Atorvastatin (40 mg) Atorvastatin

Atorvastatin 40 mg - kahi lāʻau hōʻona lipid mai ka hui o statins. Ka ke hana o ka hana o ka lāʻau lapaʻau e kuhikuhi ana e hoʻohaʻahaʻa i ka cholesterol koko

Hoʻokahi kahi papa kiʻi ʻoniʻoni:

• mea waiwai: atorvastatin calcium trihydrate (ma nā ʻōlelo o ka atorvastatin) - 40.0 mg,
• nā mea waiwai: microcrystalline cellulose - 103.72 mg, monidio lactose - 100.00 mg, calcium carbonate - 20.00 mg, crospovidone - 15.00 mg, sodium carboxymethyl starch (sodium starch glycolate) - 9.00 mg, hyprolose (hydroxypropyl cellulose) - 6, .00 mg, kaomi o ka magnesium - 3.00 mg,
• palaualelo film: hypromellose - 4,500 mg, talc - 1,764 mg, hyprolysis (hydroxypropyl cellulose) - 1,746 mg, titanium dioxide - 0,990 mg a i hoʻohuihui maloʻo no ka uhi ʻana o ka kiʻi me nā hypromellose (50.0%), talc (19.6%), hyprolose (hydroxypropyl cellulose) (19.4%), titanium dioxide (11.0%) - 9,000 mg.

Nā ʻāpana lapalapa a me ke keʻokeʻo. Paʻokeʻe ʻeleʻele paha kahi ʻāpana ʻāpana o ke kihi.

Lapaʻau lāʻau

ʻO Atorvastatin he mea mālama i ka hoʻokūkū koho o ka HMG-CoA reductase, he kīme nui e hoʻohuli ana i ka 3-hydroxy-3-methylglutaryl-CoA i mevalonate, kahi mea i mua i ka lāʻau, a me ka kolamu. Synthetic lipid-hoʻemi haʻihaʻi.

I ka poʻe maʻi me ka homozygous a me ka heterozygous hypercholesterolemia, nā hanana ʻole-familial o ka hypercholesterolemia a me ka dyslipidemia i hui pū ʻia, atorvastatin hōʻemi i ka ʻaila o ka kolamu piha (Ch) i loko o ke koko koko. lipoprotein cholesterol haʻahaʻa (Cs-LDL) a me ka apolipoprotein B (apo-B), a me ke ʻano o ka lipoproteins low-density (Cs-VLDL) a me ka triglycerides (TG), e hōʻeha i ka piʻiʻana o ka lipoprotein kiʻekiʻe-density (Cs-HDL).

Hoʻopili ke Atorvastatin i ka hoʻoneʻe ʻana o Chs a me Chs-LHNP i ka koko koko, e hoʻoneʻe ana i ka hoʻōla a me ka hoʻōla ʻana o HMG-CoA i loko o ka ate a me ka hoʻonui ʻana i ka nui o nā "recepty" LDL ma ka papakū, e alakaʻi ana i ka hoʻonui a me ka catabolism o Chs-LDL.

Hoʻopili ʻo Atorvastatin i ka hana o LDL-C a me ka helu o ka LDL maʻamau, e hoʻomohala i ka hoʻonui ʻia ʻana o ka LDL-receptors i hui pū me nā loli o ka qualitative maikaʻi i loko o ka LDL-pāloko, a ke hōʻemi nei hoʻi i ka paʻa o ka LDL-C i ka poʻe maʻi me ka homololiololediemia homozygous i kuʻi ʻia hoʻāla.

I ka hopena o nā Atorvastatin ma waena o 10 a 80 mg e hōʻemi ana i ka uluʻana o Chs e ka 30-46%, Chs-LDL - e ka 41-61%, apo-B - nā 34-50% a me TG - e 14-33%. He like nā hopena o ka ʻoihana ma nā maʻi me ka heterozygous hypercholesterolemia famili, ʻaʻohe ʻohana ʻohana o ka hypercholesterolemia a me ka hyperlipidemia i hui pū ʻia, me ke komo pū i nā maʻi me nā maʻi maʻi type 2.

I ka poʻe maʻi me ka hypertriglyceridemia hoʻokaʻawale, hōʻemi ʻo atorvastatin i ka hoʻōla ʻana o ka kolamu a pau, Chs-LDL, Chs-VLDL, apo-B a me TG a hoʻonui i ke kāohi o Chs-HDL. I nā mea maʻi me ka dysbetalipoproteinsemia, hoʻohaʻahaʻa ka atorvastatin i ka ʻike ʻana o ka cholesterol lipoprotein intermediate-density (Chs-STD).

I ka poʻe maʻi me ka type IIa a me IIb hyperlipoproteinemia e like me ka helu ʻana o Fredrickson, ʻo ka nui o ka piʻi ʻana o ka hoʻonui ʻana o ka manaʻo o HDL-C i ka wā mālama me ka atorvastatin (10-80 mg) hoʻohālikelike ʻia me ka waiwai mua o ka 5.1-8.7% a ʻaʻole i hilinaʻi ʻia nā dosis. Aia ka nui o ka hoʻoliʻiliʻi a hilinaʻi nui i ka pae: ʻo ka kolamu piha / Chs-HDL a me Chs-LDL / Chs-HDL e ka 29-44% a me 37-55%, ia manawa.

ʻO Atorvastatin ma kahi o ka 80 mg nui e hoʻēmi i ka hopena o ka hoʻomohala ʻana i ka hoʻopiʻi ischemic a me ka make ma ka 16% ma hope o ka papa 16 wiki, a me ka hopena o ka hoʻoliʻi hou ʻana no ka angina pectoris i hui pū ʻia e nā hōʻailona o ka ischemia myocardial e 26%. I nā mea maʻi me nā manaʻo mua o ka LDL-C (me ka ʻole o ka Q me ka myocardial infarction i nā kāne, nā wahine, a me nā mea maʻi a ʻoi aku ka ʻōpio ma mua o 65 mau makahiki), hiki i ka atorvastatin ka hopena o ka hōʻemi o ka hoʻopiʻi ischemic a me ka make ma.

ʻO ka emi ʻana o ka hoʻoliʻi ʻana o ka plasma o LDL-C ka mea i ʻoi aku ka maikaʻi o ka correlated me kahi kaila o ka atorvastatin ma mua o kona ʻano plasma. A koho ʻia ke koho ʻana i ka hopena therapeutic (ʻike i ka ʻāpana "Dosage a me ka hoʻokele").

Loaʻa ka hopena therapeutic i 2 mau pule ma hope o ka hoʻomaka ʻana o ka hōʻola, a hiki i ka nui loa ma hope o 4 mau hebedoma a hoʻomau i ka holoʻokoʻa o ka wā mālama.

Kapehu

Hoʻopili koke ʻo Atorvastatin ma hope o ka lawelawe waha: ka manawa e hiki ai i kona kiko kiʻekiʻe (TCmax) i loko o ke koko koko he 1-2 mau hola. I nā wahine, ʻo ka piʻi nui o ka atorvastatin (Cmax) ka 20% ʻoi aku ka nui, a ʻo ka wahi ma lalo o ka curve-manawa curry (AUC) he 10% haʻahaʻa ma mua o nā kāne. ʻO ka pae o ke kīhū a me ka ʻike ʻana i ka plasma koko e hoʻonui me ka hoʻohālikelike o ka nui. ʻO ka bioavailability kūpono e pili ana i ka 14%, a me ka bioavailability o ka ʻōnaehana o ka hana pale i kūʻē i ka HMG-CoA reductase ma kahi o 30%. ʻO ka bioavailability systemic haʻahaʻa ma muli o ka metabolism presystemic i ka membous mucous o ka gastrointestinal tract a / ai ʻole i ka manawa o ka "hele mua" ma o ka puʻu. Hōʻemi iki ka ʻai ʻana i ka helu a me ka pae o ka hoʻopihapiha ʻana o ka atorvastatin (ma 25% a me 9%, kēlā, e hōʻike ʻia e nā hopena o ka hopena o Cmax a me AUC) naʻe, i ka hōʻemi ʻana i LDL-C ka mea like me ka wā e lawe ai i ka atorvastatin ma kahi ʻōpū ʻole. ʻOiai ka mea ma hope o ka lawe ʻana i ka atorvastatin i ke ahiahi, ua hoʻohaʻahaʻa ʻia kona kukuna (Cmax a me AUC ma kahi o 30%) ma hope o ka lawe ʻana i ke kakahiaka, ʻaʻole ka hilinaʻi ʻana o ka neʻe o ka LDL-C i ka manawa o ka lā e lawe ʻia ai ka lāʻau.

Hāpai

Hoʻohā nui ʻia ka Atorvastatin e hana i nā derivatives ortho- a para para-hydroxylated a me nā huahana beta-oxidation. In vitro, ortho- a me para-hydroxylated metabolites he hopena pale i ka HMG-CoA reductase, i hoʻohālikelike ʻia i ka atorvastatin. ʻO ka hana pale i ka HMG-CoA reductase ma kahi o 70% ma muli o ka hana o nā neʻe ʻana i nā metabolites. I loko o nā haʻawina vitro hōʻike ʻana i ka nuienenmeme CYP3A4 i kahi hana koʻikoʻi i ka metabolism o atorvastatin. Hoʻomaopopo ʻia kēia ma ka hoʻonui ʻia o ka atorvastatin i loko o ke koko koko o ke kanaka i ka wā e lawe ana i ka erythromycin, ʻo ia ka mea e hoʻomehana ai i kēia isoenzyme.

Ua hōʻike pū ʻia nā haʻawina vitro he atorvastatin kahi mea palupalu ikaika o ka isoenzyme CYP3A4. ʻAʻohe hopena koʻikoʻi ʻo Atorvastatin i ka konsfra plasma o ka terfenadine, ka mea i koho ʻia e ka isoenzyme CYP3A4, no laila, ʻo kona hopena koʻikoʻi i ka pharmacokinetics o nā hana hou o ka CYP3A4 isoenzyme i hemahema (ʻike i ka ʻāpana "Interaction me nā lāʻau lapaʻau hou").

Hoʻokomo ʻia ʻo Atorvastatin a me kāna mau metabolite me ka bile ma hope o ka hepatic a / a i ʻole metabolism nui aʻe (atorvastatin ʻaʻole i pau i ka enterohepatic recirculation). ʻO ka hapalua ola (T1 / 2) ma kahi o 14 mau hola, ʻoiai ka hopena o ka pale o ka atorvastatin e pili ana i ka hoʻōla ʻana o HMG-CoA ma kahi o 70% e hoʻoholo ana e ka hana o nā hoʻopuni kūlohelohe a lōʻihi mau loa ma kahi o 20-30 mau hola ma muli o kā lākou alo. Ma hope o ka lawe ʻana i ka lāʻau lapaʻau i loko o ka pāʻai, ʻoi aku ma mua o 2% o ka loaʻa ʻana o ka lāʻau.

Nā hōʻailona no ka hoʻohana ʻana

• ma ke ʻano he meaʻaiʻai e hōʻemi ai i ka kolamu ka nui o ka kolamu, LDL-C, apo-B, a me ka triglycerides i nā pākeke, ʻōpio, a me nā keiki he 10 mau makahiki a keu aku paha me ka hypercholesterolemia haʻahaʻa, e komo pū ana me ka hypercholesterolemia familial (he hezyzygous version) a i hui pū ʻia (hoʻohui ʻia) hyperlipidemia ( ʻano IIa a me IIb e like me ka helu ʻana o Fredrickson), i ka wā e pau ʻole ai ka hopena o ka meaʻai a me nā lāʻau lapaʻau ʻē aʻe.
• E hōʻemi i ka cholesterol kiʻekiʻe, LDL-C i nā pākeke me ka hypercholesterolemia homozygous homozygous i hoʻopili ʻia i nā lāʻau lapaʻau lipid-haʻahaʻa (e.g. LDL-apheresis) a i ʻole loaʻa nā lapaʻau like ʻole.

Hoʻopilikia i nā maʻi Cardiovascular:

• ka pale ʻana o nā hanana cardiovascular ma ka maʻi o nā pākia i ke kiʻekiʻe kiʻekiʻe o ka hoʻomohala ʻana i nā hanana cardiovascular mua, he mea hoʻi i ka hoʻoponopono ʻana o nā pilikia ʻē aʻe,
• ka pale ʻana i ka lua o nā hoʻopiʻi cardiovascular ma nā mea maʻi me ka maʻi puʻukui coronary i mea e hōʻemi ai i ka huina huina holo kino, myocardial infarction, stroke, re-hospitalization no angina pectoris a me ka pono no ka revascularization.

Nā Hoʻohui

ʻO nā hoʻohālikelike i ka hoʻohana ʻana o atorvastatin i:

• hypersensitivity i ka atorvastatin a / a i ʻole kekahi o nā mea pono o ka lāʻau lapaʻau,
• ka maʻi 'aʻai aolaola a me ka hana nui o ka "ati" transaminases i ke koko plasma o ka' ike 'ole' ana mai 'oi aku ma mua o ʻekolu mau manawa a ke hoʻololi nei me ka palena o luna o ke kumu.
• cirrhosis o ka ake o kekahi etiology,
• hoʻohana ma nā wahine o ka makahiki o ka hānau ʻana nāna e hoʻohana i nā ʻano kūpono o ke kō.
• hana me ka waikawa fusidic,
• mau makahiki a hiki i 10 mau makahiki - no nā mea maʻi me ka hypercholesterolemia ʻohana heterozygous,
• mai nā makahiki he 18 a hiki i ka wā i hoʻohana ʻia e like me nā hōʻailona ʻē aʻe (ʻaʻole i hoʻokūpaʻa ʻia ka hopena a me ka palekana).
• hapai, hapai
• lactose intolerance, hemahema lactase, hōʻeha glucose-galactose.

Hiki ke hāʻawi ʻia ʻo Atorvastatin i kahi wahine o ka hua hānau wale nō inā he kumu hilinaʻi paha ʻaʻole ia i hānai a hoʻomaopopo ʻia i ka pilikia o ka lāʻau i ka kuʻi.

Me ka mālama aka: ka inu ʻona, kahi mōʻaukala o nā maʻi ate, i nā mea maʻi me nā mea pili i ka rhabdomyolysis (hana i ʻole ka hopena, hypothyroidism, hōʻeha i ka hanana ʻōhua i nā maʻi me ka mōʻaukala a me ka mōʻaukala, nā mea ola kino o nā HMG reductase inhibitors a i nā fibrates ma ka ʻōpū ua paʻa. nā kiko, ʻoi aku ma mua o 70 mau makahiki, hoʻohana pinepine ʻia me nā lāʻau lapaʻau e hoʻonui ana i ka hopena o ka myopathy a me rhabdomyolysis

ʻLoe a me ke kākele

I loko. Lawe i kekahi manawa o ka lā, kahi manaʻo o ka ʻai ʻana o ka meaʻai.

Ma mua o ka hoʻomaka ʻana i ka mālama ʻana me ka Atorvastatin, pono ʻoe e hoʻāʻo e hoʻokō i ka hypercholesterolemia me ka hoʻohana ʻana i ka mea ʻai, hoʻomaʻamaʻa a me ka hoʻohaʻemi ʻana o ka mea hoʻolalelale ma nā maʻi me ka huelo, me ka mālama ʻana i ka maʻi kumu.

Ke koho ʻana i ka lāʻau lapaʻau, pono ke ahonui e mālama i kahi pāʻina hypocholesterolemic maʻamau, pono ʻo ia e hoʻopili pono i ka manawa holoʻokoʻa o ka mālama ʻana.

Ka hoʻohālikelike ʻia o ka lāʻau o ka lāʻau mai 10 mg a 80 mg i hoʻokahi lā i kēlā me kēia lā a nānā ʻo ia i ka noʻonoʻo ʻana o ka ʻike mua o ka LDL-C, ke kumu o ka hōʻola a me ka hopena o kēlā me kēia lāʻau. ʻO ka lāʻau kiʻekiʻe loa o kēlā me kēia lā ka 80 mg.

I ka hoʻomaka ʻana o ka hoʻōla a me / a i ka manawa o ka hoʻonui ʻana i ka mahele o Atorvastatin, pono ia e nānā i ka nānā ʻana o nā lipids i ka plasma koko i kēlā me kēia mau hebedoma ʻo 2 a hoʻoponopono i kēia maʻa.

Heterozygous familial hypercholesterolemia

ʻO ka maʻa mua he 10 mg i kēlā me kēia lā. Pono ke koho pono ʻia i ka pākuhi a loiloi i kona pili ʻana i kēlā me kēia 4 hebedoma me kahi hoʻonui e hoʻonui ai i 40 mg i kēlā me kēia lā. A laila hiki ke hoʻonui ʻia ka nui i ka nui o 80 mg pākahi i kēlā me kēia lā, a i ʻole ka hoʻohui ʻana o nā sequestrants o nā waikawa bile me ka hoʻohana ʻana i atorvastatin i kahi pākaʻi o 40 mg no kēlā me kēia lā hiki.

Hoʻohana ma nā keiki a me nā ʻōpio mai 10 a 18 mau makahiki me ka hypercholesterolemia familial heterozygous

ʻO ka papa ʻōlelo hoʻomaka ʻia he 10 mg hoʻokahi i ka lā. Hiki ke hoʻonui ʻia ka nui i ka 20 mg i kēlā me kēia lā, e pili ana i ka hopena lapaʻau. ʻO ka ʻike me kahi mahele o ka 20 mg (e pili ana i ka nui o ka 0.5 mg / kg) ua palena. Pono e titrate i ka hopena o ka lāʻau lapaʻau ma muli o ke kumu o ka lipid-lowering therapy. Pono e hoʻoponopono ʻia nā pila ma nā wā 1 o 4 mau hola i hoʻokahi a keu paha.

Hoʻohana me ka hui pū me nā lāʻau ʻē aʻe

Inā pono, hoʻohana ka manawa like me ka cyclosporine, telaprevir a i ʻole ka hui ʻana o ka tipranavir / ritonavir, ʻaʻole pono ka nui o ka lāʻau Atorvastatin i ka 10 mg i kēlā me kēia lā.

Pono e hoohana ʻia a ʻoi aku ka liʻiliʻi o ka hopena o ka atorvastatin i ka wā e hoʻohana ʻia ai me ka inhibitor o ka protease HIV, hepatitis C virus protease inhibitors (boceprevir), clarithromycin a me itraconazole.

Nā hopena hopena

Ke lawe nei i Atorvastatin, hiki ke hopena i nā hopena pili:

• Mai ka pūnaehana nūhou: insomnia, hōʻeha, kaʻeha aseweic, malaise, dizziness, peripheral neuropathy, amnesia, paresthesia, hypesthesia, ʻehaʻeha.
• Mai ka pūnaehana hana ʻana: ka nausea, ka ʻeha, ka ʻeha o ka ʻōpū, ka dyspepsia, ka lemulewa, ka constipation, ka luaʻi, ka anorexia, ka hepatitis, pancreatitis, jaundice cholestatic.
• Mai ka pūnaehana musculoskeletal: myalgia, ʻeha hope, arthralgia, uaua mākala, myositis, myopathy, rhabdomyolysis.
• Nā hui kūloko: urticaria, pruritus, keʻokeʻo, ka ʻōpū o ka bipi, anaphylaxis, erythema polymorphic exudative (e pili ana i ka maʻi o Stevens-Johnson), nā Laille syndrome.
• Mai nā ʻāpana hemopoietic: thrombocytopenia.
• Mai ka ʻaoʻao o ka hana metabolism: hyp- a i ʻole hyperglycemia, hoʻonui i ka hana o ka serum CPK.
• Mai ka pūnaehana endocrine: diabetes mellitus - e pili ana i ka hala o ka ulu ʻana me ka ʻole a me ka ʻole o nā hopena pilikia (wikiwiki glucose ≥ 5.6, indexation kino kino> 30 kg / m2, he hoʻonui i ka triglycerides, kahi mōʻaukala o ka hypertension).
• ʻO nā mea'ē aʻe: tinnitus, nā nāhelehele, ka hana hewa, ka edema peripheral, ke kiʻi ʻana, ka hōʻeha ʻana o ka umauma, alopecia, nā hihia o ka hoʻomohala ʻana i nā maʻi interstitial, ka nui loa me ka hoʻohana ʻana i ka wā lōʻihi, ka hemorrhagic stroke (i ka wā e lawe ʻia ai i nā kuʻi kiʻekiʻe a me nā CYP3A4 inhibitors), ka luaal ʻaole ʻole.

Nā hōʻailona āpau

ʻAʻole paʻa i nā hōʻailona kikoʻī o kahi overdose. Hiki i kēia ʻōhuhi ke komo i ka ʻeha i ke akepaʻa, paʻa ʻole ʻo ka renal ʻole, ka hoʻohana lōʻihi ʻana i ka myopathy a me ka rhabdomyolysis.

Ma kahi o ka overdose, pono nā ʻōnaehana holoʻokoʻa nei: ka nānā ʻana a mālama i nā hana nui o ke kino, a me ke kāohi ʻana i ka nui o ke komo ʻana i ka lāʻau (lavage gastric, lawe ʻia i ka ulaula a me nā laxatives).

Me ka hoʻomohala ʻana i ka myopathy, i ukali ʻia e ka rhabdomyolysis a me ka hāʻule ʻole o ka renal opa, pono e hoʻopau koke ʻia ka lāʻau a hoʻomaka ʻia ka infusion diuretic a me ka sodium bicarbonate. Hiki i ka Rhabdomyolysis ke alakaʻi i ka hyperkalemia, e koi ana i ka hoʻoponopono intravenous i kahi hopena o ka calcium chloride a i ʻole ka hopena o ka calcium gluconate, ka infusion o kahi 5% hopena o ka hekili (glucose) me ka insulin, a me ka hoʻohana ʻana o nā resins potassium-exchange.

Ma muli o ka hoʻopaʻa lima ʻana i ka lāʻau i ka protein plasma, ʻaʻole pono ka hemodialysis.

Pākuʻi helu

Nā Papa Kūmole 10 mg, 20 mg a me 40 mg

Aia i loko o hoʻokahi papa:

mea waiwai - atorvastatin (me ka paʻakai paʻakai o trihydrate) 10 mg, 20 mg a me 40 mg (10.85 mg, 21.70 mg a 43.40 mg),

nā mea hoʻowalewale: kalima, carbonate, crospovidone, sodium lauryl sulfate, silicon dioxide, colloidal anhydrous, talc, microcrystalline cellulose,

ukana moku: Opadry II ulaula (talc, polyethylene glycol, titanium dioxide (E171), polyvinyl alika, hao (III) oxide melemele (E172), hao (III) oxide ulaula (E172), hao (III) oxide ʻeleʻele (E172).

ʻO nā papa kuʻina poni me kahi papa biconvex

ʻO nā waiwai Pharmacological

Lapaʻau lāʻau

Hoʻopili koke ʻia ʻo Atorvastatin ma hope o ka lawelawe ʻana o ka waha, ua hōʻea i kona kukuna kiʻekiʻe i ka pae kiʻekiʻe loa no 1 - mau hola 2. ʻO ka bioavailability o ka atorvastatin he 95-99%, kūʻokoʻa - 12-14%, systemic (hoʻolako i ka pale o HMG-CoA reductase) - ma kahi o 30 % Ua wehewehe ʻia ka bioavailability haʻahaʻa haʻahaʻa e ka cleyce presystemic i ka membous mucous o ka gastrointestinal tract a / a i ʻole metabolism i ka hele mua ma ka pepeka. Hoʻopili i ka'ōpū a me ka plasma e hoʻonui i ka hapa me ka nui o ka lāʻau. ʻOiai ka mea i ka wā i lawe ʻia me ka meaʻai, hoʻemi ka nui o nā lāʻau lapaʻau (ʻo ka nui o ke koʻo a me ka AUC ma kahi o 25 a 9% mau mea āpau), ka hopena o ka pae LDL cholesterol ʻaʻole hilinaʻi i ka atorvastatin i lawe ʻia me ka meaʻai a ʻaʻole paha. Ke lawe nei i ka atorvastatin i ke ahiahi, ua emi iho kona kukuna plasma (ma kahi o 30% no ka nui loa o ke koʻikoʻi a me AUC) ma mua o ka lawe ʻana i ke kakahiaka. Eia nō naʻe, ʻaʻole ka hilinaʻi i ka liʻiliʻi o ka pae o ka LDL cholesterol i ka manawa e lawe ai i ka lāʻau lapaʻau.

ʻOi aku ma mua o 98% o ka lāʻau lapaʻau e hoʻopili i nā protein plasma. ʻO ka palena o ka erythrocyte / plasma ma kahi o 0.25, e hōʻike ana i kahi nāwaliwali nāwaliwali o ka lāʻau lapaʻau i loko o nā ʻāpana koko ʻokoʻa.

Hoʻonohonoho ʻia ka Atorvastatin i nā derivatives ortho- a para para-hydroxylated a me nā huahana beta-oxidized. ʻO ka hopena o ka pale i ka lāʻau pili i ka HMG-CoA reductase e pili ana i ka 70% maopopo ma muli o ka hana o nā kaila hoʻololi. Loaʻa ʻo Atorvastatin no kahi nāwaliwali nāwaliwali o ka cytochrome P450 ZA4.

Hoʻopili ʻia ʻo Atorvastatin a me kāna metabolites me ka bile ma hope o ka hepatic a / a i ʻole metabolism nui. Eia naʻe, ʻaʻole palē o ka lāʻau i ka recirculation enterohepatic koʻikoʻi. ʻO ka hapalua hapalua o nā atorvastatin ma kahi o 14 mau hola, akā ʻo ka manawa o ka hana pale ʻana i ka hoʻemi hou ʻana o ka HMG-CoA ma muli o ka hoʻopaloli ʻana i nā metabolites ikaika he 20-30 mau hola.hiki a emi mai ka 2% o kahi kūlohelohe waha o atorvastatin i hoʻopili ʻia i ka urine.

ʻO ke kukuna plasma o ka atorvastatin i nā poʻe olakino olakino (ma mua o 65) ʻoi aku ka kiʻekiʻe (ma kahi o 40% no ka pae kiʻekiʻe a me 30% no AUC) ma mua o nā kānaka ʻōpio. ʻAʻohe ʻano ʻokoʻa i ka hopena o ka mālama ʻana me ka atorvastatin i nā poʻe maʻi maʻi a me nā poʻe maʻi o nā hui ʻē aʻe.

Hoʻololi ʻia ka ʻike o ka atorvastatin i loko o ke koko koko i nā wahine i ka nānā ʻana i ke koko koko i loko o nā kāne (i ka wahine, ʻo ka nui o ka ʻike kiʻekiʻe e like me 20% i kiʻekiʻe, a ʻo AUC - 10% haʻahaʻa). Eia naʻe, ʻaʻohe mau hanana koʻikoʻi o nā clinically i ka hopena i nā pae lipid ma nā kāne a me nā wahine.

ʻAʻole hopena ka maʻi o ka pūpū i ka hoʻomohala ʻana i ka lāʻau i loko o ka plasma a i ʻole ka hopena o ka atorvastatin i nā pae lipid, no laila, ʻaʻohe kumu no ka hoʻoponopono ʻana i nā maʻi maʻi i nā mea maʻi me ka maikaʻi ʻole. ʻAʻole i hoʻopaʻa ʻia nā haʻawina i nā mea maʻi me ka pau ʻole o ka hope o ka moloka; ʻoi paha, ʻaʻole e loli nui ka hemodialysis i ka hoʻomaʻemaʻe o ka atorvastatin, no ka mea, kokoke pau ka pili i ka protein plasma.

Hoʻonui nui ka mea paʻa o ka atorvastatin i loko o ke koko koko (ka nui o ka piʻiʻana - ma kahi o 16 mau manawa, AUC - 11 mau manawa) i nā mea maʻi me ka cirrhosis o ka nui o ka waiʻona etiology.

Lapaʻau lāʻau

ʻO ka Atorvastatin he mea mālama i ka hoʻokūkū koho HMG-CoA reductase-enzyme, e hoʻoponopono ana i ka huli ʻana o HMG-CoA i mevalonate, kahi mea i mua i ka sterol (e pili ana i ka cholesterol (kolesterol)). I nā maʻi me ka homozygous a heterozygous familial hypercholesterolemia, kahi hoʻoilina o ka hypercholesterolemia a me ka dyslipidemia i hui ʻia, hoʻohaʻahaʻa ka atorvastatin i ka kaila o ka kolamu, ka lipoproteins haʻahaʻa haʻahaʻa (LDL) a me ka apolipoprotein B (Apo B). Hōʻemi hoʻi ʻo Atorvastatin i ka hoʻoliʻiliʻi ʻana o nā lipoproteins density haʻahaʻa loa (VLDL) a me nā triglycerides (TG), a ke hoʻonui hou nei i ka ʻike o ka cholesterol kiʻekiʻe lipoproteins kiʻekiʻe (HDL).

Hoʻopili ke Atorvastatin i ka pae o ka kolamu a me nā lipoproteins i loko o ke kaila koko ma ka pale ʻana i ka hoʻōla ʻana o HMG-CoA, synthesis o ka kolamu ma ka ate a hoʻonui i ka nui o nā mea LDL ma ka papa o nā hepatocytes, i hui pū ʻia e ka piʻi aʻe a me ka catabolism o LDL. Hoʻemi ka Atorvastatin i ka hana LDL, kumu i ka hoʻonui a hoʻonui mau i ka hana receptor LDL. Hoʻomaʻamaʻa maikaʻi ʻo Atorvastatin i nā pae LDL i nā mea maʻi me ka hypercholesterolemia homozygous homozygous, ʻaʻole ia e pono e pili ana i ka lāʻau maʻamau me nā lipid-hoʻemi haʻahaʻa.

ʻO ka papa pae mua o ka hana o ka atorvastatin ka ate, ka mea nui i ka hana koʻikoʻi ma ke kāpili ʻana o ka cholesterol a me ka hoʻomaʻemaʻe ʻana o LDL. ʻO ka hōʻemi o ka pae o ka LDL cholesterol i hoʻopaʻa pū me ka nui o ka lāʻau a me ka paʻa ʻana i ke kino.

ʻO Atorvastatin ma kahi o 1080 mg ka hoʻemi ʻana i ka nui o ka kolamu (ma ka 30-46%), ka LDL cholesterol (e ka 41-66%), ʻo Apo B (e 34-50%) a me TG (e 14-33%). Kēia hopena kēia i nā mea maʻi me ka heterzygous famamial hypercholesterolemia, kahi mea i loaʻa i ka hypercholesterolemia a me kahi ʻano o ka hyperlipidemia, me nā mea maʻi me ka non-diabetes-mellitus non-diabetes.

I ka poʻe maʻi me ka hypertriglyceridemia hoʻokaʻawale, hōʻemi ʻo atorvastatin i ka pae o ka kolamu o ka kolamu, LDL cholesterol, VLDL cholesterol, Apo B, TG a hoʻonui i ke kiʻekiʻe o ka HDL cholesterol. I nā maʻi me ka dysbetalipoproteinemia, hoʻemi ka atorvastatin i ka pae o ka cholesterol-hoʻohaʻahaʻa i ka ate.

I ka poʻe maʻi me ka type IIa a me IIb hyperlipoproteinemia (e like me ka helu ʻana o Fredrickson), ka pae kiʻekiʻe o ka hoʻonui ʻana o ka kolamu HDL i ka wā e hoʻohana ai i ka atorvastatin ma kahi pākēpē o 10-80 mg he 5.1–8.7%, ʻaʻohe o ka dosis. Eia kekahi, aia kekahi hōʻemi nui i hilinaʻi nui i ka hoʻohālikelike o ka nui o ka cholesterol / HDL cholesterol a me HDL cholesterol. ʻO ka hoʻohana ʻana o ka atorvastatin e hōʻemi i ka hopena o ka ischemia a me ka make i nā poʻe maʻi me ka myocardial infarction me ka neʻe o ka Q a me ka panghina paʻa ʻole (me ka manaʻo o ka wahine a me ka makahiki o ka pae) i hoʻohālikelike ʻia i ka pae o ka LDL cholesterol.

Hohonuzygous e pili ana i ka hypercholesterolemia ma ka lolo. I nā keikikāne a me nā kaikamahine he 10-17 mau makahiki me ka hechzygous familial hypercholesterolemia a he hypercholesterolemia koʻikoʻi, atorvastatin ma kahi lāʻau o 10-20 mg hoʻokahi manawa i ka lā nui a emi ka nui o ka kolamu o ka kolamu, LDL cholesterol, TG a me Apo B i ka koko koko. Eia naʻe, ʻaʻohe hopena koʻikoʻi i ka ulu ʻana a me ka popo kāne i nā keikikāne a i ʻole ka lōʻihi o ke kau ʻana o nā kāne. ʻO ka palekana a me ka hana pono o nā ʻōpiopio ma luna o 20 mg no ka mālamaʻana i nā keiki ʻaʻole i aʻo ʻia. ʻAʻole i hoʻokumu ʻia ka hopena o ka lōʻihi o ka lāʻau atorvastatin i ka wā kamaliʻi ma ka hōʻemi o ka morbidity a me ka make ma ka pākeke.

ʻLoe a me ke kākele

Ma mua o ka hoʻomaka ʻana i ke ʻano Atorvastatin, pono e hoʻoholo i ke kiʻekiʻe o ka kolamu ma ke koko i ke kūkaʻa ʻana o ka meaʻai kūpono, kuhikuhi i nā hoʻomaʻamaʻa kino a hana i nā hana kūpono e hōʻemi i ke kaumaha o ke kino i nā mea maʻi me ka momona, a me ka hoʻomaʻamaʻa ʻana i ka mālama ʻana no nā maʻi lalo. I ka wā o ka mālama ʻana me ka atorvastatin, pono e hoʻopiʻi nā maʻi i nā meaʻai hypocholesterolemic maʻamau. Ua ʻōlelo ʻia ka lāʻau lapaʻau ma loko o kahi hapa o 1080 mg hoʻokahi i ka lā i kēlā me kēia lā, akā i kēlā me kēia lā, ʻo ke ʻano o ka lā. Hiki ke hoʻokaʻawale ʻia nā ʻōmole mua a me ka mālama e like me ka pae o ka kolamu LDL mua, nā pahuhopu a me ka hopena pono o ka ʻālana. Ma hope o 2 mau hebedoma mai ka hoʻomaka ʻana o ka lāʻau lapaʻau a me / a i ʻole hoʻoponopono ʻia i ka lāʻau me Atorvastatin, pono e kiʻi ʻia kahi kiʻi lipid a e hoʻoponopono ʻia ka ʻōlelo kūpono.

ʻO ka hypercholesterolemia mua a me nā hui pū (a hui ʻia) hyperlipidemia. I ka nui o nā hihia, ua lawa ia e kuhikuhi i kahi lāʻau lapaʻau ma kahi kinona o 10 mg hoʻokahi manawa i ka lā i kēlā me kēia lā. Hoʻopilikia ka hopena hopena ma hope o 2 mau hebedoma, ka hopena kiʻekiʻe - ma hope o 4 hebedoma. Ke kākoʻo ʻia nei nā loli kūpono e ka hoʻohana lōʻihi ʻana o ka lāʻau.

Homozygous familial hypercholesterolemia. ^ E Ha yM. Ua kuhikuhi ʻia ka lāʻau lapaʻau ma loko o kahi waihona ʻo 10 i ka 80 mg hoʻokahi i ka lā i kēlā me kēia lā, i kēlā me kēia manawa, me ke ʻano o ka kō o ka meaʻai. Hoʻomoe paʻa ʻia nā pehu kū mua a me ka mālama ʻana. I ka hapa nui, i nā mea maʻi me ka homozygous hypercholesterolemia homozygous, ua loaʻa ka hopena me ka hoʻohana ʻana o Atorvastatin ma kahi ʻāpana o 80 mg hoʻokahi i ka lā.

ʻO ka hoʻohālikelike familial hypercholesterolemia famerozygous i nā keiki pediatrics (nā maʻi maʻi 10-17 mau makahiki). Hoʻoikaika ʻia ʻo Atorvastatin i ka pane mua.

10 mg hoʻokahi manawa i ka lā. ʻO ka 20 ka nui o ke kau ʻana ma mua o 20 i hoʻokahi lā i kēlā me kēia lā (i hala ʻole nā ​​20 mg ʻaʻole i aʻo ʻia i nā poʻe maʻi o kēia ʻōpiopio). Hoʻonohonoho ʻia ka ʻūpī hoʻokahi, me ka noʻonoʻo ʻana i ke kumu o ka lāʻau lapaʻau, hiki ke hoʻoponopono ʻia ke ʻano me ka manawa o 4 mau hebedoma a ʻehā paha.

Hoʻohana i ka poʻe maʻi me ka maʻi o ka kidney a me ka maikaʻi ʻole. ^ E Ha yM. ʻAʻole hōʻeha ka maʻi o ka pūpū i ka neʻe ʻana o ka atorvastatin a i ʻole ka hoʻēmi ʻana i ka cholesterol LDL plasma, no laila ʻaʻohe kumu o ka hoʻoponopono ʻana i ka dosis.

Hoʻohana i nā mea maʻi maʻi. ^ E Ha yM. ʻAʻohe ʻano ʻokoʻa i ka palekana a me ka pono o ka lāʻau lapaʻau ma ka mālama ʻana i ka hypercholesterolemia i nā poʻe maʻi maʻi a me nā mea maʻi ʻoiaʻiʻo ma hope o ke mau makahiki he 60.

ʻO nā mea maʻi me ka hana pūlima hemahema Ua hoʻoholo ʻia ka lāʻau lapaʻau me ka mālama ʻana i ka pili me ka hoʻolohi ʻana i ka hoʻopau ʻana i ka lāʻau mai ke kino. Hōʻike ʻia ka mana o nā lāʻau lapaʻau a me nā ʻoihana laboratiki, a inā i ʻike ʻia nā loli pathological koʻikoʻi, pono e hoʻemi ʻia ka lāʻau ʻomaʻi ʻole e hoʻopau ʻia ka lāʻau lapaʻau.

Inā hoʻoholo ia ma ka hui pū ʻana o nā Atorvastatin a me CYP3A4 inhibitors, a laila:

E hoʻomaka mau i ka mālama ʻana me ka liʻiliʻi liʻiliʻi (10 mg), e nānā pono i ka mālama ʻana i nā lipum serum ma mua o ka ʻimi ʻana i ka ʻono.

Hiki iā ʻoe ke ho'ōki iki i ka lawe ʻana i ka Atorvastatin inā he CYP3A4 inhibitors i kuhikuhi ʻia i loko o kahi papa pōkole (no ka laʻana, he ala pōkole o kahi antibiotic e like me clarithromycin).

ʻO nā ʻōlelo ʻōlelo e pili ana i nā iniha nui loa o Atorvastatin i ka wā e hoʻohana ai:

me ka cyclosporine - ʻaʻole pono ka nui o ka momona ma mua o 10 mg,

me ka clarithromycin - ʻaʻole pono ka nui o ka momona ma mua o 20 mg,

me itraconazole - ʻaʻole pono ʻo ka pona eʻoi aku ma mua o 40 mg.

Hoʻopili i nā lāʻau lapaʻau

Hoʻopili ʻia ka pilikia o ka myopathy i ka wā e mālama ai me nā lāʻau ʻē aʻe o kēia papa aʻo ka hoʻohana ʻana i ka cyclosporine, ka poʻe i loaʻa i ka fibric acid, erythromycin, antifungals e pili ana i ka azoles, a me ka nicotinic acid.

ʻĀpono: i ka manawa o ka hoʻokaʻina ʻana o nā mea hoʻōla i loaʻa me ka konupera a me ka konohiko alumina e hoʻoneʻe ana i ka kukuna o ka atorvastatin i loko o ke koko koko ma kahi o 35%, akā naʻe, ʻaʻole i loli ka nui o ke kahe ʻana o ka LDL cholesterol.

Hoʻopau: ʻAʻole pili ʻo Atorvastatin i ka pharmacokinetics o antipyrine, no laila, ʻaʻole i kali ʻia ka launa pū me nā lāʻau ʻē aʻe i hoʻoliʻiliʻi ʻia e ka cytochrome samaenzymes.

Malikia i ka noiʻi ʻana o nā hana o ka lāʻau lapaʻau i nā kānaka olakino, ka hoʻomohala ʻana i ka atorvastatin i ka nui o 80 mg a me amlodipine ma ke ʻano o ka 10 mg i alakaʻi i ka hoʻonui o ka hopena o ka atorvastatin ma ka 18%, ʻaʻole ia no ka hoʻopulapula.

Halohahulaʻa: ma muli o ka hoʻonui nui o ka hoʻomohala ʻana i ka myopathy / rhabdomyolysis me ka hoʻohana pū ʻana o HMG-CoA reductase inhibitors me gemfibrozil, ʻokoʻa ka hoʻokaʻawale ʻana o kēia mau lāʻau.

Nā mea ʻē aʻe: ma muli o ka hoʻonui nui o ka myopathy / rhabdomyolysis me ka hoʻohana pū ʻana o ka HMG-CoA reductase inhibitors me nā fibrates, pono ke kuhikuhi atorvastatin me ka mālama ʻana i ka wā e lawe ai i nā fibrates.

ʻO ka waikawa Nicotinic (niacin): hiki ke hoʻonui i ka hopena o ka hoʻomohala ʻana i ka myopathy / rhabdomyolysis i ka wā e hoʻohana ai i ka atorvastatin i hui pū ʻia me ka acid nicotinic, no laila, i kēia kūlana, pono e noʻonoʻo e noʻonoʻo i ka hoʻēmi ʻana i ka hewa o atorvastatin.

Kieolol: me ka hoʻohana pū ʻana o colestipol, ua hoʻemi ʻia ka nui o ka atorvastatin i loko o ke koko koko e pili ana i 25%. Eia nō naʻe, ʻoi aku ka hopena o ka lipid-hoʻemi ʻana i ka hui o ka atorvastatin a me colestipol i kēlā me kēia pālolo.

Nūpepa: me ka hana like o ka atorvastatin me colchicine, ua hōʻike ʻia nā hihia o myopathy, me ka rhabdomyolysis, no laila, pono e hana ka akahele ʻana i ka wā e kuhikuhi ana i ka atorvastatin me colchicine.

Hōʻākena: me ka hoʻokele pinepine ʻana o ka digoxin a me atorvastatin ma kahi maʻa o 10 mg, ʻaʻole i loli ka manaʻo o ka ekiole ʻana o ka digoxin i loko o ke koko koko. Eia naʻe, i ka manawa i hoʻohana ʻia ka digoxin i hui pū me ka atorvastatin ma kahi maʻa o 80 mg / lā, hoʻonui ʻia ka ʻike o ka digoxin ma kahi o 20%. ʻO nā maʻi e loaʻa ana i ka digoxin i hui pū me ka atorvastatin e pono ai ka nānā pono.

Erythromycin / clarithromycin: me ka hoʻohana ʻana o ka atorvastatin a me ka erythromycin (500 mg ʻehā mau manawa i ka lā) a i ʻole clarithromycin (500 mg ʻelua i kēlā lā i kēia lā), kahi e hoʻokaʻawale ai i ka cytochrome P450 ZA4, kahi hoʻonui i ka ʻike o ka atorvastatin i loko o ke kahe koko.

Hoʻolilima: me ka hana like o ka atorvastatin (10 mg hoʻokahi i ka lā) a me ka azithromycin (500 mg / hoʻokahi i ka lā), ʻaʻole i loli ka ulu ʻana o ka atorvastatin i ka plasma.

Kepono: me ka hana like o ka atorvastatin a me terfenadine, ʻaʻole i ʻike ʻia nā loli koʻikoʻi i ka pharmacokinetics o terfenadine.

Hoʻolaha kūlohelohe: ʻOiai e hoʻohana ana i ka atorvastatin a me ka mea hoʻomalu waha e loaʻa ana i ka norethindrone a me ka ethinyl estradiol, he nui nui ka nui o ka AUC o norethindrone a me ka ethinyl estradiol i nānā ma kahi o 30% a 20%, kahi. Pono e noʻonoʻo ʻia kēia hopena i ke koho ʻana i kahi contraceptive ā waha no ka wahine e lawe ana i ka atorvastatin.

ʻO Warfarin: i ke aʻo ʻana i ka paio o ka atorvastatin me warfarin, ʻaʻohe hōʻailona o ka hui koʻikoʻi nui i loaʻa.

Peneiid i ka wā e noiʻi ana i ka hoʻopili ʻana o ka atorvastatin me ka cimetidine, ʻaʻohe mau hōʻailona o nā pilina koʻikoʻi i loaʻa i ka maʻi.

Nā kahu hōʻike: ka hana like o atorvastatin me nā protease inhibitors i ʻike ʻia ka cytochrome P450 ZA4 inhibitors i hoʻohui ʻia e ka piʻi ʻana o ka hiki ʻana o ka plasma o atorvastatin.

ʻO nā ʻōlelo hoʻomohala no ka hoʻohana like ʻana o ka atorvastatin a me ka HIV protease inhibitors:

E hoʻokuʻu i ke ʻano a me ka ʻano

Hāʻawi ʻia ke huahana huahana i loko o ke ʻano o nā papa i loko o nā lāʻau lapaʻau. ʻO ka mea ikaika o ka lāʻau lapaʻau ka atorvastatin calcium trihydrate (40 mg i kēlā me kēia papa.

Nā kumuwaiwai hou: microcrystalline cellulose, calcium carbonate, StarKap 1500 complex (pregelatinized starch and mais starchate), aerosil, magnesium stearate, titanium dioxide, talc, macrogol, ʻeleʻeleʻulaʻula, iron oxide, yellow dye, iron oxide, polyvinyl alkohol).

Aia ka helu i ka helu 1.2 a i ʻole 3 blisters o 10.15 a i ʻole 30 papa.

Hoʻohui nūhou

ʻO ka hoʻohana like pū me nā ʻenehana antibacterial (erythromycin, clarithromycin), nā lāʻau antifungal (fluconazole, ketoconazole, itraconazole), cyclosporine, derivatives waikawa fibroic e hoʻonui i ka konsentrasi o ka atorvastitis a me ka hopena o ka hoʻomohala ʻana i ka myalgia.

ʻO ka hoʻohana pū ʻana me nā mea hoʻoluhi, i komo ai ka magnesium a me alumini, ua hoʻopiʻi i ka hoʻemi ʻana o ka ʻike o ka atorvastatin. ʻAʻole pili kēia i ke kiʻekiʻe o ka hoʻohaʻahaʻa i ka cholesterol a me nā lipoproteins haʻahaʻa haʻahaʻa.

Pono nā wahine e lawe i nā kūmole waha e noʻonoʻo i ka atorvastatin e hoʻonui i ka ʻike o ka ethinyl estradiol a me ka norethindrone.

ʻO kahi hui e koi ana i ka akahele: ka hui ʻana o ka atorvastatin me nā lāʻau lapaʻau e kōkua i ka hoʻemi ʻana i ka kaomi o nā ʻenekone steroid (spironolactone, ketoconazole).

ʻAʻole i mālama ʻia nā pilina o ka atorvastatin me nā lāʻau antihypertensive.

ʻO ka hana lāʻau lapaʻau ma atorvastatin 40

Ua hoʻākāka ka ʻano ikaika o ka lāʻau i ka hana lipid-lowing a komo i ka māhele o statins. Hoʻopili ka māhele i ka hoʻoneʻe ʻana o HMG-CoA, kahi enzyme kikoʻī e hoʻololi ai i ka type A hydroxymethylglutaryl coenzyme i ka mevalonic acid.

Hoʻemi ka lāʻau lapaʻau i ka hoʻokumu ʻana o LDL (haʻahaʻa lipoproteins haʻahaʻa) a hoʻonui i ka kiʻekiʻe o ka hana o nā receptors LDL. Eia kekahi, i nā mea maʻi me ka hypercholesterolemia, hōʻemi ka lāʻau i ka LDL.

Hoʻopohopo, hoʻēmi i ka lāʻau lapaʻau i ka pae o Ho (ka nui a me ka hoʻonui ʻana i ka cholesterol o nā lipoproteins density kiʻekiʻe (HDL).

Loaʻa iā Atorvastatin kahi haʻawina kiʻekiʻe. Loaʻa ʻo Statin i ka plasma i kona hoʻokehi nui loa ma 60-120 mau minuke. ʻAi liʻiliʻi ka liʻiliʻi o ka ʻai ʻana o ka lāʻau lapaʻau.

Loaʻa ia mau mea ka bioavailability o 12%. Hoʻomili ka mea waiwai i nā kiko o ke ake. Hoʻopili ʻia ka lāʻau lapaʻau me ka hua bile. ʻO ka hapalua hapalua o ka atorvastatin he 14 mau hola. Ma kahi o 2% o ka lāʻau lapaʻau i hoʻopā ʻia e nā keiki. ʻAʻole pili ʻo Hemodialysis i ka pōkole pharmacokinetic o ka lāʻau lapaʻau.

Nā ʻōlelo kikoʻī

Hiki i ke Atorvastatin ke hoʻonui i ka hoʻonui ʻana i ka CPK serum, pono ia e mālama i ka hopena ʻē aʻe o ka ʻeha o ka umauma. Pono e noʻonoʻo i ka hoʻonui ʻana o ka CPK ma o 10 mau manawa i hoʻohālikelike ʻia me ke ʻano maʻamau, i hele pū me ka myalgia a me nā nāwaliwali o ka naʻau e pili me myopathy, pono e hoʻokuʻu ʻia ka mālama ʻana.

Me ka hoʻohana pū ʻana o ka atorvastatin me ka cytochrome CYP3A4 protease inhibitors (cyclosporine, clarithromycin, itraconazole), pono ka hoʻomaka mua ʻana me ka 10 mg, me ka papa pōkole o nā ʻano lāʻau lapaʻau, pono e hoʻokuʻu ʻia ʻo atorvastatin.

Pono e kiaʻi mau i nā hōʻailona o ka hana o ka ate ma mua o ka hoʻōla, 6 a me 12 mau pule ma hope o ka hoʻomaka ʻana o ka lāʻau lapaʻau a ma hope paha o ka hoʻonui ʻana i ka nui, a me kēlā manawa (ʻo kēlā me kēia 6 mau mahina) i ka manawa holoʻokoʻa o ka hoʻohana (a hiki i ka maʻamau maʻamau o ke ʻano o nā mea maʻi o nā pae o ka transaminase ma mua o ka maʻamau. ) Hoʻonui ʻia ka hoʻonui ʻana i ka transaminases hepatic i ka 3 mau mahina o ka hoʻokele lāʻau. Manaʻo ʻia e kāpae i ka lāʻau lapaʻau a hōʻemi paha i ka maʻi me ka piʻi o AST a me ALT ma mua o 3 mau manawa. ʻO ka hoʻohana ʻana o ka atorvastatin e hoʻoleʻaleʻa i kahi manawa inā loaʻa ka hoʻomohala ʻana i nā hōʻailona lapaʻau e hōʻike ana i ka noho ʻana o ka myopathy akula, a i ʻole mua ʻana o nā mea i manaʻo ʻia i ka hoʻomohala ʻana i ka hana ʻoi ʻana o ka maʻi kaulike ma muli o ka rhabdomyolysis (nā hopena koʻikoʻi, ka hoʻemi ʻana i ke koko, ka hōʻemi nui, trauma, metabolic, endocrine a i ʻole ka hoʻopilikia i ka electrolyte) . ^ E Ha yM. Hoʻomaʻamaʻa ʻia nā mea maʻi e pono koke lākou e kūkā i ke kauka inā ʻaʻole i loaʻa ka ʻeha a i ʻole nā ​​nāwaliwali o ka naʻau, ʻoiai inā e hele pū lākou me ka malaise a me ka maʻi maʻi.