Atorvastatin-TEVA (atorvastatin)coated tablets 20 mg. №30

$26.00

Manufacturer: Spain

Atorvastatin-TEVA is used for the prevention of cardiovascular disease, as well as an adjunct to diet to reduce elevated levels of total cholesterol.

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Description

Ingredients

active ingredient : atorvastatin;

1 film-coated tablet contains 10 mg or 20 mg, 40 mg, or 80 mg of atorvastatin (as atorvastatin calcium)

Excipients:

core: microcrystalline cellulose, sodium carbonate, maltose, croscarmellose sodium, magnesium stearate

shell: hypromellose (E 464), hydroxypropyl cellulose, triethyl citrate (E 1505), polysorbate 80, titanium dioxide (E 171).

Dosage form

Film-coated tablets.

Basic physical and chemical properties: 20 mg: white or almost white, elliptical, biconvex, smooth tablets, approximately
12.5 mm × 6.6 mm in size.

Pharmacotherapeutic group

Drugs that lower the level of cholesterol and triglycerides in the blood serum. HMG-CoA reductase inhibitors. Code ATX C10A A05.

Pharmacodynamics

Atorvastatin is a selective competitive inhibitor of HMG-CoA reductase, an enzyme that regulates the rate of conversion of 3-hydroxy-3-methylglutaryl coenzyme A to mevalonate, a precursor of sterols, including cholesterol. Cholesterol and triglycerides circulate in the bloodstream in combination with lipoproteins. These complexes are separated by ultracentrifugation into HDL (high density lipoprotein), LDLP (intermediate density lipoprotein), LDL (low density lipoprotein) and VLDL (very low density lipoprotein) fractions. Triglycerides (TG) and cholesterol in the liver are incorporated into VLDL and released into the blood plasma for transport to peripheral tissues. LDL is formed by VLDL and catabolized by interaction with high-affinity LDL receptors.

Atorvastatin lowers plasma cholesterol and lipoprotein levels by inhibiting hepatic HMG-CoA reductase and cholesterol synthesis and by increasing the number of hepatic LDL receptors on cell surfaces to enhance LDL uptake and catabolism; atorvastatin also reduces the production of LDL and the number of these particles. Atorvastatin lowers LDL cholesterol levels in some patients with homozygous familial hypercholesterolemia, a group of people who rarely respond to treatment with other lipid-lowering drugs.

Numerous clinical studies have shown that elevated levels of total cholesterol, LDL cholesterol and apo B (membrane complex for LDL cholesterol) provoke the development of atherosclerosis. Similarly, reduced levels of HDL cholesterol (and its transport complex – a by A) are associated with the development of atherosclerosis. Epidemiological studies have established that cardiovascular morbidity and mortality vary in direct proportion to the level of total cholesterol and LDL cholesterol and inversely with the level of HDL cholesterol.

Atorvastatin reduces total cholesterol, LDL cholesterol and apo B in patients with homozygous and heterozygous familial hypercholesterolemia, non-familial forms of hypercholesterolemia and mixed dyslipidemia. Atorvastatin also lowers VLDL and TG cholesterol levels, and also causes an unsustainable increase in HDL cholesterol and apolipoprotein A-1. Atorvastatin lowers total cholesterol, LDL cholesterol, VLDL cholesterol, apo B, triglycerides and HDL-C, and increases HDL cholesterol in patients with isolated hypertriglyceridemia. Atorvastatin reduces LDL-C in patients with dysbetalipoproteinemia.

Like LDL, lipoproteins rich in cholesterol and triglycerides, including VLDL, LDLP, and residues, may also contribute to the development of atherosclerosis. Elevated plasma triglyceride levels are often found in the triad of low HDL cholesterol and small LDL lobules, as well as in combination with non-lipid metabolic risk factors for coronary heart disease. Total plasma triglycerides per se have not been consistently shown to be an independent risk factor for coronary artery disease. In addition, an increase in HDL or a decrease in triglycerides has been found to have an independent effect on the risk of coronary and cardiovascular morbidity and mortality.

Atorvastatin, like some of its metabolites, is pharmacologically active in humans. The main site of action of atorvastatin is the liver, which plays a major role in cholesterol synthesis and LDL clearance. The dose of the drug, in contrast to the systemic concentration of the drug, better correlates with a decrease in LDL cholesterol. Individual dose selection should be carried out depending on the therapeutic response.

Indications

Prevention of cardiovascular disease

In adults without symptomatic coronary artery disease but with multiple risk factors for coronary artery disease, such as age, smoking, hypertension, low HDL, or a family history of early coronary artery disease, Atorvastatin-TEVA is indicated for:

  • reducing the risk of myocardial infarction
  • reducing the risk of stroke;
  • reducing the risk of the need for revascularization procedures and angina pectoris.

In patients with type II diabetes without symptomatic coronary heart disease, but with several risk factors for coronary heart disease, such as retinopathy, albuminuria, smoking, or arterial hypertension, Atorvastatin-Teva is indicated for:

  • reducing the risk of myocardial infarction
  • reducing the risk of stroke.

For patients with clinically severe coronary heart disease, Atorvastatin-Teva is indicated for:

  • reduced risk of non-fatal myocardial infarction
  • reducing the risk of fatal and non-fatal stroke;
  • reducing the risk of the need for revascularization procedures;
  • reduced risk of needing hospitalization for congestive heart failure
  • reducing the risk of angina pectoris.

Hyperlipidemia

  • As an adjunct to diet to reduce elevated levels of total cholesterol, LDL cholesterol, apolipoprotein B and triglycerides, and to increase HDL cholesterol levels in patients with primary hypercholesterolemia (heterozygous familial and non-familial) and mixed dyslipidemia (Fredrickson classification types IIa and IIb) .
  • As an adjunct to diet for the treatment of patients with elevated serum triglyceride levels (Fredrickson type IV).
  • For the treatment of patients with primary dysbetalipoproteinemia (Fredrickson type III) in cases where dietary compliance is not effective enough.
  • To reduce total and LDL cholesterol levels in patients with homozygous familial hypercholesterolemia as an adjunct to other lipid-lowering treatments (eg LDL apheresis) or when such treatments are not available.
  • As an adjunct to a diet to reduce total cholesterol, LDL cholesterol, and apolipoprotein B in boys and girls (postmenarchal) aged 10 to 17 years with heterozygous familial hypercholesterolemia, if, after appropriate dietary therapy, test results are:

a) LDL cholesterol remains ³ 190 mg/dl or

b) LDL cholesterol ³ 160 mg/dl and:

  • Family history of early cardiovascular disease or
  • Two or more other risk factors for cardiovascular disease are present in a pediatric patient.

Contraindications

Hypersensitivity to any of the components of Atorvastatin-TEVA.

Active liver disease or a persistent increase in liver transaminase activity of unknown etiology, which is three times higher than normal.

Use of the antiviral drug glecaprevir/pibrentasvir for the treatment of hepatitis C.

Pregnancy and lactation period.

Contraindicated in women of reproductive age who do not use contraceptives.

Dosage and administration

Atorvastatin is for oral use. The dose is taken completely 1 time per day, daily, at any time of the day, regardless of the meal.

Before using atorvastatin, the patient should start a standard cholesterol-lowering diet and follow it thereafter during treatment with atorvastatin.

The dose is selected individually in accordance with the initial level of LDL cholesterol, the goal of therapy and the patient’s response. The maximum dose is 80 mg once a day.

Hyperlipidemia (heterozygous familial and non-familial) and mixed dyslipidemia (Fredrickson type IIa and IIb)

The recommended starting dose of Atorvastatin-TEVA is 10 or 20 mg once daily. For patients who require a significant reduction in LDL cholesterol (greater than 45%), therapy may be initiated at a dosage of 40 mg once daily. The dosing range for atorvastatin is 10 to 80 mg once daily. The drug can be taken as a single dose at any time and regardless of food intake. Initial and maintenance doses of atorvastatin should be individualized depending on the goal of treatment and response. After initiation of treatment and/or after dose titration of atorvastatin, lipid levels should be analyzed over a period of 2 to 4 weeks and the dose adjusted accordingly.

Heterozygous familial hypercholesterolemia in pediatric patients (aged 10-17 years)

The recommended starting dose of atorvastatin is 10 mg/day; the maximum recommended dose is 20 mg/day (doses exceeding 20 mg have not been studied in this group of patients). Doses of the drug should be selected individually for the purpose of treatment. Dose adjustments should be made at intervals of 4 weeks or more.

Homozygous familial hypercholesterolemia

The dose of atorvastatin in patients with homozygous familial hypercholesterolemia is 10 to 80 mg per day. Atorvastatin should be used as an adjunct to other lipid-lowering therapies (eg, LDL apheresis) or if lipid-lowering therapies are not available.

Simultaneous lipid-lowering therapy

Atorvastatin-TEVA can be used with bile acid sequestrants. The combination of HMG-CoA reductase inhibitors (statins) and fibrates should generally be used with caution.

Dosing for patients taking ciclosporin, clarithromycin, itraconazole, or certain protease inhibitors

Treatment with atorvastatin should be avoided in patients taking cyclosporine or HIV protease inhibitors (tipranavir + ritonavir) or an inhibitor of hepatitis C virus protease (telaprevir). Atorvastatin-TEVA should be used with caution in HIV patients taking lopinavir + ritonavir and used at the most appropriate dose. For patients taking clarithromycin, itraconazole, and for HIV patients taking combinations of saquinavir + ritonavir, darunavir + ritonavir, fosamprenavir, or the combination of fosamprenavir + ritonavir, the therapeutic dose of atorvastatin should be limited to a dose of 20 mg, and appropriate clinical evaluations are recommended for ensuring the use of a low required dose of atorvastatin. In patients taking the hepatitis C antiviral drug elbasvir/grazoprevir, the dose of atorvastatin should not exceed 20 mg/day. In patients taking the HIV protease inhibitor nelfinavir or the hepatitis C protease inhibitor boceprevir, treatment with atorvastatin should be limited to a dose of 40 mg, and appropriate clinical examinations are recommended to ensure the use of the low required dose of atorvastatin.

Patients with impaired renal function

Kidney disease does not affect either plasma concentrations or LDL-C lowering with atorvastatin; therefore, dose adjustment of the drug for patients with impaired renal function is not required.

Patients with impaired liver function

Atorvastatin should be used with caution in patients with hepatic impairment. Atorvastatin-TEVA is contraindicated in patients with active liver disease.

Elderly patients

There is no difference in safety and efficacy in patients over 70 years of age when used at recommended doses compared with the general population.