Atorvastatin 20 mg - litaelo tsa tšebeliso

Matlapa a koahetsoeng ka filimi, 20 mg.

Letlapa le leng le na le

ntho e sebetsang - atorvastatin (ka sebopeho sa letsoai la khalsiamo ea atorvastatin) - 20 mg
excipients - lactose monohydrate, cellulose ea microcrystalline, sodium e tsoekere, hypromellose 2910, polysorbate 80, calcium stearate, calcium carbonate
sebopeho sa shell - hypromellose 2910, polysorbate 80, titanium dioxide (E 171), talc

Letlapa le koahetsoeng ka filimi e tšoeu e tšoeu. Nakong ea khefu, matlapa a tšoeu kapa a batla a soeufetse.

Pharadodynamics

Hypolipidemic moemeli ea tsoang sehlopheng sa li-statins. Mochine o ka sehloohong oa ts'ebetso ea atorvastatin ke thibelo ea ts'ebetso ea 3-hydroxy-3-methylglutarylcoenzyme A- (HMG-CoA) reductase, enzyme e thusang ho fetoloa ha HMG-CoA ho mevalonic acid. Phetoho ena ke e meng ea mehato ea pele ho ketane ea kholeseterole ea 'mele. Ho hatelloa ha atorvastatin cholesterol synthesis ho lebisa ho ho eketseha hape ha li-receptor tsa LDL (lipalo tse fokolang tsa methapo ea methapo) ho sebete, hammoho le liseleng tse eketsehileng. Li-receptor tsena li tlama likaroloana tsa LDL le ho li tlosa plasma ea mali, e lebisang ho cholesterol ea LDL e tlase maling.

Matla a antisulinotic a atorvastatin ke litholoana tsa litlamorao marang-rang a methapo ea mali le likarolo tsa mali. Lithethefatsi li thibela motsoako oa isoprenoids, e leng lintlha tsa kholo tsa lisele tse kahare tsa methapo ea mali. Tlas'a tšusumetso ea atorvastatin, ho atoloha ho itšetlehileng ka methapo ea methapo ea mali hoa ntlafala. Atorvastatin lowers cholesterol, lipensiprotein tse tlase, apolipoprotein B, triglycerides. E baka keketseho ea cholesterol ea HDL (lipalo tse phahameng tsa methapo ea methapo) le apolipoprotein A.

Ketso ea moriana, joalo ka molao, e tsoela pele kamora libeke tse peli tsa tsamaiso, mme phello e phahameng e fihlella kamora libeke tse 'ne.

Mofumahali

Ho chona ho phahameng. Nako ea ho fihlela khatello e phahameng ke lihora tse 1-2, boholo bo phahameng ba basali bo phahame ka 20%, AUC (sebaka se ka tlas'a khefu) e tlase ka 10%, palo e phahameng ea bakuli ba nang le cirrhosis ea lino tse tahang e makhetlo a 16, AUC e makhetlo a 11 ho feta e tloaelehileng. Lijo li fokotsa sekhahla le nako ea ho monya lithethefatsi (ka 25% le 9%, ka ho latellana), empa ho fokotseha ha cholesterol ea LDL ho ts'oana le ts'ebeliso ea atorvastatin ntle le lijo. Keketseho ea atorvastatin ha e sebelisoa mantsiboea e tlase ho feta hoseng (hoo e ka bang 30%). Kamano ea linear pakeng tsa tekanyo ea ho amoheloa le lethalinyana la lithethefatsi e ile ea senoloa.

Bioavailability - 14%, systemic bioavailability ea mesebetsi e thibelang khahlanong le HMG-CoA reductase - 30%. Bioavailability e tlase e bakoa ke metabolism ea "presystemic metabolism" mucous membrane ea "gastrointestinal" le "nakong ea" karolo ea pele "ka sebete.

Bophahamo bo boholo ba kabo ke 381 l, khokahano le liprotheine tsa plasma ke 98%. E tšelisoa haholo-holo ka har'a sebete ka tlasa ts'ebetso ea cytochrome P450 CYP3A4, CYP3A5 le CYP3A7 ka ho thehoa ha li-metabolites tse sebetsang tsa kemiso (ortho- le parahydroxylated derivatives, lihlahisoa tsa beta-oxidation). Phello ea inhibitory ea lithethefatsi khahlanong le HMG-CoA reductase e batla e le 70% e khethiloeng ke ts'ebetso ea potoloho ea metabolites.

E pepesitsoe ka har'a bile ka mor'a hore e sebelisoe ka hepatic le / kapa metabolism e eketsehileng (ha e ts'oaroe ka mokhoa o matla).

Bophelo ba halofo ke lihora tse 14. Ts'ebetso ea inhibitory khahlanong le HMG-CoA reductase e phehella lihora tse ka bang 20-30, ka lebaka la ho ba teng ha metabolites e sebetsang. Ka tlase ho 2% ea tekanyetso ea molomo e behiloe ka har'a moroto.

Ha e qhekelloe nakong ea hemodialysis.

Matšoao a ho sebelisoa

Matšoao a sebelisang atorvastatin ke:

hypercholesterolemia, joalo ka tlatsetso ea lijo bakeng sa kalafo ea bakuli ba nang le boemo bo phahameng ba cholesterol e ngata, LDL cholesterol (lipenshene tse nang le methapo e fokolang), apolipoprotein B le triglycerides, hammoho le ho eketsa cholesterol ea HDL (high density lipoprotein) ho bakuli ba nang le hypercholesterolemia ea ka sehloohong hypercholesterolemia eo e seng ea lefutso), e kopantsoeng (e kopaneng) hyperlipidemia (mofuta oa Fredrickson IIa le IIb), maemo a phahameng a plasma triglyceride (mofuta oa Fredrickson III), maemong ao ho ja ho se nang phello e lekaneng.
ho theola cholesterol e felletseng le bakuli ba nang le homozygous hereditary hypercholesterolemia maemong ao ho se nang karabelo e lekaneng ea ho ja kapa mehato e meng eo e seng ea lithethefatsi.
bakeng sa prophylaxis ho bakuli ba se nang matšoao a ho kula a pelo le lefu la dyslipidemia, empa le na le mabaka a mangata a tšoaetso ea lefu la pelo le kang ho tsuba, khatello ea mali, lefu la tsoekere, cholesterol e tlase ea HDL (HDL-C), kapa le pele ho nako lefu la pelo le mokokotlong historing ea lelapa (ho fokotsa kotsi ea ho bolaoa ke lefu la pelo le ho se sebetse hoa myocardial infarction, fokotsa kotsi ea ho tšoaroa ke lefu la sethoathoa).

Ketso ea pharmacological

Phello ea pharmacological ke hypolipidemic.

Ntho e sebetsang e thibela enzyme HMG-CoA reductase, e amehang ho kopaneng ea cholesterol le lipoprotein tsa atherogenic le sebete, hape e eketsa bongata ba li-receptor tsa "membrane cell membrane" tse amanang le LDL. Ho nwa moriana ka tekanyetso ea 20 mg ho lebisa ho fokotseha hoa cholesterol e felletseng ka 30-46%, lipenshene tsa methapo e tlase ka 41-61%, triglycerides ka 14-33%, le keketseho ea tekanyo e phahameng ea li-antiatherogenic lipoproteins.

Ho beha moriana ka tekanyo e phahameng ea 80 mg ho fokotsa kotsi ea ho se sebetse hantle tsamaisong ea pelo le methapo, ho fokotsa lefu le khafetsa lipetlele sepetleleng sa lefu la pelo, ho kenyelletsa le ho bakuli ba kotsing e kholo.

Tekanyetso ea lithethefatsi e fetoloa ho latela boemo ba LDL.

Ho sebetsa hantle ho fihlella khoeli e le 'ngoe ka mor'a ho qala kalafo.

Pharmacokinetics: e kenngoe ho tsoa mokokotlong oa mpa, e fihla molekong o moholo oa plasma kamora lihora tse 1-2. Ho ja le nako ea letsatsi ha ho ame katleho. E tsamaisoa ka plasma protein bind state. E nosetsoa ka har'a sebete 'me e thehiloe metabolites ea metabolacology. E pepisoa ka bile.

Bakeng sa bakuli ba lilemo tse fetang 65, ha ba bapisoa le bakuli ba banyenyane, ts'ebetso le polokeho ea lithethefatsi li joalo.

Mosebetsi o fokolisitsoeng oa renal filtration ha o ame metabolism le tlhahiso ea moriana mme ha e hloke phetoho ea tekanyetso.

Ho hloka matla ha sebete ke ho sitisa tšebeliso ea atorvastatin.

Hobaneng matlapa Atorvastatin 20

Matšoao a sebeliso:

mathata a metabolic a lipoprotein le tse ling lipidemia,
Hypercholesterolemia
hypertriglyceridemia e ntle,
hyperlipidemia e tsoakiloeng le e sa hlalosoang,
thibelo ea liketsahalo tsa pelo le bakuli ba kotsing e kholo,
lefu la pelo (corina ea pelo) (angina pectoris, infarction ea myocardial),
o ile a otloa ke setorouku.

Melemo ea pharmacological

Mofumahali

Ho chona ho phahameng. Ho felisoa ha halofo ea bophelo ke lihora tse 1-2, Cmax ho basali e phahame ka 20%, AUC e tlase ka 10%, Cmax ho bakuli ba nang le cirrhosis ea joala bo tahang ka makhetlo a 16, AUC e phahame makhetlo a 11 ho feta e tloaelehileng. Lijo li fokotsa sekhahla le nako ea ho monya lithethefatsi (ka 25 le 9%, ka ho latellana), empa ho fokotseha ha cholesterol ea LDL ho ts'oana le ts'ebeliso ea atorvastatin ntle le lijo. Keketseho ea atorvastatin ha e sebelisoa mantsiboea e tlase ho feta hoseng (hoo e ka bang 30%). Kamano ea linear pakeng tsa tekanyo ea ho amoheloa le lethalinyana la lithethefatsi e ile ea senoloa. Bioavailability - 14%, systemic bioavailability ea mesebetsi e thibelang khahlanong le HMG-CoA reductase - 30%. Bioavailability e tlase e bakoa ke metabolism ea "presystemic metabolic" mucosa ea ka mpeng le nakong ea "karolo ea pele" ka sebete. Bophahamo bo boholo ba kabo ke 381 l, khokahano le liprotheine tsa plasma li feta 98%. E na le metabolism haholo ka har'a sebete tlas'a ts'ebetso ea cytochrome CYP3A4, CYP3A5 le CYP3A7 ka ho thehoa ha li-metabolites tse sebetsang tsa kemiso (ortho le parahydroxylated, lihlahisoa tsa beta oxidation). In vitro, ortho- le para-hydroxylated metabolites li na le phello e thibelang ho fokotsoa ha HMG-CoA, ho bapisoa le atorvastatin. Matla a thibelo ea lithethefatsi khahlanong le HMG-CoA reductase e batla e le 70% e khethiloeng ke ts'ebetso ea ho potoloha ha metabolites mme e phehella lihora tse ka bang 20-30 ka lebaka la ho ba teng ha eona. Ho felisoa ha halofo ea bophelo ke lihora tse 14. E pepesitsoe ka har'a bile ka mor'a hore e sebelisoe ka hepatic le / kapa metabolism e eketsehileng (ha e ts'oaroe ka mokhoa o matla). Ka tlase ho 2% ea tekanyetso ea molomo e behiloe ka har'a moroto. Ha e qhekelloe nakong ea haemodialysis ka lebaka la ho tlama liprotheine tsa plasma haholo. Ka ho hloleha ha sebete ho bakuli ba nang le cirrhosis ea joala (Child-Pyug B), Cmax le AUC li eketseha haholo (makhetlo a 16 le 11, ka ho latellana). Cmax le AUC ea lithethefatsi ho batho ba tsofetseng (ba lilemo li 65) ba 40 le 30%, ka ho latellana, li phahame ho feta ho bakuli ba baholo ba lilemo tse nyane (ha li na bohlokoa ba kliniki). Cmax ho basali e phahame ka 20%, mme AUC e tlase ka 10% ho feta ho banna (ha e na boleng ba kliniki). Ho hloleha ka nama ha ho ame khatello ea mali ea plasma.

Pharadodynamics

Atorvastatin ke moemeli oa hypolipidemic ea tsoang sehlopheng sa li-statins. Ke inhibitor e khethiloeng ea HMG-CoA reductase, enzyme e fetolang 3-hydroxy-3-methylglutaryl coenzyme A ho mevalonic acid, e leng selelekela sa li-sterols, ho kenyelletsa cholesterol. Triglycerides le cholesterol e leng ka har'a sebete e kenyellelitsoe ho hlophisoa ha lipomprotein tse fokolang haholo (VLDL), li kenella ka har'a plasma 'me li tsamaisoa ka lisele tsa thipa. Li-density lipoproteins tse tlase (LDL) li thehoa ho tsoa ho VLDL nakong ea tšebelisano le li-receptor tsa LDL. E fokotsa cholesterol ea plasma le lipoprotein ka lebaka la thibelo ea ho fokotsoa ha HMG-CoA, motsoako oa cholesterol bokong le keketseho ea lipalo tsa "sebete" tsa LDL seleng ea cell, e lebisang ho nkeng le ho eketseha ha litho tsa LDL. E fokotsa sebopeho sa LDL, e baka keketseho e boletsoeng le e phehellang mosebetsing oa li-receptors tsa LDL. E fokotsa LDL ho bakuli ba nang le homozygous Familia hypercholesterolemia, eo hangata e ke keng ea lokeleha ho phekoloa ka lithethefatsi tse fokotsang lipid. E fokotsa boemo ba cholesterol ka botlalo ka 30-46%, LDL - ka 41-61%, apolipoprotein B - ka 34-50% le triglycerides - ka 14-33%, e baka keketseho ea boemo ba cholesterol-lipoprotein e phahameng le apolipoprotein A. LDL ho bakuli ba nang le homozygous hereditary hypercholesterolemia, e hananang le kalafo ka lithethefatsi tse ling tse fokotsang lipid. Ho fokotsa haholo kotsi ea ho ba le mathata a ischemic (ho kenyelletsa le lefu la lefu le tsoang myocardial infarction) ka 16%, kotsi ea ho kenngoa sepetlele bakeng sa angina pectoris, e tsamaeang le matšoao a ischemia ea myocardial, ka 26%. Ha e na phello ea carcinogenic le mutagenic. Phello ea kalafo e fumanoa libeke tse 2 kamora ho qala kalafo, e fihla hofihlella kamora libeke tse 4 mme e tšoarella nakong eohle ea kalafo.

Tekanyetso le tsamaiso

Kahare, nka nako efe kapa efe ea letsatsi, ho sa tsotelehe lijo tseo u li jang. Pele o qala kalafo, o lokela ho chencha lijo tse netefatsang ho fokotseha ha lipids maling, 'me u li shebelle nakong eohle ea kalafo.

Thibelo ea lefu la pelo Tekanyetso ea pele ea batho ba baholo ke 10 mg hang ka letsatsi. Tekanyetso e lokela ho fetoloa ka nako ea ho qeta bonyane libeke tse 2 le 2 ka tlasa taolo ea methapo ea lipid ho plasma. Tekanyetso e kholo ea letsatsi le letsatsi ke 80 mg ho tekanyetso e le 'ngoe. Ka tsamaiso e ts'oanang ka cyclosporine, lethal dose e phahameng ea letsatsi le letsatsi ea atorvastatin ke 10 mg, ka clarithromycin - 20 mg, le itraconazole - 40 mg.

Hohypercholesterolemia ea mantlha le hyperlipidemia e kopaneng 10 mg hang ka letsatsi. Phello e iponahatsa ka nako ea libeke tse 2, phello e phahameng e bonoa nakong ea libeke tse 4.

Hohomozygous Familia hypercholesterolemia Tekanyetso ea pele ke 10 mg hang ka letsatsi, ebe keketseho ea 80 mg hang ka letsatsi (ho fokotseha hoa LDL ka 18-45%). Pele a qala kalafo, mokuli o lokela ho fuoa lijo tse tloaelehileng tsa hypocholesterolemic, tseo a lokelang ho li latela nakong ea kalafo. Ka ho hloleha ha sebete, tekanyo e tlameha ho fokotsoa. Bakeng sa bana ho tloha ho lilemo tse 10 ho isa ho 17 (ke bashanyana feela le banana ba ho ea khoeling) ba nang le heterozygous Famation hypercholesterolemia, tekanyo ea pele ke 10 mg 1 nako ka letsatsi. Tekanyetso ha ea lokela ho eketsoa pele ho libeke tse 4 kapa ho feta. Tekanyetso e kholo ea letsatsi le letsatsi ke 20 mg (tšebeliso ea litekanyetso tse fetang 20 mg ha e so ithutoe).

Batho ba baholo le bakuli ba nang le lefu la liphio Ho fetola mofuta oa moriana ha ho hlokehe.

Bakuli ba nang le ts'ebetso ea sebete e sa sebetseng tlhokomelo e tlameha ho nkoa mabapi le ho lieha ho felisoa ha moriana 'meleng. Matšoao a kliniki le a laboratori a ts'ebetso ea sebete a tlameha ho hlahlojoa ka hloko mme, ka liphetoho tse kholo tsa pathological, lethal dose le lokela ho fokotsoa kapa ho hlakoloe.

Sebelisa hammoho le metsoako e meng ea meriana. Haeba tšebeliso ea nako e tšoanang ea atorvastatin le cyclosporine e hlokahala, tekanyo ea atorvastatin ha ea lokela ho feta 10 mg.

Litlamorao

Ho tsoa tsamaisong ea methapo: ho hloka boroko, ho opeloa ke hlooho, ho hlaseloa ke lefu la sethoathoa, mala, ho ba le letsoele, ho ruruha ha pelo, amnesia, paresthesia, hypesthesia, khatello ea maikutlo.

Ho tsoa ts'ebetsong ea tšilo ea lijo: ho nyekeloa ke pelo, lets'ollo, bohloko ba ka mpeng, dyspepsia, botšosi, ho sokela, ho hlatsa, ho ipolaisa tlala, lefu la sebete, pancreatitis, cholestatic jaundice.

Ho tsoa tsamaisong ea musculoskeletal: myalgia, bohloko ba morao, arthralgia, mesifa ea mokokotlo, myositis, myopathy, rhabdomyolysis.

Litla-morao: urticaria, pruritus, lekhopho la letlalo, lekhopho le bolaeang mahlo, anaphylaxis, polymorphic exudative erythema (ho kenyeletsoa le Stevens-Johnson syndrome), lefu la Laille.

Ho tsoa lithong tsa hemopoietic: thrombocytopenia.

Ho tloha ka lehlakoreng la metabolism: hypo- kapa hyperglycemia, ts'ebetso e eketsehileng ea serum CPK.

Sistimi ea Endocrine: lefu la tsoekere "lefu la" tsoekere "- khafetsa ea nts'etsopele e tla ipapisa le ho ba teng hoa maemo a kotsi (ho itima lijo ha glucose ≥ 5.6, index ea boima ba 'mele> 30 kg / m2, triglycerides e phahameng, nalane ea khatello ea mali).

Tse ling: tinnitus, mokhathala, ho hlobaela ka thobalano, edema e potolohang, boima ba sefuba, bohloko ba sefuba, alopecia, linyeoe tsa nts'etsopele ea maloetse a mahareng, haholo-holo ka tšebeliso ea nako e telele, lefu la hemorrhagic (ha le nooa ka tekanyetso e kholo le CYP3A4 inhibitors) .

Contraindication

hypersensitivity ho karolo efe kapa efe ea lithethefatsi

mafu a sebete a sebetsang, tšebetso e eketsehang ea "sebete" transaminase (makhetlo a fetang a 3) a sa tsejoeng

basali ba lilemo tsa ho ba le bana ba sa sebeliseng mekhoa e lekaneng ea ho thibela pelehi

bana ba ka tlase ho lilemo tse 18 (ho sebetsa hantle le polokeho ha e thehiloe)

Tšebelisano-mmoho le li-inhibitors tsa HIV tsa HIV (telaprevir, tipranavir + ritonavir)

lefutso la lefutso la galactose, khaello ea lactase kapa ho monya ha glucose-galactose

Atorvastatin e ka fuoa mosali ea lilemo tsa ho ba le bana ha feela ho tsebahala hore ha a ima le ho tsebisoa ka kotsi e ka bang teng ea lithethefatsi ho lesea.

nalane ea lefu la sebete

khaello e matla ea electrolyte

mathata a endocrine le metabolic

mafu a hlobaetsang a matla (sepsis)

opereishene e kholo

Ho sebelisana le lithethefatsi

Ka tsamaiso e ts'oanang ea cyclosporine, fibrate, erythromycin ,cacithromycin, immunosuppression, lithethefatsi tsa antifungal (tse amanang le azoles) le nicotinamide, mokokotlo oa atorvastatin ho plasma le kotsi ea myopathy ka rhabdomyolysis le ho hloleha ha renal ho eketseha.

Li-antacids li fokotsa khatello ea maikutlo ka 35% (phello ea cholesterol ea LDL ha e fetohe).

Tšebeliso e kopanetsoeng ea atorvastatin e nang le warfarin e ka ntlafatsa phello ea warfarin litekanyetsong tsa mali tsa mali matsatsing a pele (phokotso ea nako ea prothrombin). Tšusumetso ena e nyamela kamora matsatsi a 15 a tsamaiso ea tšebelisano ea meriana ena.

Ts'ebeliso e kopanetsoeng ea atorvastatin e nang le li-inhibitors tsa CYP3A4 e tsamaisana le keketseho ea lipalo tsa plasma tsa atorvastatin (ha ts'ebeliso ea erythromycin le Cmax, atorvastatin e eketseha ka 40%). Li-inhibitors tsa HIV tsa protease ke li-inhibitors tsa CYP3A4. Ts'ebeliso e kopaneng ea li-inhibitors tsa HIV le li-protein tsa HIV li eketsa boemo ba li-serum tsa mali, tseo maemong a sa lekanyetsoang li lebisang ho ntlafatso ea myalgia, le maemong a ikhethang ho rhabdomyolysis, ho ruruha ho matla le ho phatloha ha mesifa e tsitsitseng, ho lebisang ho myoglobulinuria le ho hloleha ha renal. Karolo ea ho qetela ea lekhotla le leng le le leng e fella ka lefu.

Sebelisa atorvastatin ka hloko le ka tekanyo e sebetsang e tlase e nang le li-inhibitors tsa HIV tse nang le HIV: lopinavir + ritonavir. Tekanyetso ea atorvastatin ha ea lokela ho feta 20 mg ka letsatsi ha e nkuoa hammoho le li-inhibitors tsa HIV: fosamprenavir, darunavir + ritonavir, fosamprenavir + ritonavir, saquinavir + ritonavir. Tekanyetso ea atorvastatin ha ea lokela ho feta 40 mg ka letsatsi ha e etsoa hammoho le HIV proteinase inhibitor nelfinavir.

Ha o sebelisa digoxin hammoho le atorvastatin ka tekanyo ea 80 mg / ka letsatsi, mahloriso a digoxin a eketseha ka hoo e ka bang 20%.

Eketsa khatello ea kelello (ha e laetsoe le atorvastatin ka tekanyo ea 80 mg / letsatsi) ea lithibela-pelehi tsa molomo tse nang le norethisterone ka 30% le ethinyl estradiol ka 20%.

Phello e fokotsang lipid ea ho kopanya le colestipol e phahame ho seo bakeng sa moriana ka mong ka thoko, leha ho le joalo, ho fokotsehile ka 25% khoebong ea atorvastatin ha e sebelisoa ka mokhoa o tšoanang le colestipol.

Ho sebelisoa ka nako e tšoanang le lithethefatsi tse fokotsang khoholeho ea lihormone tsa endo native steroid (ho kenyelletsa ketoconazole, spironolactone) ho eketsa kotsi ea ho fokotsa lihormone tsa endidia tsa steroid (tlhokomeliso e lokela ho sebelisoa).

Ts'ebeliso ea lero la morara nakong ea kalafo e ka lebisa keketseho ea meeli ea plasma ea atorvastatin. Ka hona, nakong ea kalafo, lero la morara le lokela ho qojoa.

Litaelo tse khethehileng

Atorvastatin e ka baka keketseho ea serum CPK, e lokelang ho tsotelloa tlhokomelong e khethollang ea bohloko ba sefuba. Re lokela ho hopola hore keketseho ea KFK ka makhetlo a 10 ha e bapisoa le tloaelo, e tsamaeang le bofokoli ba myalgia le mesifa e ka amahanngoa le myopathy, kalafo e lokela ho emisoa.

Ka tšebeliso e tšoanang ea atorvastatin e nang le cytochrome CYP3A4 proteinase inhibitors (cyclosporine ,cacithromycin, itraconazole), lethal dose la pele le lokela ho qalisoa ka 10 mg, ka netefatso ea kalafo ea lithibela-mafu, atorvastatin e lokela ho emisoa.

Hoa hlokahala ho hlokomela matšoao a ts'ebetso ea sebete pele ho kalafo, libeke tse 6 le tse 12 kamora ho qala ha moriana kapa kamora ho eketsa tekanyetso, le nako le nako (likhoeli tse ling le tse ling tse 6) ka nako eohle ea ts'ebeliso (ho fihlela boemo bo tloaelehileng ba bakuli bao maemo a bona a transaminase a fetang tloaelehileng ) Keketseho ea "transpase" ea "hepatic" e shebeloa haholo likhoeling tse 3 tse qalang tsa taolo ea lithethefatsi. Ho khothalletsoa ho hlakola lithethefatsi kapa ho fokotsa tekanyetso ka keketseho ea AST le ALT makhetlo a fetang a 3. Ts'ebeliso ea atorvastatin e lokela ho emisoa ka nakoana ho nts'etsopele ea matšoao a bongaka a fanang ka maikutlo a ho ba teng ha myopathy ea hlobaetsang, kapa boteng ba lintlha tse rerang pele ho nts'etsopele ea ho hlaphoheloa ke methapo ka lebaka la rhabdomyolysis (ts'oaetso e matla, ho fokotseha ha khatello ea mali, ts'ebetso e kholo, ho sithabela maikutlo, metabolic, endocrine kapa ts'oenyeho e kholo ea electrolyte) . Bakuli ba lokela ho lemosoa hore ba lokela ho ea ngakeng hang-hang haeba ho ba le bohloko bo sa hlalosoang kapa bofokoli ba mesifa, haholoholo haeba bo tsamaisana le malaise kapa feberu.

Ho na le litlaleho tsa nts'etsopele ea atonic fasciitis ka tšebeliso ea atorvastatin, leha ho le joalo, khokahano le tsamaiso ea lithethefatsi e ka etsahala, empa ha e e-so fumanoe bopaki ba hore etiology ha e tsejoe.

Tšusumetso ho mesifa ea marapo. Ha u sebelisa atorvastatin, joalo ka lithethefatsi tse ling tsa sehlopha sena, linyeoe tse sa tloaelehang tsa rhabdomyolysis tse nang le ho hlonama ho morao hoa sesole tse bakiloeng ke myoglobinuria li hlalositsoe. Nalane ea ho se sebetse hantle ha liphoko e ka ba sesosa sa kotsi bakeng sa rhabdomyolysis. Boemo ba bakuli ba joalo bo lokela ho hlahlojoa ka hloko bakeng sa nts'etsopele ea lipontšo tsa mokokotlo oa marapo.

Atorvastatin, hammoho le li-statins tse ling, maemong a sa tloaelehang li ka lebisa ho nts'etsopele ea myopathy, e bonahatsoang ke bohloko ba mesifa kapa bofokoli ba mesifa hammoho le keketseho ea boemo ba phello ea "creatine phosphokinase (CPK) ho feta makhetlo a 10 ho tloha boleng bo phahameng. Ts'ebeliso e kopaneng ea litekanyetso tse phahameng tsa atorvastatin e nang le lithethefatsi tse kang cyclosporine le potent inhibitors tsa CYP3A4 isoenzyme (k.v.cacithromycin, itraconazole le HIV protease inhibitors) e eketsa kotsi ea myopathy / rhabdomyolysis. Ha u sebelisa li-statins, ho tlalehiloe liketsahalo tse sa tloaelehang tsa necrotizing myopathy (IONM), autoimmune myopathy. IONM e tšoauoa ke bofokoli lihlopheng tsa mesifa tsa proximal le keketseho ea litekanyetso tsa serum creatine kinase, tse phehellang leha ho emisoa ho nka li-statins, necrotizing myopathy e bonoa nakong ea mesifa biopsy, e sa tsamaellaneng le ho ruruha ho matla, ntlafatso e etsahala ha ho etsoa li-immunosuppressants.

Nts'etsopele ea myopathy e lokela ho belaelloa ho bakuli ba nang le tumellano ea mokokotlo, ho opeloa ke mesifa kapa bofokoli le / kapa keketseho e tšoaeang maemong a CPK. Bakuli ba lokela ho lemosoa hore ba lokela ho tsebisa ngaka ea bona hang ka ponahalo ea bohloko bo sa hlalosoang, ho opeloa kapa bofokoli mesifa, haholo haeba bo tsamaisana le malaise kapa feberu, le ha matšoao a mesifa a phehella kamora ho emisa atorvastatin. Ka keketseho e tšoaeang ho boemo ba CPK, tšoaetso ea myopathy kapa myopathy e belaelloang, kalafo e nang le atorvastatin e lokela ho khaotsa.

Kotsi ea ho ba le myopathy nakong ea kalafo ka lithethefatsi tsa sehlopha sena e eketseha ka tšebeliso e tšoanang ea cyclosporin, derivatives of fibric acid, erythromycin ,cacithromycin, hepatitis C virusase protease inhibitor, telaprevir, ts'ebeliso e kopaneng ea HIV proteinase inhibitors (ho kenyeletsa saquinavir + ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir, ritonavir. darunavir + ritonavir, fosamprenavir le fosamprenavir + ritonavir), nicotinic acid kapa mahlahana a antifungal a tsoang sehlopheng sa azole. Ka ho hlahloba potso e ke ho le tiisetsa motswako phekolo le atorvastatin le fibric derivatives acid e, erythromycin, clarithromycin, saquinavir hammoho le ritonavir, lopinavir hammoho le ritonavir, darunavir hammoho le ritonavir, fosamprenavir, kapa fosamprenavir hammoho le ritonavir, mahlahana antifungal ho tloha sehlopha sa azoles kapa acid e nicotinic litekong tse theolang lipid tse fokotsang lipid, lingaka li lokela ho sekaseka ka hloko melemo e boletsoeng le likotsi tse ka bang teng 'me li hlahlobe ka hloko boemo ba bakuli ba ho fumana matšoao le matšoao a bohloko ba mesifa, ho opa kapa ho fokola ha mesifa, haholoholo likhoeling tsa pele tsa kalafo, hammoho le nakong ea keketseho ea tekanyetso ea e 'ngoe le e' ngoe ea meriana ena. Haeba u hloka ho sebelisa atorvastatin le lithethefatsi tse kaholimo, u lokela ho nahana ka monyetla oa ho sebelisa atorvastatin ka tekanyo e tlase e tlase le tekanyo ea tlhokomelo.

Maemong a joalo, ho hlokahala hore nako le nako ho lekola ts'ebetso ea creatine phosphokinase (CPK), leha ho le joalo, taolo e joalo ha e tiise thibelo ea myopathy e matla.

Ho bakuli ba nang le nalane ea hemorrhagic stroke kapa infunction ea lacunar, ts'ebeliso ea Atorvastatin e ka etsahala feela kamora ho tseba hore na sekhahla sa kotsi / melemo ea melemo e ka ba eng.

Basali ba lilemo tsa ho ba le bana ba lokela ho sebelisa mekhoa e tšepahalang ea ho thibela pelehi. Kaha cholesterol le lintho tse kopantsoeng ho tloha ho cholesterol li bohlokoa holima kholo ea masea, kotsi e ka ba teng ea ho thibela ts'oaro ea HMG-CoA e feta molemo oa ho sebelisa lithethefatsi nakong ea kemolo. Ha bo-mme ba sebelisa lovastatin (HMG-CoA reductase inhibitor) e nang le dextroamphetamine ho trimester ea pele ea bokhachane, tsoalo ea bana ba nang le deformation ea masapo, tracheo-esophageal fistula, le anus atresia. Maemong a bokhachane nakong ea kalafo, moriana o lokela ho emisoa hang-hang, 'me bakuli ba lokela ho lemosoa ka kotsi e ka bang teng ho lesea.

Bopaki bo bong bo fana ka maikutlo a hore li-statin e le sehlopha li eketsa tsoekere ea mali, mme ho bakuli ba kotsing e kholo ea ho ba le lefu la tsoekere, ba ka baka keketseho ea tsoekere ea mali, e hlokang phekolo e nepahetseng. Leha ho le joalo, melemo ea li-statins ho fokotsa likotsi tsa lefu la pelo le matla le feta keketseho e nyane ea menyetla ea ho ba le lefu la tsoekere, ka hona ts'ebeliso ea statin ha ea lokela ho emisoa. Ho na le mabaka a ho lekola nako le nako ha glycemia ho bakuli ba kotsing: (glucose e potlakileng ea 5.6 - 6.9 mmol / l, index ea mmele> 30 kg / m2, triglycerides e matla, khatello ea mali), ho latela likhothaletso tsa hajoale.

Litšobotsi tsa phello ea lithethefatsi ho bokhoni ba ho khanna makoloi kapa mekhoa e ka bang kotsi: ha u fuoa litlamorao tsa lithethefatsi, ho tlameha ho ba hlokolosi ha u khanna makoloi kapa ka mekhoa e meng e ka bang kotsi.

Bongata

Matšoao matšoao a itseng a overdose ha a e-so fumanoe. Matšoao a ka kenyelletsa bohloko sethong sa sebete, ho hloleha ha renal haholo, tšebeliso ea nako e telele ea myopathy le rhabdomyolysis.

Phekolo: ha ho na litlhare tse tobileng, kalafo ea matšoao le mehato ea ho thibela ho monya ho eketsehileng (phallo ea sefuba le tšebeliso ea mashala a sebetsang). Atorvastatin e tlama haholo le liprotheine tsa plasma; ka lebaka leo, hemodialysis ha e na thuso. Ka nts'etsopele ea myopathy, e lateloang ke rhabdomyolysis le ho hloleha hoa renal (hangata) - ho khaotsa hanghang ha lithethefatsi le ho hlahisoa ha tharollo ea diuretic le sodium bicarbonate. Rhabdomyolysis e ka lebisa ho nts'etsopele ea hyperkalemia, e hlokang tsamaiso e kenang ea calcium chloride kapa calcium gluconate, infusion ea tsoekere ka insulin, ts'ebeliso ea li-exchanges tsa potasiamo kapa, maemong a matla, hemodialysis.

Moetsi

RUE Belmedpreparaty, Rephaboliking ea Belarus

Aterese ea Molao le Kopo ea Likopo:

220007, Minsk, Fabricius, 30,

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

Lebitso le naha ea setifikeiti sa ngoliso

RUE Belmedpreparaty, Rephaboliking ea Belarus

Aterese ea mokhatlo e amohelang litletlebo tse tsoang ho bareki ka boleng ba lihlahisoa tse sebakeng sa Rephabliki ea Kazakhstan:

KazBelMedFarm LLP, 050028, Rephabliki ea Kazakhstan,

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

Aterese ea lengolo-tsoibila: [email protected]

I.O. Motlatsa Motsamaisi Kakaretso bakeng sa Boleng

Tekanyetso le tsamaiso

Pele a qala kalafo le Atorvastatin, mokuli o lokela ho fetisetsoa lijong tse netefatsang ho fokotseha ha lipids tsa mali, tse lokelang ho shejoa nakong ea kalafo le moriana.

Ka hare, nka nako efe kapa efe ea letsatsi (empa ka nako e ts'oanang), ho sa tsotelehe lijo tse ngata.

Motsoako oa ho qala o khothalelitsoeng ke 10 mg hang ka letsatsi. Ka mor'a moo, lethal dose le khethoa ka bonngoe ho latela se hlokoang ke cholesterol - LDL. Tekanyetso e lokela ho fetoloa nako le nako ea libeke tse 4. Tekanyetso e kholo ea letsatsi le letsatsi ke 80 mg ho tekanyetso e le 'ngoe.

Homozygous hereditary hypercholesterolemia

Lenane la litekanyo le tšoana le mefuta e meng ea hyperlipidemia. Tekanyetso ea pele e khethoa ka bonngoe ho latela botebo ba lefu lena. Ho bakuli ba bangata ba nang le homozygous hereditary hypercholesterolemia, phello e nepahetseng e bonoa ha ho sebelisoa lithethefatsi ka tekanyetso ea letsatsi le letsatsi ea 80 mg (hang).

Ts'ebetso ea sebete e sa sebetseng

Bakeng sa bakuli ba nang le ts'ebetso ea sebete e sa sebetseng hantle, ho lokela ho sebelisoe tlhokomeliso mabapi le ho theoha ha moriana 'meleng. Litekanyetso tsa kliniki le tsa laboratori li lokela ho behoa leihlo ka hloko, 'me haeba liphetoho tse kholo tsa pathological li fumanoa, tekanyo e lokela ho fokotsoa kapa kalafo e lokela ho khaotsa.

Ho sebelisana le lithethefatsi tse ling

Ka tsamaiso e tšoanang ea cyclosporine, fibrate, erythromycin ,cacithromycin, immunosuppression, lithethefatsi tsa antifungal (tse amanang le azoles) le nicotinamide, mahloriso a atorvastatin ho plasma (le kotsi ea myopathy) e eketseha.

Li-antacids li fokotsa khatello ea maikutlo ka 35% (phello ea cholesterol ea LDL ha e fetohe).

Ts'ebeliso e kopanetsoeng ea atorvastatin e nang le li-inhibitors tsa CYP3A4 cytochrome P450 e tsamaisana le keketseho ea plasma ea atorvastatin.

Ha u sebelisa digoxin hammoho le atorvastatin ka tekanyo ea 80 mg / ka letsatsi, mahloriso a digoxin a eketseha ka hoo e ka bang 20%.

E eketsa khatello ea maikutlo ka 20% (ha e laetsoe le atorvastatin ka lethal dose ea 80 mg / letsatsi) ea lithibela-pelehi tsa molomo tse nang le norethindrone le ethinyl estradiol. Phello e fokotsang lipid ea ho kopanya le colestipol e phahametse eo ho moriana ka mong.

Ka tsamaiso e tšoanang ka warfarin, nako ea prothrombin ea fokotseha matsatsing a pele, leha ho le joalo, kamora matsatsi a 15, letšoao lena le beha maemong. Tabeng ena, bakuli ba nkang atorvastatin e nang le warfarin ba lokela ho feta nako ea prothrombin ho laoloa.

Ts'ebeliso ea lero la morara nakong ea kalafo le atorvastatin e ka lebisa ho eketseha ha khatello ea lithethefatsi maling a mali. Mabapi le sena, bakuli ba noang moriana ba lokela ho qoba ho noa lero lena.

Matšoao a overdose

Matšoao a khethehileng a overdose ha a e-so fumanoe. Matšoao a ka kenyelletsa bohloko sethong sa sebete, ho hloleha ha renal haholo, tšebeliso ea nako e telele ea myopathy le rhabdomyolysis.

Ha ho na antidote, kalafo ea matšoao le mehato ea ho thibela ho monya ho eketsehileng (phallo ea sefuba le tšebeliso ea mashala a sebetsang).Atorvastatin e tlama haholo le liprotheine tsa plasma; ka lebaka leo, hemodialysis ha e na thuso. Ka nts'etsopele ea myopathy, e lateloang ke rhabdomyolysis le ho hloleha hoa renal (hangata) - ho khaotsa hanghang ha lithethefatsi le ho hlahisoa ha tharollo ea diuretic le sodium bicarbonate. Rhabdomyolysis e ka lebisa ho nts'etsopele ea hyperkalemia, e hlokang tsamaiso e kenang ea calcium chloride kapa calcium gluconate, infusion ea tsoekere ka insulin, ts'ebeliso ea li-exchanges tsa potasiamo kapa, maemong a matla, hemodialysis.