Yuav siv Atorvastatin 10 li cas? > Kev khomob thiab kev tiv thaiv

Kev piav qhia cuam tshuam rau 26.01.2015

Lub npe Latin: Atorvastatin
ATX Code: S10AA05
Yam tshuaj muaj sia: Txoj Kev Sib Tw (Atorvastatin)
Chaw tsim tshuaj paus: CJSC ALSI Pharma

Ib ntsiav tshuaj muaj 21.70 lossis 10.85 milligrams atorvastatin calcium trihydrate, uas sib haum rau 20 lossis 10 milligrams ntawm atorvastatin.

Raws li cov khoom siv pabcuam, Opadra II, magnesium stearate, aerosil, hmoov txhuv nplej siab 1500, lactose, microcrystalline cellulose, calcium carbonate.

Pharmacological kev txiav txim

Cov tshuaj no yog hypocholesterolemic - nws cov kev sib tw thiab kev xaiv qhov tsis txaus siab rau kev tswj hwm qhov kev hloov pauv ntawm HMG-CoA rau mevalonate, uas tom qab ntawd nkag mus rau hauv sterols, suav nrog cov roj (cholesterol).

Qhov txo qis ntshav ntshav lipoproteins thiab cov cholesterol tom qab noj cov tshuaj yog vim qhov txo qis hauv cov roj ntsha hauv lub siab ua haujlwm thiab cov haujlwm ntawm HMG-CoA reductase, nrog rau kev nce qib ntawm LDL receptors nyob rau ntawm daim siab ua cov ntshav siab, uas ua rau muaj kev nce siab ntau thiab catabolism ntawm LDL.

Hauv cov neeg muaj homozygous thiab heterozygous tsev neeg hypercholesterolemia, sib xyaw dyslipidemia, thiab tsis muaj mob hypercholesterolemia, txo qis hauv apolipoprotein B, tag nrho cov roj cholesterol, thiab cov roj cholesterol qis-lipoproteins tau pom thaum noj cov tshuaj no.

Cov tshuaj no yuav txo tau txoj hauv kev loj hlob. ischemia thiab kev tuag nyob hauv tus neeg ntawm txhua lub hnub nyoog muaj myocardial infarction tsis muaj qhov tsis khov thiab tsis sawv ntawm Qoj. Nws kuj txo cov zaus uas tsis ua kom neeg tuag taus thiab tuag taus, qhov ntau zaus ntawm cov kab mob plawv thiab qhov kev pheej hmoo ntawm kev tsim cov kab mob ua rau lub siab thiab cov hlab ntshav.

Pharmacodynamics thiab pharmacokinetics

Nws muaj lub siab nqus, qhov siab tshaj plaws nyob rau hauv cov ntshav tau pom tom qab ib mus rau ob teev tom qab kev coj. Txoj kev noj qab haus huv tsis tshua muaj siab vim yog lub teeb txheeb ntawm lub cev uas pom tias yog cov kab mob ua rau lub plab thiab cov nyhuv ntawm thawj "hla ntawm daim siab" - 12 feem pua. Kwv yees li ntawm 98 feem pua ntawm cov koob tshuaj uas tau noj yog ua txhua yam rau cov ntshav protein. Kev zom zaub mov tshwm sim hauv daim siab nrog rau kev tsim cov khoom noj ua kom lub cev thiab cov tshuaj yeeb dej caw. Ib nrab-lub neej yog 14 teev. Thaum mob hemodialysis yuav tsis tshwm.

Cov Yuav Tsum Muaj

Cov tshuaj yuav tsum tsis txhob noj nrog:

tsis tau muaj 18 xyoo
cev xeeb tub thiab sijhawm pub niam mis,
daim siab ua hauj lwm,
nquag ua mob rau daim siab lossis ua haujlwm nce siab ntawm daim siab "siab" rau cov tsis paub meej,
hypersensitivity rau cov ntsiab lus ntawm cov tshuaj.

Nws yuav tsum tau noj nrog tus kab mob pob txha, kev raug mobcov txheej txheem phais dav ntxiv uas tswj tsis tau qaug dab peg, sepsis, arterial hypotensionteeb meem metabolic thiab endocrine, cuam tshuam kev tsis sib luag ntawm electrolyte qhov sib npaug ntawm qhov mob siab, keeb kwm ntawm daim siab mob siab thiab haus dej cawv.

Sab sij huam

Thaum noj cov ntsiav tshuaj, koj yuav ntsib kev:

kev txom nyem mob gout, mastodyniahnyav nce (tsawg kawg)
albuminuria ntshav qoghyperglycemia (tsawg heev)
petechiae, ecchymoses, seborrhea, eczematawm hws, xeroderma, alopecia,
Lyell cov tsos mob, multiforme exudative erythema, photosensitization, o ntawm lub ntsej muag, angioedema, urticaria, sib cuag dermatitisdaim tawv nqaij ua pob khaus thiab khaus (muaj tsawg),
ua txhaum ntawm ejaculation, impotence, txo qis libido, epididymitis, metrorrhagia, nephrourolithiasis, los ntshav hauv qhov chaw mos, hematuria, jade, mob plab pliav,
cov ntawv cog lus sib koom tes, leeg mob hypertonicity, torticollisrhabdomyolysis myalgiaarthralgia mob hlwb, kev mob plab, leeg pob txha caj qaum, bursitistxhais ceg cramps mob caj dab,
tenesmus, los ntawm cov pos hniav los ntshav, melena, los ntshav tawm, ua rau cov leeg lub siab ua haujlwm, cholestatic mob daj ntseg, pancreatitis, duodenal rwj, mob ncauj plab, biliary colic, kab mob siabmob ncauj plab, mob txhab ntawm lub qhov ncauj mucosa, glossitis, txoj hlab pas, mob plab, ntuavdysphagia nplawmlub qhov ncauj qhuav, nce ntxiv los sis tsis qab los noj mov, mob plab, mob ncauj plab, flatulence, zawv plab lossis cem quav, Kev mob siab, xeev siab,
taub ntswg, exacerbation ntawm bronchial hawb pob, dyspnea, mob ntsws, rhinitis, mob ntsws,
thrombocytopenia, lymphadenopathy, anemia,
angina pectoris, arrhythmia, phlebitis, nce ntshav siab, orthostatic hypotension, palpitations, mob hauv siab,
ploj ntawm saj, parosmia, mob ntsws, lag ntseg, retinal hemorrhage, kev cuam tshuam kev pabcuam, kev ua kom lub cev qhuav, tawv nqaij me me, tsis hnov tsw,
tsis nco qabtshuaj mob siab kev nyuaj siab, mob taub hauhyperkinesis, ntsej muag tuag tes tuag taw, ataxiakev xav lability amnesiaperipheral neuropathy, paresthesia, npau suav phem, tsaug zog, malaise, asthenia, mob taub hau, kiv taub hau, insomnia.

Kev sib txuam

Ib txhij tswj hwm nrog cov tshuaj tiv thaiv protease inhibitors tsub kom lub siab ntawm cov tshuaj nquag muaj nyob hauv cov ntshav ntshav. Concomitant siv nrog cov tshuaj uas txo cov kev ua kom txaus ntawm cov tshuaj hormones endogenous steroid (suav nrog Spironolactone, Ketoconazole thiab Cimetidine) ua rau muaj peev xwm txo cov tshuaj hormones endogenous steroid.

Thaum noj ib txhij nrog nicotinic acid, erythromycin, fibrates thiab cyclosporins, nws tseem muaj peev xwm txhim kho myopathy thaum kho nrog lwm cov tshuaj ntawm cov chav kawm no.

Simvastatin thiab Atorvastatin - uas zoo dua?

Simvastatin Yog lub ntuj statin, thiab Atorvastatin yog ib qho tseem ceeb tshaj plaws tam sim no ntawm hluavtaws keeb kwm. Txawm hais tias lawv muaj cov kev sib txawv hauv cov metabolism hauv lub cev thiab tshuaj qauv, lawv muaj cov nyhuv zoo sib xws. Lawv kuj muaj cov kev mob tshwm sim ib yam, tab sis Simvastatin muaj nqis ntau dua li Atorvastatin, yog li los ntawm cov nqi ntsuas Simvastatin yog qhov kev xaiv zoo dua.

Cov Tshuaj Pharmacokinetics

Kev tshem tawm yog qhov siab. Lub sijhawm nce 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 qhov nqus ntawm qhov nqus thiab qhov tshuaj ntawm cov 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

raws li kev pabcuam rau kev noj zaub mov kom txo tau cov roj (cholesterol) tag nrho, LDL-C, apo-B, thiab triglycerides rau cov neeg laus, cov hluas, thiab cov menyuam hnub nyoog 10 xyoo lossis laus dua nrog thawj hypercholesterolemia, suav nrog kev mob ntshav qab zib (heterozygous) lossis kev sib xyaw (sib xyaw) hyperlipidemia ( hom IIa thiab IIb raws li kev faib tawm ntawm Fredrickson), thaum cov lus teb rau kev noj zaub mov noj thiab lwm yam tshuaj uas tsis siv tshuaj tsis txaus,
kom txo qis tag nrho cov roj (cholesterol), LDL-C hauv cov neeg laus nrog homozygous tsev neeg hypercholesterolemia ua tus txiav rau lwm txoj kev kho lipid-txo qis (piv txwv li LDL-apheresis) lossis, yog tias tsis muaj kev kho zoo li ntawd,

Kev Tiv Thaiv Kab Mob:

kev tiv thaiv ntawm cov kev mob plawv hauv cov neeg mob cov neeg laus uas muaj kev pheej hmoo loj los tsim cov txheej txheem plawv plawv, ntxiv rau kev txhim kho ntawm lwm yam kev pheej hmoo,
kev tiv thaiv kab mob thib ob hauv kev mob plawv hauv cov neeg mob plawv mob plawv txhawm rau txhawm rau txo qis kev phom sij tag nrho, mob ntshav hlab plawv, mob stroke, rov pw hauv tsev kho mob rau angina pectoris thiab qhov xav kom rov qab kho dua.

Tsuas tshuaj thiab tswj hwm

Sab hauv. Siv sijhawm twg los xij ntawm hnub, tsis hais noj zaub mov.

Ua ntej pib txoj kev kho mob nrog Atorvastatin, koj yuav tsum sim ua kom tiav kev tswj hwm ntawm hypercholesterolemia siv kev noj haus, kev tawm dag zog thiab kev poob phaus hauv cov neeg mob rog, nrog rau kev kho mob ntawm lwm tus kab mob.

Thaum sau tshuaj, tus neeg mob yuav tsum pom zoo rau ib qho kev noj haus hypocholesterolemic noj, uas nws yuav tsum ua raws li txhua lub sijhawm ntawm kev kho mob.

Qhov ntau npaum li cas ntawm cov tshuaj nws txawv ntawm 10 mg rau 80 mg ib hnub ib zaug thiab yog titrated noj mus rau hauv tus lej thawj qhov kev xav ntawm LDL-Xc, lub hom phiaj ntawm txoj kev kho thiab cov tib neeg cov txiaj ntsig ntawm txoj kev kho. Qhov siab tshaj plaws niaj hnub noj tshuaj yog 80 mg.

Thaum pib ntawm kev kho mob thiab / lossis thaum lub sijhawm nce ntxiv ntawm Atorvastatin, nws yog ib qho tsim nyog los saib xyuas qhov tsis txaus ntawm cov lipids hauv cov ntshav ntshav txhua 2-4 lub lis piam thiab kho qhov tshuaj raws li.

Heterozygous tsev neeg hypercholesterolemia

Qhov tshuaj thawj zaug yog 10 mg rau ib hnub. Cov koob tshuaj yuav tsum tau xaiv ib tus zuj zus thiab ntsuas qhov cuam tshuam txhua 4 lub lis piam nrog kev nce ntxiv txog 40 mg ib hnub twg. Tom qab ntawd cov koob tshuaj tuaj yeem ua rau nce mus txog qhov siab kawg ntawm 80 mg rau ib hnub, lossis kev sib txuas ntawm cov tshuaj tiv thaiv cov kab mob kua tsib nrog rau kev siv atorvastatin hauv ib koob ntawm 40 mg ib hnub yog ua tau.

Siv rau hauv cov menyuam yaus thiab cov hluas los ntawm 10 txog 18 xyoo nrog heterozygous tsev neeg hypercholesterolemia

Qhov pom zoo kom pib noj yog 10 mg ib hnub ib zaug. Qhov kev txhaj tshuaj yuav raug nce ntxiv mus rau 20 mg ib hnub twg, nyob ntawm qhov siv los soj ntsuam. Kev paub nrog ib koob ntau tshaj 20 mg (sib haum rau ib koob ntawm 0.5 mg / kg) yog txwv. Nws yog ib qho tsim nyog yuav tau them ib feem ntawm cov tshuaj raws li lub hom phiaj kho lipid-txo qis kev kho mob. Kev hloov koob tshuaj yuav tsum tau ua ntawm ncua sijhawm ntawm 1 lub sijhawm hauv 4 lub lis piam lossis ntau dua.

Siv nrog rau lwm cov tshuaj

Yog tias tsim nyog, ib txhij siv nrog cyclosporine, telaprevir lossis kev sib xyaw ntawm tipranavir / ritonavir, cov koob tshuaj Atorvastatin yuav tsum tsis pub tshaj 10 mg rau ib hnub.

Kev ceev faj yuav tsum tau siv thiab kev siv tshuaj qis tshaj plaws ntawm atorvastatin yuav tsum tau siv thaum nws siv nrog HIV tiv thaiv kab mob tiv thaiv kab mob, kab mob siab C virus protease inhibitors (boceprevir), clarithromycin thiab itraconazole.

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.

Thaum muaj kev noj ntau dhau, qhov kev ntsuas dav dav hauv qab no yog qhov tsim nyog: kev saib xyuas thiab tswj hwm lub luag haujlwm tseem ceeb ntawm lub cev, nrog rau kev tiv thaiv ntxiv kom nqus cov tshuaj (pais plab lav, noj hluav ncaig lossis laxatives).

Nrog rau kev txhim kho ntawm myopathy, tom qab los ntawm rhabdomyolysis thiab mob raum tsis zoo, cov tshuaj yuav tsum tau muab tshem tawm sai li sai tau thiab txoj kev lis ntshav ntawm diuretic thiab sodium bicarbonate pib. Rhabdomyolysis tuaj yeem ua rau hyperkalemia, uas yuav tsum muaj kev tswj hwm ntawm cov tshuaj calcium calcium los yog cov tshuaj calcium gluconate, kev sib tov ntawm 5% kev daws teeb meem ntawm thunderstorm (qabzib) nrog insulin, thiab siv cov poov tshuaj-pauv pauv cov tshuaj.

Txij li thaum cov tshuaj nquag khi rau plasma protein, hemodialysis siv tsis tau.

Yeeb tshuaj sib cuam tshuam

Txoj kev pheej hmoo ntawm kev tsim myopathy nrog rhabdomyolysis thiab lub raum tsis ua haujlwm thaum kho mob nrog HMG-CoA reductase inhibitors tsub kom ntau ntxiv nrog kev siv cyclosporine, tshuaj tua kabmob (erythromycin, clarithromycin, hipupristine / dalphopristine), HIV protease inhibitors (indinavir, ritonoviraz, anti-ritonovira itraconazole, ketoconazole), nefazodone. Tag nrho cov tshuaj no inhibit CYP3A4 isoenzyme, uas koom nrog cov metabolism hauv atorvastatin hauv lub siab. Kev sib cuam tshuam zoo sib xws yog ua tau nrog kev siv tib lub sij hawm ntawm atorvastatin nrog fibrates thiab nicotinic acid hauv lipid-txo cov koob tshuaj (ntau dua 1 g hauv ib hnub).

Nrog rau siv ib txhij nrog HIV protease inhibitors. kab mob siab C tus kab mob protease inhibitors, clarithromycin thiab itraconazole yuav tsum ua tib zoo saib thiab siv cov tshuaj atorvastatin qis tshaj plaws.

CYP3A4 Isoenzyme Tus Neeg Txom Nyem

Txij li thaum atorvastatin metabolized los ntawm isoenzyme CYP3A4, kev siv atorvastatin nrog inhibitors ntawm isoenzyme CYP3A4 tuaj yeem ua rau muaj kev nce plasma ntau dua ntawm atorvastatin. Qib kev sib cuam tshuam thiab kev ua kom muaj zog yog txiav txim siab los ntawm qhov txawv txav ntawm cov nyhuv rau CYP3A4 isoenzyme.

OATP1B1 thauj cov tshuaj tiv thaiv protein

Atorvastatin thiab nws cov metabolites yog cov me me ntawm OATP1B1 thauj protein. OATP1B1 inhibitors (piv txwv li, cyclosporine) yuav ua rau kom muaj kev nyab xeeb ntawm atorvastatin. Hack, kev siv tib lub sijhawm ntawm atorvastatin ntawm ib koob ntawm 10 mg thiab cyclosporine ntawm koob tshuaj ntawm 5,2 mg / kg / hnub ua rau kev nce siab hauv cov concentration ntawm atorvastatin hauv ntshav ntshav los ntawm 7.7 lub sijhawm. Cov nyhuv ntawm inhibition ntawm hepatic uptake transporter muaj nuj nqi ntawm qhov kev tawm ntawm atorvastatin hauv hepatocytes tsis paub. Nyob rau hauv rooj plaub nws tsis tuaj yeem zam dhau qhov kev siv ua ke ntawm cov tshuaj no, nws raug nquahu kom txo qhov koob thiab tswj kev ua haujlwm ntawm kev kho.

Gemfibrozil / fibrates

Tawm tsam keeb kwm yav dhau los ntawm kev siv fibrates hauv kev kho mob monotherapy, kev phiv tshuaj tsis zoo tau muab sau tseg tsis tu ncua, suav nrog rhabdomyolysis cuam tshuam nrog cov leeg mus rau lub cev. Txoj kev pheej hmoo ntawm cov kev tawm tsam no nce ntxiv nrog kev siv cov fibrates thiab atorvastatin tib lub sijhawm. Yog tias kev siv ua ke siv cov tshuaj no yuav zam tsis dhau, ces yuav tsum siv cov tshuaj atorvastatin tsawg kawg nkaus. thiab kev soj ntsuam tsis tu ncua ntawm tus neeg mob lub neej yuav tsum tau ua.

Tso cov ntaub ntawv thiab cov nyob ua ke

Hauv cov khw muag tshuaj koj tuaj yeem pom tsuas yog 1 yam tshuaj - nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj. Lub cuab tam yog hais txog cov tshuaj tiv thaiv ib leeg. Atorvastatin ua rau txo qis hauv lipid cov ntsiab lus, thiab cov tshuaj no suav nrog hauv kev npaj hauv daim ntawv ntawm calcium ntsev (calcium trihydrate). Hauv kev xaiv cov tshuaj hauv cov lus nug, qhov ntau npaum ntawm cov khoom siv nquag yog hloov tawm - 10 mg. Tus nqi no muaj nyob hauv 1 ntsiav tshuaj. Cov tshuaj tsis qhia kev cuam tshuam cov yeeb yaj kiab vim tias muaj qhov ua yeeb yaj kiab zaj duab xis.

Atorvastatin tuaj yeem nqus tau hauv cov ntawv ntim ntawm tes. Txhua tus muaj 10 ntsiav tshuaj. Tus naj npawb tag nrho cov hlwv hauv ib daim thawv ntawv yog 1, 2, 3, 4, 5, lossis 10 pcs.

Atorvastatin 10 yog ib qho enzyme inhibitor uas cuam tshuam rau hauv tus txheej txheem ntawm cov cholesterol.

Dab tsi yog sau tseg?

Cov chaw tseem ceeb hauv daim ntawv thov:

nce cov hauj lwm zoo ntawm cov tshuaj uas lawv ua yog ua rau txo cov roj (Atorvastatin yog txoj cai kho mob), ua tiav cov txiaj ntsig uas xav tau nrog kev noj zaub mov noj,
kev kho mob ntawm cov hlab plawv, tiv thaiv kev txhim kho ntawm cov teeb meem tshwm sim los ntawm kev muaj ntshav ntau ntxiv, cov roj (cholesterol), cov hlab ntsha nqaim.

Dosage daim ntawv

Coated ntsiav tshuaj 10 mg, 20 mg thiab 40 mg

Muaj ib ntsiav tshuaj:

cov tshuaj nquag - atorvastatin (raws li calcium ntsev ntawm trihydrate) 10 mg, 20 mg thiab 40 mg (10.85 mg, 21.70 mg thiab 43.40 mg),

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

plhaub muaj pes tsawg leeg: Opadry II liab (talc, polyethylene glycol, titanium dioxide (E171), polyvinyl cawv, hlau (III) oxide daj (E172), hlau (III) oxide liab (E172), hlau (III) oxide dub (E172).

Cov yeeb yuj pleev xim txau nrog cov biconvex nto

Protease inhibitors

AUC tus nqi ntawm atorvastatin nce nce nrog kev siv tib txhij ntawm atorvastatin thiab qee qhov sib xyaw ua ke ntawm HIV protease inhibitors, ntxiv rau atorvastatin thiab kab mob siab C tus kab mob tiv thaiv inhibitor telaprevir. Yog li, siv tib lub sijhawm atorvastatin hauv cov neeg mob noj tshuaj tiv thaiv kab mob HIV protease inhibitors tipranavir thiab ritonavir lossis kab mob siab C tus kab mob protease inhibitor telaprevir yuav tsum zam. Kev ceev faj yuav tsum tau siv nrog kev siv atorvastatin tib lub sijhawm thiab kev sib xyaw ntawm cov kab mob HIV protease inhibitors lopinavir thiab ritonavir, thiab qhov txo qis ntawm atorvastatin kuj yuav tsum tau sau tseg. Kev ceev faj yuav tsum tau siv nrog kev siv atorvastatin ib txhij thiab kev sib xyaw ntawm HIV tiv thaiv cov tshuaj tiv thaiv kab mob, saquinavir thiab ritonavir, darunavir thiab ritonavir, fosamprenavir thiab ritonavir lossis fosamprenavir, thaum koob tshuaj atorvastatin yuav tsum tsis pub tshaj 20 mg. Hauv cov neeg mob noj cov kab mob HIV tiv thaiv tus mob nelfinavir lossis tus kab mob siab C tiv thaiv kab mob protease inhibitor boceprevir, koob tshuaj atorvastatin yuav tsum tsis pub ntau tshaj 40 mg; kev tshuaj ntsuam xyuas tau pom zoo rau cov neeg mob.

Cov chaw muag tshuaj

Cov Tshuaj Pharmacokinetics

Atorvastatin nrawm nrawm tom qab lub qhov ncauj tswj hwm, nws cov ntshav plasma nce mus txog qhov siab kawg rau 1 - 2 teev. Qhov txheeb ze bioavailability ntawm atorvastatin yog 95-99%, tsis muaj tseeb - 12-14%, ib puag ncig (muab cov inhibition ntawm HMG-CoA reductase) - txog 30 % Kev siv lub cev tsis tshua muaj kab ntsig ua haujlwm tau piav qhia los ntawm cov kab mob presystemic tshem tawm hauv cov qog ua kua rau txoj hnyuv thiab / lossis kev zom zaub mov thaum pib tso lub siab. Kev nqus thiab ntshav qab zib nce ntxiv hauv qhov sib npaug nrog cov koob tshuaj. Txawm hais tias qhov tseeb tias thaum noj nrog zaub mov, qhov nqus ntawm cov tshuaj tsawg dua (qhov siab tshaj plaws thiab AUC yog kwv yees li 25 thiab 9%, feem), qhov txo qis hauv LDL cov qib roj cholesterol tsis nyob ntawm atorvastatin noj nrog zaub mov lossis tsis. Thaum noj atorvastatin thaum yav tsaus ntuj, nws lub plasma ntshav qis dua (kwv yees 30% rau qhov siab tshaj plaws thiab AUC) dua li thaum noj thaum sawv ntxov. Txawm li cas los xij, qhov txo qis hauv theem ntawm LDL cov roj cholesterol tsis yog nyob ntawm lub sijhawm ntawm kev noj tshuaj.

Ntau tshaj li 98% ntawm cov tshuaj khi rau cov ntshav plasma. Qhov piv ntawm erythrocyte / ntshav ntshav yog kwv yees 0.25, uas qhia pom qhov nkag qis ntawm cov tshuaj mus rau hauv cov ntshav liab.

Atorvastatin metabolized rau ortho- thiab para-hydroxylated derivatives thiab ntau yam beta-oxidized khoom. Cov nyhuv inhibitory ntawm cov tshuaj uas txheeb ze rau HMG-CoA reductase yog kwv yees li 70% pom tau vim muaj cov kev ua hauv lub cev hloov cov rog. Atorvastatin tau pom tias yog qhov ua kom tsis muaj zog ntawm cytochrome P450 ZA4.

Atorvastatin thiab nws cov khoom ua kom lub cev txhaws tas nrog cov kua tsib tom qab mob rau hepatic thiab / lossis metabolism ntxiv. Txawm li cas los xij, cov tshuaj tsis raug rau qhov tseem ceeb ntawm kev nkag mus ua ib qho recirculation. Qhov nruab nrab ib nrab ntawm lub neej ntawm atorvastatin yuav luag 14 teev, tab sis lub sijhawm ntawm kev tiv thaiv qhov kev tiv thaiv tiv thaiv HMG-CoA reductase vim yog nthuav tawm cov roj ntsha nquag mus rau 20-30 teev. Tsawg dua li 2% ntawm qhov ncauj ntawm atorvastatin raug tso tawm hauv cov zis.

Lub plasma concentration ntawm atorvastatin hauv cov neeg laus noj qab haus huv (tshaj 65) yog siab dua (kwv yees li 40% rau qhov kev xav ntau tshaj thiab 30% rau AUC) dua li cov neeg hluas. Tsis muaj qhov sib txawv hauv qhov ua tau zoo ntawm kev kho mob nrog atorvastatin hauv cov neeg laus thiab cov neeg mob ntawm lwm pawg hnub nyoog.

Qhov siab ntawm atorvastatin nyob rau hauv cov ntshav ntshav hauv cov poj niam sib txawv ntawm cov concentration hauv cov ntshav ntshav hauv cov txiv neej (hauv cov poj niam, qhov siab tshaj plaws yog kwv yees li 20% siab dua, thiab AUC - 10% qis dua). Txawm li cas los xij, tsis muaj qhov sib txawv hauv tsev kho mob tau pom nyob rau hauv cov nyhuv ntawm lipid ntau ntau hauv cov txiv neej thiab poj niam.

Kab mob hauv lub raum tsis cuam tshuam rau qhov kev txiav txim siab ntawm cov tshuaj hauv plasma lossis cov nyhuv ntawm atorvastatin ntawm qib lipid, yog li tsis tas yuav tsum tau txhaj koob tshuaj rau hauv cov neeg mob lub raum tsis ua haujlwm. Cov kev tshawb fawb tsis tau them rau cov neeg mob raum tsis ua haujlwm ntawm lub raum; tej zaum, hemodialysis tsis hloov pauv ntawm atorvastatin, vim tias cov tshuaj yuav luag txhua cov ntshav muaj ntshav tsis txaus.

Qhov kev txiav txim siab ntawm atorvastatin nyob rau hauv cov ntshav plasma nce ntau (ntau qhov siab tshaj - kwv yees li 16 zaug, AUC - 11 zaug) hauv cov neeg mob uas ua mob rau daim siab ntawm lub siab ntawm cawv cawv.

Cov Tshuaj Hauv Tshuaj

Atorvastatin yog ib qho kev xaiv sib tw muaj zog ntawm HMG-CoA reductase-enzyme, uas tswj cov kev hloov pauv ntawm HMG-CoA rau mevalonate - ua ntej ntawm sterols (suav nrog cov roj (cov roj (cholesterol))). Hauv cov neeg mob uas muaj homozygous thiab heterozygous tsev neeg hypercholesterolemia, ib daim ntawv los ntawm hypercholesterolemia thiab sib xyaw dyslipidemia, atorvastatin txo qhov kev xav ntawm tag nrho cov cholesterol, qis ceev lipoproteins (LDL) thiab apolipoprotein B (Apo B). Atorvastatin kuj txo qhov kev kub siab ntawm cov lipoproteins tsawg heev (VLDL) thiab triglycerides (TG), thiab kuj nce me ntsis cov ntsiab lus ntawm cov roj lipoproteins (HDL) ntau.

Atorvastatin txo qib ntawm cov roj (cholesterol) thiab lipoproteins hauv ntshav plasma los ntawm kev tiv thaiv HMG-CoA reductase, ua ke ntawm cov roj cholesterol nyob rau hauv daim siab thiab nce cov LDL receptors nyob rau ntawm hepatocytes, uas nrog los ntawm kev nce siab thiab catabolism ntawm LDL. Atorvastatin txo LDL ntau lawm, ua rau muaj suab nrov thiab ntxiv ntev rau LDL receptor kev ua si. Atorvastatin txo qis qis LDL ntau ntau hauv cov neeg mob homozygous tsev neeg hypercholesterolemia, uas tsis yog qhov zoo rau cov qauv kho nrog lipid-txo tshuaj.

Lub hauv paus loj ntawm kev ua ntawm atorvastatin yog lub siab, uas ua lub luag haujlwm tseem ceeb hauv kev sib txuas ntawm cov roj (cholesterol) thiab kev tshem tawm ntawm LDL. Kev txo qis hauv cov qib ntawm LDL cov roj (cholesterol) txuam nrog rau cov tshuaj ntawm qhov tshuaj thiab qhov tshuaj nyob hauv lub cev.

Atorvastatin ntawm ib koob ntawm 10-80 mg txo qib theem ntawm cov roj (los ntawm 30–46%), LDL cov roj (los ntawm 41–61%), Apo B (los ntawm 34 %50%) thiab TG (los ntawm 14–33%). Cov txiaj ntsig no tau ruaj khov nyob hauv cov neeg mob mob heterozygous tsev neeg hypercholesterolemia, ib daim ntawv kis tau los ntawm hypercholesterolemia thiab ib hom tshuaj hyperlipidemia, suav nrog cov neeg mob uas tsis muaj ntshav qab zib tsis muaj tshuaj tiv thaiv ntshav qab zib mellitus.

Hauv cov neeg mob uas muaj tus kabmob hypertriglyceridemia, atorvastatin txo qib ntawm cov roj (cholesterol) tag nrho, LDL cov roj (cholesterol), VLDL cov cholesterol, Apo B, TG thiab nce me ntsis ntawm qib roj HDL. Hauv cov neeg mob uas muaj dysbetalipoproteinemia, atorvastatin txo qib ntawm cov roj cholesterol ua kom lub siab.

Hauv cov neeg mob uas muaj hom IIa thiab IIb hyperlipoproteinemia (raws li kev sib cais ntawm Fredrickson), qhov nruab nrab ntawm nce ntawm HDL cov roj (cholesterol) thaum siv atorvastatin ntawm ib koob ntawm 10-80 mg yog 5.1-8.7%, tsis hais koob tshuaj. Tsis tas li ntawd, muaj qhov tseem ceeb los ntawm qhov txo qis hauv feem ntau ntawm cov roj cholesterol tag nrho / HDL roj thiab roj HDL. Kev siv atorvastatin txo txoj kev pheej hmoo ntawm ischemia thiab kev tuag nyob rau hauv cov neeg mob nrog myocardial infarction tsis muaj Q yoj thiab tsis khov tsis hnov qhov tsis zoo (tsis hais poj niam txiv neej thiab hnub nyoog) yog ncaj qha sib luag rau theem ntawm LDL cov cholesterol.

Heterozygous ntsig txog hypercholesterolemia hauv kev kho mob pediatrics. Hauv cov tub thiab ntxhais hnub nyoog 10-17 xyoo nrog rau kev ua mob rau heterozygous tsev neeg hypercholesterolemia lossis mob ntshav siab, atorvastatin ntawm ib zaug ntawm 10-20 mg ib hnub ib hnub txo cov theem ntawm cov roj (cholesterol) tag nrho, LDL cov rog, TG thiab Apo B hauv ntshav ntshav. Txawm li cas los xij, tsis muaj kev cuam tshuam loj heev rau kev loj hlob thiab kev nkauj nraug hauv tub lossis los ntawm lub sijhawm rau cev ntas rau poj niam. Kev nyab xeeb thiab ua tau ntawm cov koob tshuaj siab tshaj 20 mg rau kev kho mob ntawm cov menyuam yaus tsis tau kawm. Kev cuam tshuam ntawm lub sijhawm ntawm atorvastatin kev kho mob hauv lub hnub menyuam yaus txog kev txo qis ntawm kev mob hlwb thiab kev tuag ntawm cov neeg laus tsis tau tsim.

Tsuas tshuaj thiab tswj hwm

Ua ntej pib Atorvastatin txoj kev kho, nws yog qhov yuav tsum tau txiav txim siab txog qib qib ntawm cov roj cholesterol hauv cov ntshav tiv thaiv keeb kwm ntawm kev noj zaub mov kom tsim nyog, qhia txog kev tawm dag zog lub cev thiab ntsuas kev ntsuas los txo lub cev qhov hnyav hauv cov neeg mob rog, nrog rau kev ua rau kev kho mob hauv qab. Thaum kho nrog atorvastatin, cov neeg mob yuav tsum ua raws li cov qauv hypocholesterolemic noj haus. Cov tshuaj tau sau tseg nyob rau hauv ib koob ntawm 10-80 mg ib hnub ib hnub, ntawm ib qho twg, tab sis tib lub sijhawm ntawm hnub, tsis hais noj zaub mov noj. Cov koob tshuaj thaum xub thawj thiab txij nkawm tuaj yeem tsim kho tus kheej raws qib pib ntawm LDL cov roj (cholesterol), cov hom phiaj thiab kev kho kom zoo. Tom qab 2-4 lub lis piam los ntawm kev pib kho thiab / lossis tshuaj kho nrog Atorvastatin, yuav tsum tau siv cov tshuaj lipid thiab qhov tshuaj txhaj raws.

Thawj hypercholesterolemia thiab sib xyaw (sib xyaw) hyperlipidemia. Feem ntau, nws txaus los sau tshuaj rau hauv ib koob tshuaj 10 mg ib hnub ib hnub. Cov kev kho mob muaj txiaj ntsig tom qab 2 lub lis piam, cov nyhuv siab tshaj plaws - tom qab 4 lub lis piam. Cov kev hloov pauv zoo yog txhawb los ntawm kev siv lub sijhawm ntev ntawm cov tshuaj.

Homozygous tsev neeg hypercholesterolemiaCov. Qhov tshuaj no tau sau tseg hauv 10 rau 80 mg ib hnub ib hnub, txhua lub sijhawm, tsis hais noj zaub mov twg. Cov koob tshuaj thaum pib thiab tswj hwm raug teeb tsa ua ib leeg zuj zus. Feem ntau, hauv cov neeg mob homozygous tsev neeg hypercholesterolemia, qhov tshwm sim tau tiav nrog kev siv Atorvastatin ntawm koob ntawm 80 mg ib hnub ib zaug.

Heterozygous tsev neeg hypercholesterolemia hauv kev kho mob hauv plab (cov neeg mob hnub nyoog 10-17 xyoo). Atorvastatin pom zoo nyob rau hauv thawj zaug.

10 mg ib hnub ib hnub. Qhov koob tshuaj ntau tshaj plaws yog 20 mg ib hnub ib hnub ib zaug (cov koob tshuaj ntau tshaj 20 mg tsis tau kawm hauv cov neeg mob ntawm pab pawg hnub nyoog no). Cov koob tshuaj tau teeb tsa ib leeg zuj zus, suav nrog lub hom phiaj ntawm txoj kev kho, qhov tshuaj tuaj yeem hloov kho nrog ncua nrog 4 lis piam lossis ntau dua.

Siv rau hauv cov neeg mob mob raum thiab lub raum tsis ua haujlwmCov. Kab mob hauv lub raum tsis cuam tshuam rau kev txiav txim ntawm atorvastatin lossis txo qis ntshav ntshav LDL cov roj cholesterol, yog li tsis tas yuav siv tshuaj kho kom haum.

Siv rau cov neeg mob lausCov. Tsis muaj qhov sib txawv hauv kev nyab xeeb thiab muaj txiaj ntsig ntawm cov tshuaj hauv kev kho mob hypercholesterolemia hauv cov neeg laus thiab cov neeg laus tom qab lub hnub nyoog 60 xyoo.

Cov neeg mob uas muaj lub siab ua haujlwm tsis zoo cov tshuaj yog sau ntawv nrog kev ceev faj nyob rau hauv kev sib txuas nrog qeeb qeeb hauv kev tshem tawm cov tshuaj ntawm lub cev. Kev tswj hwm ntawm cov chaw kuaj mob thiab kuaj pom, thiab yog tias pom muaj kev hloov pauv loj, cov koob tshuaj yuav tsum raug txo lossis kev kho yuav tsum nres.

Yog tias kev txiav txim siab tau txiav txim siab ntawm kev sib koom tes ntawm Atorvastatin thiab CYP3A4 inhibitors, ces:

Txhua zaus yuav tsum pib kho nrog qhov tsawg kawg nkaus (10 mg), nco ntsoov saib xyuas cov kua lipids ua ntej titrating koob tshuaj.

Koj tuaj yeem txiav tawm ib ntus tsis noj tshuaj Atorvastatin yog tias CYP3A4 inhibitors tau tawm hauv lub sijhawm luv luv (piv txwv, lub sijhawm luv luv ntawm cov tshuaj tua kab mob xws li clarithromycin).

Cov lus pom zoo txog kev txhaj tshuaj ntau tshaj ntawm Atorvastatin thaum siv:

nrog cyclosporine - qhov koob tshuaj yuav tsum tsis pub tshaj 10 mg,

nrog clarithromycin - cov koob tshuaj yuav tsum tsis pub tshaj 20 mg,

nrog itraconazole - cov koob tshuaj yuav tsum tsis pub tshaj 40 mg.

Azithromycin

Nrog rau kev siv tib lub sijhawm ntawm atorvastatin ntawm koob tshuaj 10 mg ib zaug ib hnub thiab azithromycin ntawm koob tshuaj 500 mg ib hnub, kev siv tshuaj azithromycin hauv cov ntshav ntshav tsis hloov pauv.

Kev siv ua ke ntawm atorvastatin ntawm kev noj tshuaj ntawm 40 mg nrog diltiazem ntawm koob tshuaj ntawm 240 mg ua rau kev nce siab ntawm atorvastatin hauv cov ntshav ntshav.

CYP3A4 Isoenzyme Inductors

Kev siv atorvastatin nrog inducers ntawm CYP3A4 isoenzyme (piv txwv li, efavirenz, phenytoin, rifampicin, St. John lub wort npaj) tuaj yeem ua rau txo qis ntawm cov tshuaj atorvastatin hauv ntshav ntshav. Vim muaj ob lub tshuab sib cuam tshuam ntawm kev sib raug zoo nrog rifampicin (inducer ntawm CYP3A4 isoenzyme thiab hepatocyte thauj protein inhibitor OATP1B1), kev siv tib lub sijhawm ntawm atorvastatin thiab rifampicin pom zoo, txij li kev ncua sijhawm ntawm atorvastatin tom qab noj rifampicin ua rau muaj kev txo qis hauv cov ntshav atorvastatin. Txawm li cas los xij, qhov tshwm sim ntawm rifampicin rau kev ua haujlwm ntawm atorvastatin hauv hepatocytes tsis paub txog thiab yog tias siv ib txhij tsis tuaj yeem zam, qhov kev ua tau zoo ntawm kev sib txuam thaum kho yuav tsum tau ua tib zoo saib.

Nrog kev noj ib txhij ntawm atorvastatin thiab kev ncua uas muaj magnesium thiab aluminium hydroxides, qhov concentration ntawm atorvastatin nyob rau hauv cov ntshav ntshav poob qis li 35%, txawm li cas los xij, cov degree ntawm kev txo qis hauv LDL-C tsis hloov pauv.

Atorvastatin tsis cuam tshuam rau lub pharmacokinetics ntawm phenazone, yog li ntawd, kev cuam tshuam nrog lwm cov tshuaj metabolized los ntawm cov enzymes tib yam ntawm cytochrome P 450 system tsis xav.

Kauj ruam

Nrog rau kev siv tib lub sijhawm ntawm colestipol, qhov kev txiav txim siab ntawm atorvastatin hauv cov ntshav ntshav poob qis li kwv yees li 25%, txawm li cas los xij, lipid-txo cov nyhuv ntawm kev sib xyaw ntawm atorvastatin thiab colestipol ntau dua li qhov ntawm txhua cov tshuaj ib tus zuj zus.

Nrog kev rov qab siv digoxin thiab atorvastatin ntawm koob tshuaj 10 mg rau ib hnub, qhov sib luag ntawm digoxin hauv cov ntshav ntshav tsis hloov. Txawm li cas los xij, thaum digoxin tau siv nrog kev sib xyaw nrog atorvastatin ntawm koob tshuaj 80 mg / hnub, kev siv tshuaj digoxin nce ntxiv txog 20%, yog li, cov neeg mob zoo li no yuav tsum tau saib xyuas.

Qhov ncauj txwv tsis pub muaj

Nrog kev siv atorvastatin thiab kev noj tshuaj ntau qhov ncauj muaj norethisterone thiab ethinyl estradiol, qhov tseem ceeb nce ntxiv ntawm AUC ntawm norethisterone thiab ethinyl estradiol tau tshawb pom los ntawm kwv yees li 30% thiab 20%, feem. Cov nyhuv no yuav tsum raug txiav txim siab thaum xaiv qhov ncauj tawm tsam rau tus poj niam noj atorvastatin.

Terfenadine

Atorvastatin nrog kev siv thooj txhij tsis muaj kev cuam tshuam loj hauv lub chaw muag tshuaj ntawm terfenadine.

Kev siv tib txhij ntawm atorvastatin nrog warfarin thaum ntxov ntxov tuaj yeem ua rau muaj txiaj ntsig ntawm warfarin ntawm cov ntshav coagulation (txo lub sijhawm prothrombin). Cov nyhuv no ploj mus tom qab 15 hnub ntawm kev siv cov tshuaj no ib txhij.

Nrog rau kev siv tib txhij ntawm atorvastatin ntawm koob tshuaj 80 mg thiab amlodipine ntawm koob tshuaj 10 mg, pharmacokinetics ntawm atorvastatin hauv lub xeev equilibrium tsis hloov pauv.

Fusidic acid

Thaum lub sijhawm kev tshawb fawb tom qab muag, cov mob ntawm rhabdomyolysis hauv cov neeg mob noj statins, suav nrog atorvastatin thiab fusidic acid, tau sau tseg.Hauv cov neeg mob rau tus neeg uas siv cov fusidic acid yog qhov tsim nyog, kev kho mob nrog statins yuav tsum tau txiav tawm thaum lub sijhawm tag nrho ntawm kev siv fusidic acid. Kev kho mob Statin tuaj yeem rov ua dua 7 hnub tom qab txhaj koob tshuaj fusidic acid kawg. Muaj qee kis tshwj xeeb, thaum kho lub cev ntev nrog fusidic acid yog qhov tsim nyog, piv txwv li, rau kev kho mob ntawm cov mob hnyav, qhov xav tau siv tib lub sijhawm ntawm atorvastatin thiab fusidic acid yuav tsum raug txiav txim siab nyob rau hauv txhua kis thiab nyob rau hauv kev saib xyuas nruj ntawm tus kws kho mob. Tus neeg mob yuav tsum sab laj nrog kws kho mob tam sim ntawd yog tias cov tsos mob ntawm cov leeg tsis muaj zog, rhiab, lossis qhov mob tshwm sim.

Kev siv ezetimibe yog txuam nrog kev txhim kho cov kev phiv tshuaj, suav nrog rhabdomyolysis, los ntawm cov leeg hlwb. Txoj kev pheej hmoo ntawm cov kev tsis sib haum xeeb no nce ntxiv nrog kev siv atorvastatin thiab ezetimibe tib lub sijhawm. Saib xyuas ze yog pom zoo rau cov neeg mob no.

Cov kab mob myopathy tau tshaj tawm nrog kev siv tib txhij ntawm atorvastatin thiab colchicine. Nrog rau kev kho ua ke nrog cov tshuaj no, kev ceev faj yuav tsum tau siv dag zog.

Thaum kawm txog kev cuam tshuam ntawm atorvastatin nrog cimetidine, tsis muaj kev cuam tshuam loj hauv kev tshawb nrhiav qhov tseeb tau tshawb pom.

Lwm txoj kev kho kom zoo

Kev siv cov tshuaj atorvastatin nrog rau cov tshuaj uas txo qis ntawm cov tshuaj hormones endogenous steroid (suav nrog cimetidine, ketoconazole, spironolactone) yuav ua rau muaj kev pheej hmoo ntawm txo qis qis ntawm cov tshuaj hormones endogenous steroid (ceev faj yuav tsum tau siv).

Hauv cov kev tshawb fawb soj ntsuam, atorvastatin tau siv ua ke nrog cov tshuaj tiv thaiv antihypertensive thiab estrogens, uas tau raug sau ua kev hloov kho, tsis muaj kev kho mob tseem ceeb uas tsis xav tau cov tsos mob tau sau tseg. Kev kawm txog kev sib cuam tshuam nrog cov tshuaj tshwj xeeb tseem tsis tau ua.

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 lub sijhawm 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 lub sijhawm ib txwm muaj ntawm cov mob ntawm cov neeg mob uas muaj kev hloov siab ntau dua li qub ) 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 yog hais tias muaj kev txhim kho cov tsos mob uas tau hais kom pom tias muaj tus mob myopathy zoo, lossis nyob rau ntawm qhov muaj feem cuam tshuam txog kev txhim kho ntawm lub raum tsis ua haujlwm vim rhabdomyolysis (mob hnyav, txo ntshav siab, kev phais mob ntau ntxiv, kev poob plig, metabolic, 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 tam sim ntawd yog tias tsis hnov qhov mob lossis cov leeg tsis muaj zog, tshwj xeeb yog tias lawv nrog mob lossis kub taub hau.

Cov tshuaj sib cuam tshuam

Txoj kev pheej hmoo ntawm myopathy tau nce ntxiv thaum kho nrog lwm cov tshuaj ntawm cov chav kawm no thaum siv cyclosporine, derivatives ntawm fibric acid, erythromycin, antifungals ntsig txog azoles, thiab nicotinic acid.

Antacids: kev noj haus ib txhij ntawm kev ncua kev kawm uas muaj cov magnesium thiab aluminium hydroxide txo qhov kev nkag siab ntawm atorvastatin hauv cov ntshav ntshav los ntawm li 35%, txawm li cas los xij, cov neeg kawm qib qis hauv LDL cov cholesterol tsis hloov.

Antipyrine: Atorvastatin tsis cuam tshuam rau lub pharmacokinetics ntawm antipyrine, yog li ntawd, kev cuam tshuam nrog lwm cov tshuaj metabolized los ntawm tib lub cytochrome isoenzymes tsis xav tau.

Amlodipine: nyob rau hauv kev kawm txog kev sib cuam tshuam yeeb tshuaj hauv cov neeg muaj kev noj qab haus huv, kev tswj hwm tib lub sijhawm ntawm atorvastatin ntawm ib koob ntawm 80 mg thiab amlodipine ntawm koob tshuaj 10 mg ua rau muaj kev nce ntxiv hauv cov nyhuv ntawm atorvastatin los ntawm 18%, uas tsis yog qhov tseem ceeb hauv chaw kho mob.

Gemfibrozil: vim muaj kev pheej hmoo ntau ntxiv txhim kho myopathy / rhabdomyolysis nrog tib lub sijhawm siv HMG-CoA reductase inhibitors nrog gemfibrozil, kev tswj hwm ua ke ntawm cov tshuaj no yuav tsum raug zam.

Lwm yam fibrates: vim muaj kev pheej hmoo ntxiv ntawm kev tsim cov myopathy / rhabdomyolysis nrog kev siv HMG-CoA reductase inhibitors nrog cov tshuaj fibrates, atorvastatin yuav tsum tau txiav txim nrog kev ceev faj thaum noj cov tshuaj fibrates.

Nicotinic acid (niacin): txoj kev pheej hmoo ntawm kev tsim myopathy / rhabdomyolysis yuav nce ntxiv thaum siv atorvastatin nrog cov nicotinic acid, yog li ntawd, nyob rau hauv qhov xwm txheej no, kev txiav txim siab yuav tsum tau muab rau txo qis ntawm atorvastatin.

Colestipol: nrog rau kev siv colestipol tib lub sijhawm, kev ua haujlwm ntawm atorvastatin hauv cov ntshav ntshav poob qis li 25%. Txawm li cas los xij, lipid-txo cov nyhuv ntawm kev sib txuam ntawm atorvastatin thiab colestipol ntau dua qhov ntawm txhua cov tshuaj ib tus zuj zus.

Colchicine: nrog kev siv atorvastatin nrog colchicine tib lub sijhawm, muaj tus mob myopathy tau tshaj tawm, suav nrog rhabdomyolysis, yog li ntawd yuav tsum ceev faj thaum siv tshuaj atorvastatin nrog colchicine.

Digoxin: nrog kev siv rov qab ntawm digoxin thiab atorvastatin ntawm koob tshuaj 10 mg, qhov sib npaug ntawm digoxin hauv cov ntshav ntshav tsis hloov. Txawm li cas los xij, thaum digoxin tau siv nrog kev sib xyaw nrog atorvastatin ntawm ib koob ntawm 80 mg / hnub, qhov kev txiav txim siab ntawm digoxin nce ntxiv txog 20%. Cov neeg mob uas tau txais digoxin ua ke nrog atorvastatin yuav tsum tau saib xyuas kom tsim nyog.

Erythromycin / clarithromycin: nrog kev siv tib txhij ntawm atorvastatin thiab erythromycin (500 mg plaub zaug hauv ib hnub) lossis clarithromycin (500 mg ob zaug ib hnub), uas inhibit cytochrome P450 ZA4, ib qho kev nce siab ntawm atorvastatin hauv cov ntshav ntshav tau pom.

Azithromycin: nrog kev siv atorvastatin sib xyaw ua ke (10 mg ib hnub ib zaug) thiab azithromycin (500 mg / ib hnub ib zaug), qhov tshuaj ntawm atorvastatin hauv cov ntshav tsis hloov pauv.

Terfenadine: nrog rau kev siv tib txhij ntawm atorvastatin thiab terfenadine, thaj chaw kho mob tseem ceeb hloov pauv hauv pharmacokinetics ntawm terfenadine tsis tau kuaj pom.

Qhov ncauj txwv tsis pub muaj: thaum siv atorvastatin thiab tshuaj tiv thaiv qhov ncauj uas muaj norethindrone thiab ethinyl estradiol, muaj qhov nce ntxiv ntawm AUC ntawm norethindrone thiab ethinyl estradiol los ntawm 30% thiab 20%, feem. Cov nyhuv no yuav tsum raug txiav txim siab thaum xaiv qhov ncauj tawm tsam rau tus poj niam noj atorvastatin.

Warfarin: thaum kawm txog kev sib cuam tshuam ntawm atorvastatin nrog warfarin, tsis muaj cov cim ntawm kev cuam tshuam loj hauv qhov chaw kuaj mob tau pom.

Cimetidine: thaum kawm qhov kev sib cuam tshuam ntawm atorvastatin nrog cimetidine, tsis muaj cov cim ntawm qhov sib cuam tshuam hauv chaw kho mob tau pom.

Protease Inhibitionitors: kev siv tib txhij ntawm atorvastatin nrog protease inhibitors hu ua cytochrome P450 ZA4 inhibitors tau nrog los ntawm kev nce plasma ntau ntawm atorvastatin.

Cov lus pom zoo rau kev siv ua ke ntawm atorvastatin thiab HIV protease inhibitors: