r darunavir + ritonavir, fosamprenavir thiab fosamprenavir + ritonavir), nicotinic acid lossis antifungal tus neeg sawv cev los ntawm pawg azole. Thaum xav txog cov nqe lus nug ntawm tuav ib tug ua ke kho nrog atorvastatin thiab fibric acid derivatives, erythromycin, clarithromycin, saquinavir nyob rau hauv ua ke nrog nrog ritonavir, lopinavir nyob rau hauv ua ke nrog nrog ritonavir, darunavir nyob rau hauv ua ke nrog nrog ritonavir, fosamprenavir, los yog fosamprenavir nyob rau hauv ua ke nrog nrog ritonavir, noj cov tshuaj mas siv los ntawm cov pab pawg neeg ntawm azoles los yog nicotinic acid ntawm kev noj tshuaj lipid-txo qis, cov kws kho mob yuav tsum ua tib zoo ntsuas cov txiaj ntsig uas tau npaj tseg thiab muaj peev xwm txaus ntshai thiab ua tib zoo saib xyuas cov xwm txheej ntawm cov neeg mob kom pom cov cim thiab cov tsos mob ntawm cov leeg mob, mob nqaij lossis leeg tsis muaj zog, tshwj xeeb tshaj yog nyob rau thawj lub hlis ntawm kev kho, nrog rau thaum lub sijhawm nce ntxiv ntawm cov koob tshuaj no. Yog tias koj xav siv atorvastatin nrog cov tshuaj saum toj no, koj yuav tsum xav txog kev siv atorvastatin nyob rau hauv qis dua thawj zaug thiab cov koob tshuaj txij nkawm.

Hauv cov xwm txheej zoo li no, nws yog ib qho tsim nyog yuav tsum tau txiav txim rau lub sijhawm ntawm creatine phosphokinase (CPK), txawm li cas los xij, qhov kev tswj hwm no tsis tuaj yeem lees tias muaj kev tiv thaiv ntawm myopathy mob hnyav.

Hauv cov neeg mob uas muaj keeb kwm hemorrhagic mob stroke lossis lacunar infarction, kev siv Atorvastatin yog ua tau tsuas yog tom qab txiav txim siab qhov kev pheej hmoo / cov txiaj ntsig, qhov kev pheej hmoo ntawm kev pheej hmoo hemorrhagic mob stroke yuav tsum tau txiav txim siab.

Cov pojniam muaj hnub nyoog yug me nyuam yuav tsum siv txoj hauv kev tiv thaiv kom tsis muaj menyuam. Txij li cov roj (cholesterol) thiab cov tshuaj sib tov los ntawm cov roj (cholesterol) yog qhov tseem ceeb rau kev loj hlob ntawm tus me nyuam hauv plab, qhov kev pheej hmoo muaj peev xwm los tiv thaiv HMG-CoA reductase ntau dua li cov txiaj ntsig ntawm kev siv tshuaj thaum cev xeeb tub. Thaum leej niam siv lovastatin (ib qho HMG-CoA reductase inhibitor) nrog dextroamphetamine hauv thawj peb lub hlis thaum cev xeeb tub, yug menyuam ntawm cov pob txha deformation, mob pob txha-esophageal fistula, thiab anus atresia paub. Yog tias cev xeeb tub thaum kho, cov tshuaj yuav tsum nres tam sim ntawd, thiab cov neeg mob yuav tsum ceeb toom txog qhov muaj feem yuav ua rau muaj menyuam hauv plab.

Qee cov pov thawj qhia tias cov statins ua ib chav kawm ua rau cov ntshav qabzib ntau ntxiv, thiab hauv cov neeg mob uas muaj kev pheej hmoo loj los ntawm ntshav qab zib, tuaj yeem ua rau muaj ntshav qab zib nce ntxiv, uas yuav tsum tau kho kom tsim nyog. Txawm li cas los xij, cov txiaj ntsig ntawm statins hauv kev txo qis cov kev pheej hmoo ntawm cov kab mob plawv ntau dua li qhov kev pheej hmoo me ntsis hauv kev muaj mob ntshav qab zib, yog li cov statins yuav tsum tsis txhob tsum. Muaj cov laj thawj rau kev saib xyuas qee zaus ntawm glycemia hauv cov neeg mob uas muaj kev pheej hmoo (ceev cov piam thaj ntawm 5.6 - 6.9 mmol / l, lub cev nyhav index> 30 kg / m2, nce triglycerides, kub siab), raws li cov lus pom zoo tam sim no.

Cov yam ntxwv ntawm cov nyhuv ntawm cov tshuaj ntawm lub peev xwm tsav tsheb los yog cov phom sij txaus ntshai: muab cov kev mob tshwm sim los ntawm cov tshuaj, ceev faj yuav tsum tau siv thaum tsav tsheb los yog lwm yam uas yuav muaj kev phom sij.

Noj ntau dhau

Cov tsos mob cov cim tshwj xeeb ntawm kev siv ntau dhau tsis tau tsim. Cov tsos mob yuav suav nrog mob mob rau daim siab, mob raum tsis ua haujlwm ntev, siv sijhawm ntev ntawm myopathy thiab rhabdomyolysis.

Kev Kho Mob: tsis muaj cov tshuaj tua kab mob tshwj xeeb, kev kho mob thiab kev ntsuas kom tiv thaiv kev nqus ntxiv (ua kom lub plab zom mov thiab ua kom muaj hluav ncaig ntxiv). Atorvastatin feem ntau khi rau cov plasma protein; vim li no, hemodialysis yog qhov tsis muaj txiaj ntsig. Nrog rau kev txhim kho ntawm myopathy, tom qab los ntawm rhabdomyolysis thiab mob raum tsis ua haujlwm (tsis tshua muaj) - kev cuam tshuam tam sim ntawm cov tshuaj thiab kev qhia txog diuretic thiab sodium bicarbonate tov. Rhabdomyolysis tuaj yeem ua rau kev loj hlob ntawm hyperkalemia, uas yuav tsum tau tswj hwm cov tshuaj calcium chloride lossis calcium gluconate, Txoj kev lis ntshav qabzib nrog cov tshuaj insulin, kev siv cov tshuaj potassium ion pauv los yog, nyob rau hauv loj heev, hemodialysis.

Chaw tsim tshuaj paus

RUE Belmedpreparaty, Koom pheej ntawm Belarus

Chaw Nyob Raws Cai thiab Liaj Li Chaw Nyob:

220007, Minsk, Npuag Paj, 30,

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

Lub npe thiab lub teb chaws ntawm daim ntawv pov thawj rau npe tuav

RUE Belmedpreparaty, Koom pheej ntawm Belarus

Lub chaw nyob ntawm cov koomhaum uas lees txais kev tsis txaus siab los ntawm cov neeg siv khoom ntawm cov khoom lag luam zoo hauv Republic of Kazakhstan:

KazBelMedFarm LLP, 050028, Koom pheej ntawm Kazakhstan,

Almaty, st. Beysebaeva 151

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

Email chaw nyob: [email protected]

I.O. Lwm Thawj Coj Tus Thawj Coj rau Kev Ua Tau Zoo

Tsuas tshuaj thiab tswj hwm

Ua ntej pib kho nrog Atorvastatin, tus neeg mob yuav tsum pauv mus rau qhov kev noj haus uas ua kom cov ntshav lipids tsawg dua, uas yuav tsum tau pom thaum lub sijhawm kho cov tshuaj.

Sab hauv, siv sijhawm txhua hnub ntawm lub hnub (tab sis tib lub sijhawm), tsis hais txog ntawm kev noj zaub mov.

Qhov pom zoo kom pib noj yog 10 mg ib hnub ib zaug. Tom ntej no, cov koob tshuaj tau xaiv ib tus zuj zus nyob ntawm cov roj (cholesterol) hauv cov ntshav - LDL. Cov koob tshuaj yuav tsum tau hloov nrog lub caij nyoog tsawg kawg yog 4 lub lis piam. Qhov tshuaj ntau tshaj txhua hnub yog 80 mg hauv 1 koob tshuaj.

Homozygous muaj keeb tiv thaiv hypercholesterolemia

Cov koob tshuaj ntau yog tib yam li nrog lwm hom hyperlipidemia. Thawj koob tshuaj tau xaiv ib tus zuj zus nyob ntawm qhov mob hnyav ntawm tus kab mob. Hauv feem ntau cov neeg mob homozygous kab mob hypercholesterolemia, cov txiaj ntsig zoo tshaj plaws tau pom thaum siv cov tshuaj hauv ib hnub ntawm 80 mg (ib zaug).

Lub siab ua haujlwm tsis zoo

Hauv cov neeg mob uas lub siab tsis ua hauj lwm zoo, ceev faj yuav tsum ua kom muaj kev sib txuas nrog kev ua kom qeeb ntawm kev tshem tawm cov tshuaj tawm hauv lub cev. Cov chaw kuaj mob thiab kuaj ntsuas yuav tsum tau ua tib zoo saib, thiab yog tias pom muaj cov kab mob loj hloov pauv, qhov koob tshuaj yuav tsum raug txo lossis txoj kev kho yuav tsum tau txiav tawm.

Kev cuam tshuam nrog lwm yam tshuaj

Antacids txo qhov tshuaj nyob ntawm 35% (cov nyhuv ntawm LDL cov cholesterol tsis hloov).

Qhov kev siv ntau tshaj tawm ntawm atorvastatin nrog protease inhibitors hu ua CYP3A4 cytochrome P450 inhibitors yog los ntawm kev nce ntxiv hauv plasma ntau ntawm atorvastatin.

Thaum siv digoxin sib xyaw nrog atorvastatin ntawm ib koob ntawm 80 mg / hnub, kev ua haujlwm ntawm digoxin nce ntxiv txog li 20%.

Tsub kom cov siab ntxiv 20% (thaum kho nrog atorvastatin ntawm ib koob ntawm 80 mg / hnub) ntawm qhov ncauj txwv tsis pub muaj norethindrone thiab ethinyl estradiol. Cov lipid-txo cov nyhuv ntawm kev sib xyaw nrog colestipol yog qhov zoo dua rau qhov ntawd rau txhua cov tshuaj ib tus zuj zus.

Nrog rau kev tswj hwm tib lub sijhawm nrog warfarin, lub sijhawm prothrombin txo qis hauv thawj hnub, txawm li cas los xij, tom qab 15 hnub, qhov ntsuas no tseem ceeb. Hauv qhov no, cov neeg mob noj atorvastatin nrog warfarin yuav tsum muaj ntau dua li sijhawm prothrombin tswj hwm.

Kev siv cov kua txiv kab ntxwv qaub thaum kho nrog atorvastatin tuaj yeem ua rau nce ntxiv ntawm cov tshuaj nyob rau hauv cov ntshav ntshav. Hauv qhov no, cov neeg mob noj cov tshuaj yuav tsum tsis txhob haus cov kua txiv no.

Tshaj tsos mob

Cov cim tshwj xeeb ntawm kev siv ntau dhau tsis tau tsim. Cov tsos mob yuav suav nrog mob mob rau daim siab, mob raum tsis ua haujlwm ntev, siv sijhawm ntev ntawm myopathy thiab rhabdomyolysis.

Tsis muaj ib qho tshuaj tua kab mob tshwj xeeb, kev kho mob thiab kev ntsuas kom tiv thaiv kev nqus ntxiv (ua kom lub plab zom mov thiab ua kom muaj hluav ncaig ntxiv).Atorvastatin feem ntau khi rau cov plasma protein; vim li no, hemodialysis yog qhov tsis muaj txiaj ntsig. Nrog rau kev txhim kho ntawm myopathy, tom qab los ntawm rhabdomyolysis thiab mob raum tsis ua haujlwm (tsis tshua muaj) - kev cuam tshuam tam sim ntawm cov tshuaj thiab kev qhia txog diuretic thiab sodium bicarbonate tov. Rhabdomyolysis tuaj yeem ua rau kev loj hlob ntawm hyperkalemia, uas yuav tsum tau tswj hwm cov tshuaj calcium chloride lossis calcium gluconate, Txoj kev lis ntshav qabzib nrog cov tshuaj insulin, kev siv cov tshuaj potassium ion pauv los yog, nyob rau hauv loj heev, hemodialysis.