Torvacard pills 40mg, 90pcs

Composition

atorvastatin (in the form of calcium salt) 40 mg;

Auxiliary substances:

magnesium oxide heavy,

microcrystalline cellulose,

lactose monohydrate,

sodium croscarmellose,

low-substituted hydroxypropylcellulose LH21,

colloidal silicon dioxide,

magnesium stearate.

Shell composition:

hypromellose 2910/5,

macrogol 6000,

titanium dioxide,

talc.

Pharmacological action

Hypolipidemic agent from the statin group. Selective competitive inhibitor of HMG-CoA reductase, an enzyme that converts 3-hydroxy-3-methylglutaryl coenzyme A to mevalonic acid, which is a precursor of sterols, including cholesterol (CH). Triglycerides (TG) and cholesterol in the liver are incorporated into VLDL, enter the blood plasma and are transported to peripheral tissues. LDL is formed from VLDL during interaction with LDL receptors.

Atorvastatin reduces the concentration of cholesterol and lipoproteins in blood plasma by inhibiting HMG-CoA reductase, CHOLESTEROL synthesis in the liver, and increasing the number of hepatic LDL receptors on the cell surface, which leads to increased LDL uptake and catabolism. Reduces the formation of LDL, causes a pronounced and persistent increase in the activity of LDL receptors.

Reduces LDL concentrations in patients with homozygous familial hypercholesterolemia, which usually does not respond to lipid-lowering therapy. Reduces the concentration of total cholesterol by 30-46%, LDL-by 41-61%, apolipoprotein B-by 34-50% and TG-by 14-33%; causes an increase in the concentration of HDL-C and apolipoprotein A.

Dose-dependently reduces the concentration of LDL in patients with homozygous hereditary hypercholesterolemia, resistant to therapy with other lipid-lowering agents.

Indications

• of cardiovascular disease (in patients with elevated risk factors for coronary artery disease — elderly age over 55 years, Smoking, hypertension, diabetes mellitus, peripheral vascular disease, history of stroke, left ventricular hypertrophy, protein/albuminuria, ischemic heart disease in the immediate family), including on the background of dyslipidemia, secondary prevention is to reduce the total risk of death, myocardial infarction, stroke, re-hospitalization for about angina and need for the procedure of revascularization;
• in combination with diet to reduce elevated levels of total cholesterol, cholesterol/LDL, and apolipoprotein b, and TG and increased level of cholesterol/HDL in patients with primary hypercholesterolemia, heterozygous familial and non-family hypercholesterolemia and combined (mixed) hyperlipidemia (types IIa and IIb according to Fredrickson);
• in combination with diet for the treatment of patients with elevated serum TG levels (type IV according to Fredrickson) and patients with dysbetalipoproteinemia (type III Fredrickson), whose diet does not provide an adequate effect;
• to reduce levels of total cholesterol and cholesterol/LDL in patients with homozygous familial hypercholesterolemia, when diet and other non-pharmacological treatments are insufficiently effective (as an adjunct to lipid-lowering therapy, including cell saver purified LDL from the blood).

Use during pregnancy and lactation

Atorvastatin is contraindicated for use during pregnancy and lactation (breastfeeding).

It is not known whether atorvastatin is excreted in breast milk. Taking into account the possibility of adverse events in infants, if it is necessary to use the drug during lactation, the question of stopping breastfeeding should be decided.

Women of reproductive age should use adequate methods of contraception during treatment. Atorvastatin can be prescribed to women of reproductive age only if the probability of pregnancy is very low, and the patient is informed about the possible risk of treatment for the fetus.

Contraindications

• acute liver diseases
• severe general condition of the patient
• hypersensitivity to Torvacard.

Side effects

Infectious and parasitic diseases: often-nasopharyngitis. Musculoskeletal and connective tissue disorders: often-myalgia, arthralgia, limb pain, muscle spasms, joint swelling, back pain; infrequently-neck pain, muscle weakness; rarely-myopathy, myositis, rhabdomyolysis, tendopathy (sometimes complicated by tendon rupture). From the blood and lymphatic system: rarely-thrombocytopenia. From the side of the organ of vision: infrequently-reduced visual clarity; rarely-visual impairment. From the immune system: often-allergic reactions; very rarely-anaphylaxis. From the side of the psyche: infrequently-sleep disorders, including insomnia and nightmares. From the side of metabolism and nutrition: often-hyperglycemia; infrequently-hypoglycemia, weight gain, anorexia. From the nervous system: often-headache; infrequently-dizziness, paresthesia, hypesthesia, perversion of taste, loss or loss of memory; rarely-peripheral neuropathy. From the side of the organ of hearing and labyrinth disorders: infrequently-tinnitus; very rarely-hearing loss. Respiratory, thoracic and mediastinal disorders: common-pain in the pharynx and trachea, nosebleeds. From the digestive system: often-constipation, flatulence, dyspepsia, nausea, diarrhea; infrequently-vomiting, pain in the upper and lower abdomen, belching, pancreatitis. From the liver and biliary tract: infrequently-hepatitis; rarely-cholestasis; very rarely-liver failure. From the skin and subcutaneous tissues: infrequently-urticaria, skin rash, pruritus, alopecia; rarely-angioedema, bullous dermatitis, including erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. General disorders and disorders at the injection site: infrequently-malaise, asthenia, chest pain, peripheral edema, fatigue, fever. Laboratory and instrumental data: often-increased activity of hepatic transaminases, increased activity of CPK; infrequently-leukocyturia, increased concentration of glycosylated hemoglobin.

Interaction

The risk of myopathy during treatment with other drugs in this class increases with concomitant use of cyclosporine, fibrates, erythromycin, antifungal drugs related to azoles, and niacin.

Concomitant oral use of atorvastatin and a suspension containing magnesium and aluminum hydroxide reduced plasma concentrations of atorvastatin by approximately 35%, but the degree of reduction in LDL cholesterol did not change.

Concomitant use of atorvastatin does not affect the pharmacokinetics of antipyrine, so interactions with other drugs metabolized by the same cytochrome isoenzymes are not expected.

Plasma concentrations of atorvastatin decreased by approximately 25% when colestipol was co-administered. However, the lipid-lowering effect of the combination of atorvastatin and colestipol exceeded that of each drug separately.

When digoxin and atorvastatin were re-administered at a dose of 10 mg, the steady-state plasma concentrations of digoxin did not change. However, when digoxin was used in combination with atorvastatin at a dose of 80 mg/day, the digoxin concentration increased by about 20%. Patients receiving digoxin in combination with atorvastatin should be monitored.

Concomitant use of atorvastatin and erythromycin (500 mg 4 times / day) or clarithromycin (500 mg 2 times / day), which inhibit the CYP3A4 isoenzyme, an increase in the concentration of atorvastatin in blood plasma was observed.

Concomitant use of atorvastatin (10 mg 1 time/day) and azithromycin (500 mg 1 time/day) did not change the concentration of atorvastatin in blood plasma.

Atorvastatin did not have a clinically significant effect on the plasma concentration of terfenadine, which is mainly metabolized by CYP3A4; therefore, it seems unlikely that atorvastatin can significantly affect the pharmacokinetic parameters of other CYP3A4 substrates.

Concomitant use of atorvastatin and an oral contraceptive containing norethindrone and ethinyl estradiol. When atorvastatin was co-administered with an oral contraceptive containing norethindrone and ethinylestradiol, a significant increase in the AUC of norethindrone and ethinylestradiol was observed by approximately 30% and 20%, respectively. This effect should be considered when choosing an oral contraceptive for a woman receiving atorvastatin.

When studying the interaction of atorvastatin with warfarin and cimetidine, no signs of clinically significant interaction were found.

Concomitant use of atorvastatin 80 mg and amlodipine 10 mg did not alter the pharmacokinetics of atorvastatin at steady state.

Concomitant use of atorvastatin with protease inhibitors, known as CYP3A4 inhibitors, was accompanied by an increase in the concentration of atorvastatin in blood plasma.

There was no clinically significant adverse interaction between atorvastatin and antihypertensive agents, as well as with estrogens. Interaction studies with all specific drugs have not been conducted.

How to take it, course of use and dosage

Before prescribing Torvacard, the patient should be recommended a standard lipid-lowering diet, which he should continue to follow throughout the entire period of therapy.

The initial dose is on average 10 mg 1 time/day. The dose varies from 10 to 80 mg 1 time/day.The drug can be taken at any time of the day with food or regardless of the time of meal. The dose is selected taking into account the initial LDL-C levels, the purpose of therapy, and the individual effect. At the beginning of treatment and/or during an increase in the dose of Torvacard, it is necessary to monitor blood lipid levels every 2-4 weeks and adjust the dose accordingly.

In primary hypercholesterolemia and mixed hyperlipidemia, in most cases, it is sufficient to prescribe a dose of 10 mg of Torvacard 1 time/day. A significant therapeutic effect is observed after 2 weeks, as a rule, and the maximum therapeutic effect is usually observed after 4 weeks. With long-term treatment, this effect persists.

When determining the goal of treatment, you can use the recommendations given below.

Recommendations of the National Cholesterol Education Program (USA). Diagnosed vascular atherosclerosis * LDL cholesterol, mg / dl (mmol / l).

Objectives of lipid-lowering therapy of the European Atherosclerosis Society In patients with a confirmed diagnosis of CHD and other patients at high risk of ischemic complications, the goal of treatment is to reduce LDL cholesterol levels of less than 115 mg / dl (less than 3 mmol/L) and total cholesterol of less than 190 mg/dl (less than 5 mmol/L).

National guidelines for the treatment of Homozygous familial hypercholesterolemia. In a study in adult patients with homozygous familial hypercholesterolemia, atorvastatin 80 mg therapy in most cases resulted in a reduction in LDL-C levels by more than 15% (18-45%). The use of the drug in patients with renal insufficiency and kidney diseases does not affect the level of atorvastatin in blood plasma or the degree of reduction in LDL cholesterol when it is used, so no dose changes are required. When using the drug in elderly patients, there were no differences in the safety, effectiveness or achievement of the goals of lipid-lowering therapy in comparison with the general population.

Overdose

Possible symptoms: hypotension is possible. Treatment: there is no symptomatic therapy and no specific antidote. Hemodialysis is ineffective.

Functional features

Absorption is high. _Cmax in blood plasma is reached in 1-2 hours, _Cmax in women is 20% higher, AUC is 10% lower;_Cmax in patients with alcoholic cirrhosis of the liver is 16 times higher, AUC is 11 times higher than normal.

Food slightly reduces the rate and duration of drug absorption (by 25 and 9%, respectively), but the decrease in LDL-C is similar to that when using atorvastatin without food. The concentration of atorvastatin when used in the evening is lower than in the morning (by approximately 30%). A linear relationship was found between the degree of absorption and the dose of the drug.

Bioavailability — 12%, systemic bioavailability of inhibitory activity against HMG-CoA reductase-30%. Low systemic bioavailability is due to presystemic metabolism in the gastrointestinal mucosa and at the first passage through the liver.

Mean Vd — 381 l, plasma protein binding-98%. It is mainly metabolized in the liver under the action of isoenzymes CYP3A4, CYP3A5 and CYP3A7 with the formation of pharmacologically active metabolites (ortho – and parahydroxylated derivatives, beta-oxidation products). In vitro, ortho-and parahydroxylated metabolites have an inhibitory effect on HMG-CoA reductase comparable to that of atorvastatin. The inhibitory effect of the drug on HMG-CoA reductase is approximately 70% determined by the activity of circulating metabolites.

It is excreted through the intestine with bile after hepatic and / or extrahepatic metabolism (does not undergo pronounced enterohepatic recirculation).

T_1/2 — 14 h. Inhibitory activity against HMG-CoA reductase persists for about 20-30 hours due to the presence of active metabolites. Less than 2% of the oral dose of the drug is detected in the urine. It is not excreted during hemodialysis.

Special instructions

Before starting Torvacard therapy, the patient should be prescribed a standard hypocholesterolemic diet, which he must follow during the entire treatment period.

The use of HMG-CoA reductase inhibitors to reduce blood lipids may lead to changes in biochemical parameters that reflect liver function. Liver function should be monitored before starting therapy,6 weeks,12 weeks after starting Torvacard and after each dose increase, as well as periodically (for example, every 6 months). An increase in the activity of liver enzymes in the blood serum can be observed during therapy with Torvacard. Patients with elevated transaminase levels should be monitored until their enzyme levels return to normal. In the event that the ALT or AST values are more than 3 times higher than the highest limit of normal, it is recommended to reduce the dose of Torvacard or stop treatment.

Treatment with Torvacard may cause myopathy. In patients with advanced myalgia, muscle soreness or weakness, and / or a marked increase in CPK activity, the possibility of developing myopathy (pain and weakness in the muscles combined with an increase in CPK activity by more than 10 times compared to the highest limit of normal) should be borne in mind. Patients should be warned that they should immediately inform the doctor about the appearance of unexplained pain or weakness in the muscles, if they are accompanied by malaise or fever.

Torvacard therapy should be discontinued if there is a marked increase in CPK activity or if there is a confirmed or suspected myopathy. The risk of myopathy associated with other drugs in this class was increased with concomitant use of cyclosporine, fibrates, erythromycin, nicotinic acid, or azole antifungal agents. Many of these drugs inhibit CYP3A4-mediated metabolism and / or drug transport. Atorvastatin is biotransformed by CYP3A4. When prescribing atorvastatin in combination with fibrates, erythromycin, immunosuppressive agents, azole antifungal drugs or nicotinic acid in hypolipidemic doses, the expected benefit and risk of treatment should be carefully weighed and patients should be regularly monitored for muscle pain or weakness, especially during the first months of treatment and during periods of increasing the dose of any drug. In such situations, periodic monitoring of CPK activity can be recommended, although such monitoring does not prevent the development of severe myopathy.

When using atorvastatin, as well as other drugs of this class, cases of rhabdomyolysis with acute renal failure due to myoglobinuria have been described. Torvacard therapy should be temporarily discontinued or completely discontinued if there are signs of possible myopathy or the presence of a risk factor for developing renal failure on the background of rhabdomyolysis (for example, severe acute infection, hypotension, serious surgery, trauma, severe metabolic, endocrine and electrolyte disorders and uncontrolled seizures). Before starting Torvacard therapy, it is necessary to try to achieve control of hypercholesterolemia through adequate diet therapy, increased physical activity, weight loss in obese patients, and treatment of other conditions. Patients should be warned to seek immediate medical attention if they experience unexplained muscle pain or weakness, especially if they are accompanied by malaise or fever.

Form of production

Coated tablets

Storage conditions

At a temperature of 10-30 °C

Shelf life

2 years

Active ingredient

Atorvastatin

Conditions of release from pharmacies

By prescription

Dosage form

Tablets