U ka sebelisa Atorvastatin 10 joang?

Tlhaloso e amanang le 26.01.2015

Lebitso la Latin: Atorvastatin
Khoutu ea ATX: S10AA05
Lintho tse sebetsang: Atorvastatin (Atorvastatin)
Moetsi: CJSC ALSI Pharma

Letlapa le le leng le na le li-milligram tse 21.70 kapa 10.85 atorvastatin khalsiamo e nang le calcium, e tsamaellanang le li-milligram tse 20 kapa tse 10 tsa atorvastatin.

E le likarolo tse thusang, Opadra II, magnesium stearate, aerosil, starch 1500, lactose, microcrystalline cellulose, calcium carbonate.

Ketso ea pharmacological

Setlhare sena ke hypocholesterolemic - e tlholisana le ho khetha enzyme ka tlholisano e laolang sekhahla sa phetoho ea HMG-CoA ho mevalonate, kamora moo e kenang ka har'a li-sterols, ho kenyeletsa cholesterol.

Ho fokotseha ha lipoprotein tsa plasma le cholesterol ka mor'a ho nka moriana ho bakoa ke ho fokotseha ha motsoako oa k'holeseterole sebeteng le tšebetso ea HMG-CoA reductase, hammoho le keketseho ea boemo ba li-receptor tsa LDL holim 'a lisele tsa sebete, tse eketsang ho eketseha le catabolism ea LDL.

Ho batho ba nang le homozygous le heterozygous Familyal hypercholesterolemia, dyslipidemia, le hypercholesterolemia e sa sebetseng, ho fokotseha ha apolipoprotein B, cholesterol e felletseng, le density cholesterol-lipoprotein e bonoa ha ho sebelisoa moriana ona.

Setlhare sena se fokotsa monyetla oa ho hola. ischemia le lefu ho batho ba lilemo tsohle ba nang myocardial infarction ntle le ts'ebetso ea angina e sa tsitsang le Q. E boetse e fokotsa sekhahla sa maloetse a sa bolaeang le a bolaeang, khafetsa ea mafu a pelo le kotsi ea ho ba le mafu a bolaeang a pelo le methapo ea mali.

Pharmacodynamics le pharmacokinetics

E na le monko o phahameng, khatello e phahameng maling e bonoa kamora hora e le 'ngoe ho isa ho tse peli kamora ts'ebetso. The bioavailability e tlase ka lebaka la ho pepesoa ha tlhaho ea ntho e sebetsang ka mpeng ea mucosa le phello ea "karolo ea pele ka sebete" - liperesente tse 12. Hoo e ka bang karolo ea 98 lekholong ea tekanyetso e nkuoeng e tlameletsoe ho liprotheine tsa plasma. Metabolism e etsahala ka har'a sebete le ho thehoa ha metabolites e sebetsang le lintho tse sa sebetseng. Bophelo ba halofo ke lihora tse 14. Nakong ea hemodialysis ha e bontšoe.

Contraindication

Moriana ha oa lokela ho nooa le:

ka tlase ho lilemo tse 18
ea boimana le nako sefuba,
ho hloleha ha sebete,
mafu a sebete a sebetsang kapa tšebetso e eketsehang ea li-enzyme tsa "sebete" ka mabaka a sa hlakileng,
hypersensitivity ho litaba tsa sethethefatsi.

E lokela ho nkuoa ka lefu la masapo a marapo, likotsimekhoa e meholo ea ho buoa e sa laoloe lefu la sethoathoa, sepsis, hypotension ea methapomathata a metabolic le endocrine, likhathatso litekanyetsong tsa electrolyte tsa bophahamo bo phahameng, nalane ea lefu la sebete le tšebeliso e mpe ea joala.

Litlamorao

Ha o nka matlapa ana, o ka ba le:

hlohlelletsa gout, mastodyniaboima ba mmele (ka seoelo haholo)
albinuria hypoglycemiahyperglycemia (e sa tloaelehang haholo)
petechiae, ecchymoses, seborrhea, eczemamofufutso o eketsehileng, xeroderma, alopecia,
Bolo ba lefu la Lyell, bo bongata haholo erythema, photosensitization, ho ruruha ha sefahleho, angioedema, urticaria, dermatitislekhopho la letlalo le ho hlohlona (ka seoelo),
tlhekefetso ea kemiso, ho hloka matla, libido e fokotsehile, lefu la masapo a mokokotlo, metrorrhagia, nephrourolithiasis, mali a tsoang ka popelong, hematuria, jade, dysuria,
tumellano ea kopanelo, mesifa hypertonicity, satsokhorollrhabdomyolysis myalgiaarthralgia myopathy, anisitis, tendosynovitis, bursitisleqeba leoto ramatiki,
tenesmus, le marenene a tsoang mali, melena, ho tsoa madi ka mokokotlo, ho senyeha ha ts'ebetso ea sebete, cholestatic jaundice, pancreatitis, seso sa duodenal, cheilitis, biliary colic, hepatitisgastroenteritis, liso tsa mucosa ea molomo, glossitis, esophagitis, stomatitis, ho hlatsadysphagia burpingmolomo o omileng, takatso e eketsehileng kapa e fokotsehileng, bohloko ba ka mpeng, gastralgia, botlaela, lets'ollo kapa ho sokela, pelo e bohloko, ho nyekeloa,
nosebleeds, ho mpefatsa hoa lefu la bronchial asthma, dyspnea, pneumonia, rhinitis, bronchitis,
thrombocytopenia, lymphadenopathy, phokolo ea mali,
angina pectoris, arrhythmia, phlebitis, khatello e phahameng ea mali, hypotension ea orthostatic, palpitations, bohloko ba sefuba,
tahlehelo ea tatso, parosmia, glaucoma, ho se utloe litsebeng, hemorrhage ea retinal, khathatso ea bolulo, ho omella ha conjunctival, tinnitus, amblyopia,
ho lahleheloa ke kelellohypesthesia khatello ea maikutlo, migraineHyperkinesis, ho holofala sefahleho, ataxialability ea maikutlo amnesiaperipheral neuropathy, paresthesia, bosiu, ho otsela, malaise, asthenia, hlooho e bohloko, ho tsekela, ho hloka boroko.

Tšebelisano

Tsamaiso e le 'ngoe e nang le li-inhibitors tsa proteinase e eketsa khatello ea ntho e sebetsang ka plasma ea mali. Ts'ebeliso e kopanetsoeng le lithethefatsi tse fokotsang khoholeho ea lihormone tsa endidie tsa steroid (ho kenyelletsa Spironolactone, Ketoconazole le Cimetidine) li eketsa monyetla oa ho fokotsa lihormone tsa endidia tsa steroid.

Ha e nkuoa ka mokhoa o tšoanang le nicotinic acid, erythromycin, fibrate le cyclosporins, e eketsa monyetla oa ho nts'etsapele myopathy ha e phekoloa le lithethefatsi tse ling tsa sehlopha sena.

Simvastatin le Atorvastatin - e leng betere?

Simvastatin Ke setopo sa tlhaho, 'me Atorvastatin ke mofuta oa sejoale-joale sa tlhaho oa maiketsetso. Leha ba na le methapo e mengata ea metabolic le sebopeho sa lik'hemik'hale, li na le phello e ts'oanang ea meriana. Le tsona li na le litla-morao tse tšoanang, empa Simvastatin e theko e tlaase haholo ho feta Atorvastatin, ka hona ka theko ea theko Simvastatin ke khetho e ntle.

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

e le tlatsetso ea lijo ho fokotsa cholesterol e phahameng e phahameng, LDL-C, apo-B, le triglycerides ho batho ba baholo, bacha, le bana ba lilemo tse 10 kapa ho feta ba nang le hypercholesterolemia, ho kenyeletsa hypercholesterolemia ea lelapa (heterozygous) kapa e kopaneng (hyperlipidemia) ( mefuta IIa le IIb ho latela sehlopha sa Fredrickson), ha karabelo ea lijo le litlhare tse ling tse sa sebeliseng lithethefatsi li sa lekana,
ho fokotsa cholesterol e phahameng e phahameng, LDL-C ho batho ba baholo ba nang le homozygous Famal hypercholesterolemia e le adjunct ho mefuta e meng ea kalafo ea lipid-lowing (mohlala, LDL-apheresis) kapa, haeba kalafo tse joalo li sa fumanehe.

Thibelo ea Maloetse a amanang le pelo le pelo:

thibelo ea liketsahalo tsa pelo ho bakuli ba baholo ba kotsing e kholo ea ho etsa liketsahalo tsa mantlha tsa pelo, ho kenyelletsa khalemelo ea mabaka a mang a kotsi.
Thibelo ea bobeli ea mathata a pelo le pelo ho bakuli ba nang le lefu la pelo hore a fokotse palo ea batho ba shoang, lefu la myocardial, stroke, ho kenella sepetlele bakeng sa angina pectoris le tlhokeho ea ho nchafatsoa.

Tekanyetso le tsamaiso

Ka hare. Nka ka nako efe kapa efe ea letsatsi, ho sa tsotelehe lijo tse jang.

Pele o qala kalafo le Atorvastatin, o lokela ho leka ho fihlela taolo ea hypercholesterolemia o sebelisa ho ja, ho ikoetlisa le ho theola boima ba 'mele ho bakuli ba nang le botenya, hammoho le kalafo ea lefu lena le tlase.

Ha u fana ka litlhare, mokuli o lokela ho buella phepo e tloaelehileng ea hypocholesterolemic, eo a tlamehang ho e latela nako eohle ea kalafo.

Tekanyo ea lithethefatsi e fapana ho tloha ho 10 mg ho isa ho 80 mg hang ka letsatsi mme e kenyelitsoe ho latela khatello ea mantlha ea LDL-Xc, sepheo sa pheko le phello ea motho ka mong kalafong. Tekanyetso e phahameng ea letsatsi le letsatsi ea lithethefatsi ke 80 mg.

Qalong ea kalafo le / kapa nakong ea keketseho ea tekanyetso ea Atorvastatin, ho hlokahala hore ho be le ho lekola mokokotlo oa lipids ka har'a plasma ea mali ka mor'a libeke tse ling le tse ling tse 2 le ho fetola lethal dose ho latela.

Heterozygous Familia hypercholesterolemia

Motsoako oa pele ke 10 mg ka letsatsi. Tekanyetso e lokela ho khethoa ka bonngoe le ho lekola ho tšoaneleha ha eona libeke tse 'ne le tse ling ka keketseho e ka bang teng ea 40 mg ka letsatsi. Ebe moriana o ka eketsoa ho fihla ho 80 mg ka letsatsi, kapa motsoako oa li-acid tse sebelisitsoeng ka nako e le 'ngoe ka ts'ebeliso ea atorvastatin ka tekanyetso ea 40 mg ka letsatsi e ka khonahala.

Sebelisa ho bana le lilemong tsa bocha ho tloha ho lilemo tse 10 ho isa ho tse 18 ka heterozygous Familyal hypercholesterolemia

Motsoako oa ho qala o khothalelitsoeng ke 10 mg hang ka letsatsi. Tekanyetso e ka eketsoa ho 20 mg ka letsatsi, ho latela phello ea kliniki. Phihlelo ea lethal dose e fetang 20 mg (e lekanang le tekanyetso ea 0.5 mg / kg) e lekanyelitsoe. Hoa hlokahala ho kenyelletsa lethal dose la moriana ho latela sepheo sa ho fokotsa lipid. Phetoho ea litekanyetso li lokela ho etsoa nako le nako ka nako ea 1 ka libeke tse 4 kapa ho feta.

Sebelisa hammoho le lithethefatsi tse ling

Haeba ho hlokahala, ts'ebeliso e le 'ngoe le cyclosporine, telaprevir kapa motsoako oa tipranavir / ritonavir, tekanyetso ea lithethefatsi Atorvastatin ha ea lokela ho feta 10 mg ka letsatsi.

Ho lokela hore ho sebelisoe tlhokomeliso 'me ho sebelisoe lethalose le sebetsang ka ho fetisisa la atorvastatin ha le ntse le sebelisoa le li-inhibitors tsa HIV, hepatitis C virusase protease inhibitors (boceprevir), clarithromycin le itraconazole.

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.

Haeba ho na le overdose, ho hlokahala mehato e latelang ka kakaretso: ho lekola le ho boloka mesebetsi ea bohlokoa ea 'mele, le ho thibela ho ts'oaroa ha lithethefatsi ka mokhoa o mong (gastric lavage, ho nka mashala a ts'ebetso kapa a laxatives).

Ka nts'etsopele ea myopathy, e lateloang ke rhabdomyolysis le ho hloleha ha methapo ea methapo, setlhare se lokela ho hlakoloa hang-hang mme infusion ea diuretic le sodium bicarbonate e qale. Rhabdomyolysis e ka lebisa ho hyperkalemia, e hlokang tsamaiso e kenang ea tharollo ea calcium chloride kapa tharollo ea calcium gluconate, infusion ea tharollo ea 5% ea lialuma (glucose) ka insulin, le ts'ebeliso ea li-resine tsa potasiamo.

Kaha lithethefatsi li tlama liprotheine tsa plasma ka botlalo, hemodialysis ha e sebetse.

Ho sebelisana le lithethefatsi

Kotsi ea ho ba le myopathy ka rhabdomyolysis le ho se sebetse hantle ha kalafo ka HMG-CoA reductase inhibitors e eketseha ka tšebeliso e tšoanang ea cyclosporine, lithibela-mafu (erythromycin ,cacithromycin, hipupristine / dalphopristine), HIV protease inhibitors (indinavir, ritonoviraz, anti-ritonoviraz, anti-ritonoviraz, anti-ritonoviraz itraconazole, ketoconazole), nefazodone. Lithethefatsi tsena kaofela li thibela CYP3A4 isoenzyme, e amehang ho metabolism ea atorvastatin e leng sebete. Tšebelisano e tšoanang e ka etsahala ka tšebeliso e le 'ngoe ea atorvastatin e nang le fiber le nicotinic acid ho litekanyetso tse theolang lipid tse fetang 1 g ka letsatsi.

Ka tšebeliso e le 'ngoe le li-inhibitors tsa HIV. hepatitis C vaerase ea protease inhibitors, clarithromycin le itraconazole ba lokela ho ba hlokolosi 'me ba sebelise tekanyetso e tlaase haholo ea atorvastatin.

CYP3A4 Isoenzyme Inhibitors

Kaha atorvastatin e thehiloe ke isoenzyme CYP3A4, tšebeliso ea atorvastatin e nang le li-inhibitors tsa isoenzyme CYP3A4 e ka lebisa ho eketseho ea plasma mahloriso a atorvastatin. Tekanyo ea tšebelisano le phello ea bokhoni e khetholloa ke phapang ea phello ho CYP3A4 isoenzyme.

OATP1B1 liprotein inhibitors

Atorvastatin le metabolites ea eona ke likarolo tsa protheine ea lipapatso ea OATP1B1. Li-inhibitors tsa OATP1B1 (mohlala, cyclosporine) li ka eketsa bioavailability ea atorvastatin. Ho senya, tšebeliso e le 'ngoe ea atorvastatin ka tekanyo ea 10 mg le cyclosporine ka tekanyo ea 5,2 mg / kg / letsatsi e lebisa hoketseho ea khatello ea atorvastatin ka plasma ea mali ka makhetlo a 7.7. Kameho ea thibelo ea mosebetsi oa phetisetso ea hepatic uptake transporter ho atorvastatin ho hepatocytes ha e tsejoe. Maemong ha ho khonehe ho qoba tšebeliso e tšoanang ea lithethefatsi tse joalo, ho khothalletsoa ho fokotsa tekanyetso le ho laola katleho ea kalafo.

Gemfibrozil / fibrate

Khahlano le nalane ea ts'ebeliso ea li-fibrate ho monotherapy, karabelo e mpe e ne e lemohuoa nako le nako, ho kenyelletsa le rhabdomyolysis e amanang le tsamaiso ea musculoskeletal. Kotsi ea karabelo e joalo e eketseha ka tšebeliso e tšoanang ea li-fibrate le atorvastatin. Haeba tšebeliso ea lithethefatsi tsena ka nako e tšoanang e ke ke ea qojoa, ho lokela hore ho sebelisoe litekanyetso tse fokolang tsa atorvastatin. le ho lekola khafetsa boemo ba mokuli ho lokela ho etsoa.

Lokolla liforomo le sebopeho

Ka litlhare tsa litlama u ka fumana mofuta o le mong feela oa lithethefatsi - ka mokhoa oa litafole. Sesebelisoa se bua ka lithethefatsi tsa karolo e le 'ngoe. Atorvastatin e thusa ho fokotseha ha litaba tsa lipid, 'me ntho ena e kenyelletsoa ho e hlophisoa ka mokhoa oa letsoai la calcium (calcium trihydrate). Boemong ba sehlahisoa seo ho buuoang ka sona, litekanyetso tsa motsoako o sebetsang li ngoletsoe - 10 mg. Chelete ena e fumaneha 1 letlapeng. Setlhare ha se bontše litlamorao tse mabifi ka lebaka la ho ba teng ha membrane ea filimi.

Atorvastatin e ka rekoa ka har'a liphutheloana tsa sele. E 'ngoe le e' ngoe e na le matlapa a 10. Palo eohle ea lilakane tse ka lebokoseng la karete ke 1, 2, 3, 4, 5, kapa 10 likhomphutha.

Atorvastatin 10 ke inhibitor ea enzyme e amang ka kotloloho ts'ebetso ea tlhahiso ea k'holeseterole.

Ho laetsoe eng?

Libaka tse ka sehloohong tsa kopo:

eketsa ts'ebetso ea lithethefatsi eo ketso ea eona e reretsoeng ho theola cholesterol (Atorvastatin e laetsoe e le karolo ea kalafo e rarahaneng), e fihlela sephetho se hlokahalang ka kalafo ea ho ja,
kalafo ea tsamaiso ea methapo ea pelo, ho thibela nts'etsopele ea mathata a bakoang ke ho eketseha ha mali, k'holeseterole e phahameng, ho fokotseha ha methapo ea mali.

Foromo ea litekanyetso

Matlapa a koahetsoeng 10 mg, 20 mg le 40 mg

Letlapa le leng le na le:

ntho e sebetsang - atorvastatin (e le letsoai la khalsiamo ea trihydrate) 10 mg, 20 mg le 40 mg (10.85 mg, 21.70 mg le 43.40 mg),

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

Ho hlophisoa ha khetla: Opadry II pinki (talc, polyethylene glycol, titanium dioxide (E171), joala ba polyvinyl, tšepe (III) oxide mose (E172), tšepe (III) oxide e khubelu (E172), tšepe (III) oxide e ntso (E172).

Letlapa le koahetsoeng ka mmala o bosehla bo nang le biconvex

Protease inhibitors

Boleng ba AUC ba atorvastatin bo eketseha haholo ka tšebeliso e tšoanang ea atorvastatin le mefuta e meng ea li-inhibitors tsa HIV tsa protease, hammoho le atorvastatin le hepatitis C vaerase ea protease inhibitor telaprevir. Ka hona, ts'ebeliso e tšoanang ea atorvastatin ho bakuli ba nkang motsoako oa li-virus tsa thibelo ea liprotheine tsa HIV le "ritonavir" kapa "hepatitis" "" protease inhibitor telaprevir "e lokela ho qojoa. Ho lokela hore ho sebelisoe tlhokomeliso ka tšebeliso e tšoanang ea atorvastatin le motsoako oa li-protein tsa inhibitors tsa HIV le ritonavir, 'me ho lokela ho beoa le lethal dose la atorvastatin. Tlhokomeliso e lokela ho sebelisoa ha ts'ebeliso ea atorvastatin le motsoako oa li-inhibitors tsa HIV tsa HIV, saquinavir le ritonavir, darunavir le ritonavir, fosamprenavir le ritonavir kapa fosamprenavir, ha tekanyetso ea atorvastatin e sa lokela ho feta 20 mg. Bakeng sa bakuli ba nang le HIV proteinase inhibitor nelfinavir kapa lefu la vaerase ea hepatitis C, lethathamo la atorvastatin ha lea lokela ho feta 40 mg;

Melemo ea pharmacological

Mofumahali

Atorvastatin e kenella ka potlako ka mor'a ts'ebetso ea molomo, tsamaiso ea eona ea plasma e fihla boemong bo phahameng ka nako ea lihora tse 1 - 2. Tekanyo ea bioavailability ea atorvastatin ke 95-99%, e felletseng - 12-14%, systemic (e fanang ka thibelo ea phetoho ea HMG-CoA) - e ka bang 30 % Bioavailability e tlase e hlalosoa ke ho hlakisoa ha kemiso kahara mucous membrane ea "gastrointestinal" le "kapa" metabolism nakong ea khaolo ea pele ka sebete. Ho kenella le khatello ea plasma ho eketseha ka tekanyo ea tekanyetso ea moriana. Leha ho na le taba ea hore ha e nkuoa ka lijo, ho kenngoa ha moriana hoa fokotseha (boholo ba mahloriso le AUC li ka ba 25 le 9%, ka ho latellana), ho fokotseha ha cholesterol ea LDL ha hoa itšetleha ka atorvastatin e nkuoeng ka lijo kapa che. Ha u nka atorvastatin ka shoalane, mahloriso a eona a plasma a ne a le tlase (hoo e batlang e le 30% bakeng sa mahloriso a phahameng le AUC) ho feta ha a e nka hoseng. Leha ho le joalo, ho fokotseha ha cholesterol ea LDL ha hoa itšetleha ka nako ea ho sebelisa moriana.

Ho feta 98% ea lithethefatsi li tlama ho protheine ea plasma. Tekanyo ea erythrocyte / plasma e batla e le 0,25, e bonts'ang phallo e fokolang ea moriana liseleng tse khubelu tsa mali.

Atorvastatin e tšeloa metsoako ea li-ortho- le para-hydroxylated le lihlahisoa tse fapaneng tsa beta-oxidised. Phello ea inhibitory ea setho sa lithethefatsi ho HMG-CoA reductase e ka bang 70% e lemohuoa ka lebaka la ts'ebetso ea metabolites ea potoloho. Atorvastatin e fumanoe e le inhibitor e fokolang ea cytochrome P450 ZA4.

Atorvastatin le metabolites ea eona li qhekelloa haholo ka bile ka mor'a metabolite ea hepatic le / kapa metabolism. Leha ho le joalo, sethethefatsi ha se angoe ke ho kenella hape ka matla. Nako e khutsitseng ea halofo ea bophelo ba atorvastatin e batla e le lihora tse 14, empa nako ea mesebetsi e thibelitsoeng khahlanong le HMG-CoA reductase ka lebaka la ho potoloha ha metabolite e sebetsang ke lihora tse 20-30. Ka tlase ho 2% ea tekanyetso ea molomo ea atorvastatin e pepesitsoe ka har'a moroto.

Kakaretso ea plasma ea atorvastatin ho batho ba baholo ba phetseng hantle (ba fetang 65) e phahame (hoo e ka bang 40% bakeng sa mahloriso a phahameng le 30% bakeng sa AUC) ho feta ho bacha. Ho ne ho se na phapang ea katleho ea kalafo le atorvastatin ho bakuli ba tsofetseng le bakuli ba lihlopha tse ling tsa lilemo.

Keketseho ea atorvastatin ho plasma ea mali ho basali e fapana le khatello ea plasma ea mali ho banna (ho basali, khatello e phahameng e batla e le 20% e phahameng, mme AUC - 10% e tlase). Leha ho le joalo, ha ho phapang e kholo ea bongaka e fumanoeng phello ea maemo a lipid ho banna le basali.

Lefu la liphio ha le ame khatello ea bongata ba lithethefatsi ho plasma kapa phello ea atorvastatin maemong a lipid, ka hona ha ho na tlhoko ea tokiso ea lethal dose ho bakuli ba nang le ho hlleha ha a liphio. Lithuto ha li a ka tsa koahela bakuli ba nang le ho hloleha ha methapo ea methapo ea pheletso; mohlomong, hemodialysis ha e fetole ka ho hlaka ho hlakileng ha atorvastatin, kaha sethethefatsi se batla se kopane ka botlalo ho liprotheine tsa plasma ea mali.

Keketseho ea atorvastatin ka plasma ea mali e eketseha haholo (boholo ba mahloriso - hoo e ka bang makhetlo a 16, AUC - makhetlo a 11) ho bakuli ba nang le lefu la cirrhosis la sebete sa etiology.

Mofumahali

Atorvastatin ke inhibitor e ikhethileng ea HMG-CoA reductase-enzyme, e laolang sekhahla sa phetoho ea HMG-CoA ho mevalonate - selelekela sa li-sterols (ho kenyelletsa cholesterol (cholesterol)). Ho bakuli ba nang le homozygous le heterozygous Famer hypercholesterolemia, mofuta o futsitsoeng oa hypercholesterolemia le dyslipidemia e kopaneng, atorvastatin e theola khatello ea kholo ea cholesterol, density lipoproteins e tlase (LDL) le apolipoprotein B (Apo B). Atorvastatin e boetse e fokotsa ho kopana ha lipoprotein tse fokolang haholo (VLDL) le triglycerides (TG), mme hape e eketsa hanyane dikahare tsa cholesterol high density lipoproteins (HDL).

Atorvastatin e theola boemo ba cholesterol le lipoprotein maling a mali ka ho thibela ho fokotsoa ha HMG-CoA, motsoako oa k'holeseterole ka har'a sebete le ho eketsa palo ea li-receptor tsa LDL ka holim'a li-hepatocytes, tse tsamaeang le ho eketseha le ho eketseha hoa matla ha LDL. Atorvastatin e fokotsa tlhahiso ea LDL, e baka keketseho e boletsoeng le e tšoarellang mosebetsing oa LDL receptor. Atorvastatin ka katleho e theola litekanyetso tsa LDL ho bakuli ba nang le homozygous Famal hypercholesterolemia, e sa amaneng le kalafo e tloaelehileng ka lithethefatsi tse fokotsang lipid.

Sebaka sa mantlha sa tšebetso ea atorvastatin ke sebete, se etsang karolo e kholo ho kopaneng ea cholesterol le clearance ea LDL. Ho fokotseha hoa boemo ba cholesterol ea LDL ho ikamahanya le lethalinyana la lithethefatsi le khatello ea lona 'meleng.

Atorvastatin ka tekanyetso ea 10-80 mg e fokotsitse boemo ba cholesterol e felletseng (ka 30-46%), LDL cholesterol (ka 41-61%), Apo B (ka 34-50%) le TG (ka 14-31%). Sephetho sena se tsitsitse ho bakuli ba nang le heterozygous Familia hypercholesterolemia, mofuta o fumanoeng oa hypercholesterolemia le mofuta o kopaneng oa hyperlipidemia, ho kenyelletsa le bakuli ba nang le lefu la tsoekere le sa tsitsang insulin.

Ho bakuli ba nang le hypertriglyceridemia e ka thoko, atorvastatin e fokotsa boemo ba cholesterol e felletseng, cholesterol ea LDL, cholesterol ea VLDL, Apo B, TG mme e eketsa boemo ba cholesterol ea HDL hanyane. Ho bakuli ba nang le dysbetalipoproteinemia, atorvastatin e fokotsa boemo ba sebete bo theolang cholesterol.

Ho bakuli ba nang le mofuta oa IIa le IIb hyperlipoproteinemia (ho latela sehlopha sa Fredrickson), karolelano ea keketseho ea cholesterol ea HDL ha u sebelisa atorvastatin ka tekanyo ea 10-80 mg e ne e le 5.1-8.7%, ho sa tsotelehe tekanyetso. Ntle le moo, ho bile le phokotso e kholo e thehiloeng ho lethal dose ea tekanyo ea cholesterol e felletseng / HDL cholesterol le HDL cholesterol. Ts'ebeliso ea atorvastatin e fokotsa kotsi ea ischemia le lefu ho bakuli ba nang le myocardial infarction ntle le Q wave le angina e sa tsitsang (ho sa tsotelehe bong le lilemo) e lekana ka kotloloho le boemo ba cholesterol ea LDL.

Hypercholesterolemia e amanang le Heterozygous ho bana. Ho bashanyana le banana ba lilemo tse 10-17 ba nang le heterozygous Familia hypercholesterolemia kapa hypercholesterolemia e matla, atorvastatin ka tekanyo ea 10-20 mg hang ka letsatsi o fokotse haholo boemo ba cholesterol e felletseng, LDL cholesterol, TG le Apo B ho plasma ea mali. Leha ho le joalo, ha ho na phello e kholo khōlong le bohlankaneng ho bashanyana kapa nakong ea kemaro ea ho ea matsatsing a banana. Tšireletseho le katleho ea methapo e kaholimo ho 20 mg bakeng sa kalafo ea bana ha e so ithutoe. Tšusumetso ea nako ea kalafo ea atorvastatin bongoaneng mabapi le phokotso ea ho fokola ha mmele le lefu ka ho ba motho e moholo ha e e-so theoe.

Tekanyetso le tsamaiso

Pele o qala kalafo ea Atorvastatin, ho hlokahala ho tseba hore na cholesterol e maling e khahlano le semelo sa phepo e nepahetseng, fana ka boikoetliso 'meleng le ho nka mehato e reretsoeng ho fokotsa boima ba' mele ho bakuli ba nang le botenya, le ho tsamaisa kalafo ea mafu a ka tlase. Nakong ea kalafo le atorvastatin, bakuli ba lokela ho khomarela mokhoa o tloaelehileng oa hypocholesterolemic. Lithethefatsi li fanoe ka tekanyetso ea 10-80 mg hang ka letsatsi letsatsi le letsatsi, ka nako e le ngoe, empa ka nako e ts'oanang ea letsatsi, ho sa tsotelehe ho ja lijo. Litekanyetso tsa pele le tsa tlhokomelo li ka fetoloa ka bomong ho latela boemo ba cholesterol ea qalong ea LDL, lipheo le katleho ea kalafo. Kamora libeke tse 2-4 ho tloha ho qala ha kalafo le / kapa tokiso ea litheko le Atorvastatin, setšoantšo sa lipid se lokela ho nkuoa mme lethal dose le fetoloe ka nepo.

Hypercholesterolemia ea mantlha le hyperlipidemia e kopaneng. Maemong a mangata, ho lekane ho fana ka moriana ka tekanyetso ea 10 mg hang ka letsatsi letsatsi le letsatsi. Phello ea kalafo e ba teng kamora libeke tse peli, phello e phahameng - kamora libeke tse 4. Liphetoho tse ntle li tšehetsoa ke tšebeliso ea nako e telele ea lithethefatsi.

Homozygous Familia hypercholesterolemia. Lithethefatsi li fanoe ka tekanyetso ea 10 ho isa ho 80 mg hang ka letsatsi letsatsi le leng le le leng, ka nako efe kapa efe, ho sa tsotelehe tšebeliso ea lijo. Litekanyetso tsa pele le tsa tlhokomelo li beoa ka bonngoe. Maemong a mangata, ho bakuli ba nang le homozygous Familyal hypercholesterolemia, sephetho se fihlelleha ka tšebeliso ea Atorvastatin ka tekanyo ea 80 mg hang ka letsatsi.

Heterozygous Familia hypercholesterolemia ho bana (bakuli ba lilemo tse 10-17). Atorvastatin e khothalletsoa tekanyetso ea pele.

10 mg hang ka letsatsi letsatsi le letsatsi. Tekanyo e kholo e khothalletsoang ke 20 mg hang ka letsatsi letsatsi le leng le le leng (tekanyetso e fetang 20 mg ha e so ithutoe ho bakuli ba sehlopha sena sa lilemo). Tekanyetso e beoa ka bonngoe, ho latela sepheo sa kalafo, tekanyetso e ka fetoloa le nako ea libeke tse 4 kapa ho feta.

Sebelisa ho bakuli ba nang le lefu la liphio le ho hloleha ha rebo. Boloetse ba liphio ha bo ame khatello ea mali ea atorvastatin kapa ho fokotseha ha cholesterol ea plasma LDL, ka hona ha ho na tlhoko ea tokiso ea litekanyetso.

Sebelisa ho bakuli ba tsofetseng. Ha ho na phapang phapusing ea katleho le tšebeliso ea lithethefatsi kalafong ea hypercholesterolemia ho bakuli ba tsofetseng le bakuli ba baholo kamora lilemo tse 60.

Bakuli ba nang le ts'ebetso ea sebete e sa sebetseng moriana o laetsoe ka hloko mabapi le ho thefuleha hoa phallo ea moriana 'meleng. Taolo ea methapo ea bongaka le ea laboratori e bonts'itsoe, mme haeba liphetoho tse kholo tsa pathological li fumanoa, tekanyo e lokela ho fokotsoa kapa kalafo e lokela ho emisoa.

Haeba qeto e etsoa ho tsamaiso e kopaneng ea Atorvastatin le CYP3A4 inhibitors, joale:

Kamehla qala kalafo ka bonyane lethal dose (10 mg), etsa bonnete ba ho beha serum lipids pele o kenya lethal dose.

O ka emisa ka nakoana ho nka Atorvastatin haeba li-inhibitors tsa CYP3A4 li laetsoe thupelong e khuts'oane (mohlala, khoso e khutšoane ea lithibela-mafu e kang clarithromycin).

Keletso mabapi le boholo ba tekanyetso ea Atorvastatin ha o sebelisa:

ka cyclosporine - lethal dose ha ea lokela ho feta 10 mg,

kacacithromycin - lethal dose ha ea lokela ho feta 20 mg,

le itraconazole - lethal dose ha ea lokela ho feta 40 mg.

Azithromycin

Ka tšebeliso e tšoanang ea atorvastatin ka tekanyetso ea 10 mg hang ka letsatsi le azithromycin ka tekanyo ea 500 mg ka letsatsi, mahloriso a azithromycin ka plasma ea mali ha a fetoha.

Ts'ebeliso e kopaneng ea atorvastatin ka tekanyo ea 40 mg e nang le diltiazem ka tekanyo ea 240 mg e lebisa hoketseho ea khatello ea atorvastatin plasma ea mali.

CYP3A4 Isoenzyme Inductors

Ts'ebeliso e kopaneng ea atorvastatin e nang le li-inducers tsa CYP3A4 isoenzyme (mohlala, efavirenz, phenytoin, rifampicin, litokisetso tsa wort tsa St. John) li ka lebisa ho fokotseha hoa khatello ea atorvastatin ka plasma ea mali. Ka lebaka la mekgwa e kopanetsoe ba sebelisana le rifampicin (isoenzyme CYP3A4 inducer le e sesitisa tsa hepatocytes lipalangoang protheine OATR1V1) ho sebedisa tsoa hong ea atorvastatin le rifampicin ka atorvastatin lieha ka mor'a ho amohela rifampicin haholo ho fokotsa ea mahloriso ea atorvastatin ka lero la mali. Leha ho le joalo, phello ea rifampicin ho ts'oaroa ha atorvastatin ho hepatocytes ha e tsejoe mme haeba tšebeliso e le 'ngoe ka nako e tšoanang e ke ke ea qojoa, katleho ea motsoako o joalo nakong ea kalafo e lokela ho lekoloa ka hloko.

Ka ho kenella ka nako e tšoanang ea atorvastatin le ho emisoa ho nang le magnesium le aluminium hydroxides, mahloriso a atorvastatin ka plasma ea mali a fokotseha ka hoo e ka bang 35%, leha ho le joalo, tekanyo ea ho fokotseha ha LDL-C ha e fetohe.

Atorvastatin ha e ame li-pharmacokinetics of phenazone, ka hona, ho sebelisana le lithethefatsi tse ling tse lokiselitsoeng ke li-enzyme tse tšoanang tsa tsamaiso ea cytochrome P 450 ha lia lebelloa.

Colestipol

Ka tšebeliso e tšoanang ea colestipol, khatello ea atorvastatin e plasma ea mali e fokotsehile ka hoo e ka bang 25%, leha ho le joalo, phello e fokolisang lipid ea motsoako oa atorvastatin le colestipol e ne e feta ea lithethefatsi ka bomong.

Ka tšebeliso e sa khaotseng ea digoxin le atorvastatin ka tekanyetso ea 10 mg ka letsatsi, mahloriso a lekanang a digoxin ka plasma ea mali ha a fetoha. Leha ho le joalo, ha digoxin e ne e sebelisoa hammoho le atorvastatin ka tekanyo ea 80 mg / ka letsatsi, khatello ea "digoxin" e eketsehile ka hoo e ka bang 20%, ka hona, bakuli ba joalo ba lokela ho shebelloa.

Lithibela-mafu tsa molomo

Ka tšebeliso e tšoanang ea atorvastatin le kemiso ea molomo e nang le norethisterone le ethinyl estradiol, keketseho e kholo ho AUC ea norethisterone le ethinyl estradiol e ile ea bonoa ke hoo e ka bang 30% le 20%, ka ho latellana. Tšusumetso ena e lokela ho nahanoa ha u khetha lithibela-pelehi tsa molomo bakeng sa mosali ea noang atorvastatin.

Terfenadine

Atorvastatin e sebelisitsoeng ka nako e le 'ngoe e ne e se na phello e matla litabeng tsa pharmacokinetics of terfenadine.

Ts'ebeliso e tšoanang ea atorvastatin e nang le warfarin matsatsing a pele e ka eketsa phello ea warfarin ho mali coagulation (ho fokotsa nako ea prothrombin). Tšusumetso ena e nyamela kamora matsatsi a 15 a ts'ebeliso ea lithethefatsi tsena ka nako e tšoanang.

Ka tšebeliso e tšoanang ea atorvastatin ka tekanyo ea 80 mg le amlodipine ka tekanyo ea 10 mg, pharmacokinetics ea atorvastatin e maemong a lekanang ha ea ka ea fetoha.

Fusidic asiti

Nakong ea lithuto tsa morao-rao tsa thekiso, linyeoe tsa rhabdomyolysis ho bakuli ba nkang li-statins, ho kenyeletsoa le atorvastatin le fusidic acid, li ile tsa hlokomeloa.Ho bakuli bao tšebeliso ea fusidic acid e hlokahalang, kalafo e nang le li-statins e lokela ho khaotsa nakong eohle ea ts'ebeliso ea fusidic acid. Phekolo ea Statin e ka qalisoa hape ka mor'a matsatsi a 7 ka mor'a lethal dose ea ho qetela ea fusidic acid. Maemong a ikhethang, ha kalafo ea nako e telele e nang le fusidic acid e hlokahala, ho etsa mohlala, bakeng sa kalafo ea tšoaetso e matla, tlhoko ea tšebeliso ea nako e le 'ngoe ea atorvastatin le fusidic acid e lokela ho nahanoa maemong ka mong le tlas'a taolo e tiileng ea ngaka. Mokuli o lokela ho ea ngakeng hang-hang haeba matšoao a bofokoli ba mesifa, kutloelo-bohloko kapa bohloko bo hlaha.

Ts'ebeliso ea ezetimibe e amana le nts'etsopele ea karabelo e mpe, ho kenyelletsa le rhabdomyolysis, ho tsoa tsamaisong ea musculoskeletal. Kotsi ea karabelo tse joalo e eketseha ka tšebeliso e tšoanang ea atorvastatin le ezetimibe. Ho hlahlojoa haufi-ufi ho khothalletsoa bakuli bana.

Litlaleho tsa myopathy li tlalehiloe ka tšebeliso e tšoanang ea atorvastatin le colchicine. Ka kalafo e kopaneng le lithethefatsi tsena, tlhokomeliso e lokela ho sebelisoa.

Ha re ithuta ho sebelisana ha atorvastatin le cimetidine, ha ho na ts'ebelisano e kholo ea kliniki e fumanoeng.

Pheko e 'ngoe e kopaneng

Ts'ebeliso e ts'oanang ea atorvastatin e nang le lithethefatsi tse fokotsang khatello ea lihormone tsa endo native steroid (ho kenyelletsa cimetidine, ketoconazole, spironolactone) e eketsa kotsi ea ho theola khatello ea lihormone tsa endidia tsa steroid (tlhokomeliso e lokela ho sebelisoa).

Lithutong tsa kliniki, atorvastatin e sebelisitsoe hammoho le lithethefatsi tsa antihypertgency le estrogens, tse neng li behiloe e le pheko ea ho khutlisa, ha ho na matšoao a ts'ebelisano a sa batleheng a kliniki a ileng a bonoa. Boithuto ba ho sebelisana le lithethefatsi tse ikhethileng ha bo so etsoa.

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 myalgia le bofokoli ba mesifa e ka tsamaisana 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 ho qala 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 ha ho etsoa matšoao a bongaka a fanang ka maikutlo a ho ba teng ha myopathy ea hlobaetsang, kapa boteng ba lintho tse rerang pele ho nts'etsopele ea ho hlaphoheloa ke matla a methapo ka lebaka la rhabdomyolysis (ts'oaetso e matla, ho fokotseha ha khatello ea mali, ts'ebetso e kholo ea ts'ebetso ea methapo, metabolic, endocrine kapa likhathatso tse matla tsa 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 sebelisana le lithethefatsi

Monyetla oa myopathy o eketseha nakong ea kalafo ka lithethefatsi tse ling tsa sehlopha sena ha ts'ebeliso ea cyclosporine, e tsoang ho fibric acid, erythromycin, antifungals e amanang le azoles, le nicotinic acid.

Li-antacid: Ho kenella ka nako e le 'ngoe ho emisoeng ho nang le magnesium le aluminium hydroxide ho fokotsitse khatello ea atorvastatin ka plasma ea mali ka 35%, leha ho le joalo, tekanyo ea ho fokotseha ha cholesterol ea LDL ha ea ka ea fetoha.

Antipyrine: Atorvastatin ha e ame li-pharmacokinetics tsa antipyrine, ka hona, ho sebelisana le lithethefatsi tse ling tse lokiselitsoeng ke cytochrome isoenzymes e sa lebelloang.

Amlodipine: Phuputsong e amanang le tšebelisano ea lithethefatsi ho batho ba phetseng hantle, tsamaiso e le 'ngoe ea atorvastatin ka tekanyo ea 80 mg le amlodipine ka tekanyo ea 10 mg e lebisitse keketseho ea phello ea atorvastatin ka 18%, e neng e se bohlokoa ba kliniki.

Gemfibrozil: ka lebaka la kotsi e eketsehang ea ho nts'etsapele myopathy / rhabdomyolysis ka tšebeliso e ts'oanang ea li-inhibitors tsa HMG-CoA reductase tse nang le gemfibrozil, tsamaiso e ts'oanang ea lithethefatsi tsena e lokela ho qojoa.

Meetso e meng: ka lebaka la kotsi e eketsehileng ea myopathy / rhabdomyolysis ka tšebeliso e ts'oanang ea li-inhibitors tsa HMG-CoA reductase tse nang le li-fibrate, atorvastatin e lokela ho laeloa ka hloko ha e nka fiber.

Nicotinic acid (niacin): menyetla ea ho ba le myopathy / rhabdomyolysis e ka eketsoa ha ho sebelisoa atorvastatin hammoho le nicotinic acid, ka hona, maemong ana, ho nahanela ho lokela ho fanoa ho fokotsa litekanyetso tsa atorvastatin.

Colestipol: le tšebeliso ea nako e tšoanang ea colestipol, karolelano ea atorvastatin plasma ea mali e fokotsehile ka 25%. Leha ho le joalo, phello e fokotsang lipid ea ho kopana ha atorvastatin le colestipol e ne e feta ea lithethefatsi ka bomong.

Colchicine: le tšebeliso e tšoanang ea atorvastatin e nang le colchicine, linyeoe tsa myopathy li tlalehiloe, ho kenyeletsa le rhabdomyolysis, ka hona tlhokomeliso e lokela ho sebelisoa ha ho fanoa ha atorvastatin e nang le colchicine.

Digoxin: ka taolo e khutsitseng ea digoxin le atorvastatin ka tekanyo ea 10 mg, mokokotlo oa tekano ea digoxin ka plasma ea mali ha oa ka oa fetoha. Leha ho le joalo, ha digoxin e ne e sebelisoa hammoho le atorvastatin ka tekanyo ea 80 mg / ka letsatsi, khatello ea "digoxin" e eketsehile ka hoo e ka bang 20%. Bakuli ba fumanang digoxin hammoho le atorvastatin ba hloka ho hlahlojoa ka nepo.

Erythromycin / clarithromycin: ka tšebeliso e tšoanang ea atorvastatin le erythromycin (500 mg makhetlo a mane ka letsatsi) kapa clarithromycin (500 mg habeli ka letsatsi), e thibelang cytochrome P450 ZA4, keketseho ea khatello ea atorvastatin maling a mali.

Azithromycin: le tšebeliso e tšoanang ea atorvastatin (10 mg hang ka letsatsi) le azithromycin (500 mg / hang ka letsatsi), khatello ea atorvastatin ka plasma ha e ea fetoha.

Terfenadine: ka tšebeliso e le 'ngoe ea atorvastatin le terfenadine, liphetoho tsa bohlokoa litabeng tsa pharmacokinetics tsa terfenadine ha lia ka tsa fumanoa.

Lithibela-pelehi tsa molomo: ha o ntse o sebelisa atorvastatin le lithibela-pelehi tsa molomo tse nang le norethindrone le ethinyl estradiol, keketseho e kholo ho AUC ea norethindrone le ethinyl estradiol e ile ea bonoa ke 30% le 20%, ka ho latellana. Tšusumetso ena e lokela ho nahanoa ha u khetha lithibela-pelehi tsa molomo bakeng sa mosali ea noang atorvastatin.

Warfarin: ha re ithuta ho sebelisana ha atorvastatin le warfarin, ha ho matšoao a ts'ebelisano ea bohlokoa ka ho fetisisa ka kliniki a fumanoeng.

Cimetidine: ha re ithuta ho sebelisana ha atorvastatin le cimetidine, ha ho na matšoao a ts'ebelisano e bohlokoa ea kliniki a fumanoeng.

Protease Inhibitors: tšebeliso ea nako e tšoanang ea atorvastatin e nang le li-inhibitors tsa cytechrome P450 ZA4 e ne e tsamaisana le keketseho ea plasma ea likhopolo tsa atorvastatin.

Malebela mabapi le tšebeliso e kopaneng ea li-atorvastatin le HIV proteinase inhibitors: