Atorvastatin, 20 mg, film-coated tablets, 30 pcs.

Atorvastatin - description and action

Atorvastatin

- a drug from the group of statins (lipid-lowering drugs), tablets for oral administration.
The active substance is atorvastatin calcium, an inhibitor of the specific enzyme HMG CoA reductase. Tablets of 0.01-0.08 g are produced by various pharmaceutical companies, CanonPharma, Severnaya Zvezda and many others. They differ not only in manufacturer, but also in price. For example, you can buy the drug Atorvastatin-MS (“Medisorb”) for 80 rubles (30 tablets)
. For comparison, Atorvastatin-Vertex costs 180 rubles for the same package of 30 tablets.

The additional components are:

• lactose monohydrate;
• calcium carbonate;

• primellose;
• povidone K30;
• dye;
• silicon dioxide, etc.

The medicine has a pronounced hypolipidemic effect. It inhibits the enzyme that helps convert cholesterol precursors into this substance. In patients with various forms of hyperlipidemia, atorvastatin reduces the amount of cholesterol in the blood and normalizes the level of low and very low density lipoproteins (LDL, VLDL). The medicine also inhibits the production of triglycerides and has a positive effect on the indicator of “good” cholesterol (this is considered high-density lipoprotein, HDL).

The drug is able to make blood less viscous, as it reduces the process of platelet adhesions.

Atorvastatin tablets are prescribed to lower cholesterol, as well as to optimize hemodynamics and normalize the blood coagulation system.

Its long-term use is a powerful factor in preventing the appearance of atherosclerotic plaques.

Summary table with price comparison

Indications for use

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The medicine can only be taken with a doctor's prescription; indications for use are strictly limited. Most often it is recommended to patients of older age groups to prevent complications associated with the presence of heart and vascular diseases. The drug is indicated for atherosclerosis of the coronary and cerebral vessels, in the presence of ischemic heart disease, as well as when the body is exposed to risk factors for the development of these pathologies:

• elderly age;
• diabetes;
• genetic disposition;
• long-term smoking;
• hypertension.

The medicine is also prescribed for secondary prevention of pathologies of the heart and blood vessels, when the diseases have already led to negative consequences (for example, after myocardial infarction). Other indications for the use of Atorvastatin are:

• familial or other forms of primary hyperlipidemia at any age;
• mixed hyperlipidemia;
• disturbance of protein and fat metabolism;
• familial hypertriglyceridemia.

An increase in blood cholesterol of any etiology that is not amenable to dietary correction is also a reason for prescribing these tablets.

Where to buy analogues of Atorvastatin?

You can order medications online cheaper. The most trusted and largest online pharmacy chains are:

1. "Apteka.ru" - (https://apteka.ru). For comparison, let's imagine the prices of some tablets. “Atorvastatin-SZ” 10 mg 30 tablets – 147 rubles, “Tulip” 10 mg 30 tablets – 283 rubles.
2. (https://wer.ru) - “Atorvastatin-SZ” - 138 rubles, “Tulip” - 261 rubles.

In Moscow

Pharmacies in Moscow where you can always buy lipid-lowering drugs at a low price:

1. "Rigla", metro Paveletskaya, emb. Derbenevskaya, building 22. Phone: 8-800-777-03-03.
2. "EAPteka", metro Avtozavodskaya, st. Masterkova, 3. Phone: 8-800-775-03-33.

In St. Petersburg

1. "Rigla", metro station Kupchino, st. Balkanskaya, 17. Phone: 8-800-777-03-03.
2. "Ozerki", metro station Begovaya, st. Turistskaya, 10. Phone: 8-812-603-00-00.

Instructions for use

It is better to check with your doctor for how long, how much and in what dosage to take the drug - despite the clear instructions in the instructions, an individual approach is important. The drug can be taken without dependence on food - there will be no difference in effectiveness. It is advisable to combine treatment with diet and exercise, otherwise the effect of taking the drug will be temporary - until its effect wears off.

It is also important to correct body weight and treat the underlying disease (coronary artery disease, diabetes, etc.).

The drug is taken 10-80 mg once a day, depending on the level of cholesterol in the blood.

Typically, therapy is started with a minimum dosage of 10 mg, then a control study of the lipid profile is carried out after 14-28 days, after which the drug is left at the same dosage or increased. Effectiveness reaches its maximum after 3-4 weeks, usually cholesterol is reduced by 10-50%. Special instructions for therapy:

• Prescribe medication with caution and in small doses for liver dysfunction;
• No dose changes are required for renal failure.

For elderly people, there are no differences in doses with the general population of patients. The lowest dosage is prescribed when taking drugs against HIV, hepatitis C, a number of antifungals and antibiotics.

Interaction with other drugs

When taking Atorvastatin simultaneously with:

• suspensions containing magnesium and aluminum - the concentration of Atorvastatin in plasma decreases;
• erythromycin or clarithromycin - the concentration of Atorvastatin in plasma increases;
• contraceptives containing ethinyl estradiol and norethindrone - the AUC of ethinyl estradiol and norethindrone increases significantly;
• medications that reduce the level of endogenous steroid hormones - the risk of reducing the level of endogenous steroid hormones increases;
• protease inhibitors - the concentration of Atorvastatin in plasma increases.

Side effects, contraindications

The list of contraindications includes age under 18 years, lactation, pregnancy, hypersensitivity to components, soy and peanuts, as well as the following conditions:

• acute liver diseases;
• lactase deficiency;
• muscle pathologies;
• dehydration, electrolyte imbalance;
• thyrotoxicosis;

• sepsis;
• hypotension;
• uncontrolled epilepsy;
• severe injuries, period after operations.

Despite the benefits, the harm of the drug is also manifested in its side effects, which are quite common. Many patients develop headaches, dizziness, and insomnia. There is information about nosebleeds, tinnitus, pharyngitis, and rhinitis.

If you are prone to arrhythmias, there is a high risk of increased unpleasant symptoms. The number of platelets in the blood may decrease. Chest pain, cramps, dyspepsia, jaundice, joint pain, myositis, and potency disorders often occur. Sometimes hair loss, a rash on the body are recorded, and very rarely - anaphylaxis. If severe side effects develop, treatment should be stopped immediately.

Atorvastatin

Before starting therapy with Atorvastatin, the patient must be prescribed a standard cholesterol-lowering diet, which he must follow during the entire treatment period.

If severe adverse effects occur, use of Atorvastatin should be discontinued.

Effect on the liver

As with the use of other lipid-lowering drugs of this class, after treatment with atorvastatin, a moderate (more than 3 times compared to the upper limit of normal) increase in the serum activity of “liver” transaminases AST and ALT was noted. A persistent increase in serum activity of “liver” transaminases (more than 3 times compared with the upper limit of normal) was observed in 0.7% of patients receiving Atorvastatin. The incidence of such changes when using the drug in doses of 10 mg, 20 mg, 40 mg and 80 mg was 0.2%, 0.2%, 0.6% and 2.3%, respectively. Increased activity of liver transaminases was usually not accompanied by jaundice or other clinical manifestations. When the dose of atorvastatin was reduced, or the drug was temporarily or completely discontinued, the activity of “liver” transaminases returned to the original level. Most patients continued to take atorvastatin at a reduced dose without any clinical consequences.

Before starting therapy, 6 weeks and 12 weeks after starting the use of Atorvastatin or after increasing its dose, as well as during the entire course of treatment, liver function tests should be monitored. Liver function should also be monitored when clinical signs of liver damage appear. If the activity of “liver” transaminases increases, their activity should be monitored until it returns to normal. If the increase in AST or ALT activity by more than 3 times compared to the upper limit of normal persists, a dose reduction or discontinuation of the drug is recommended (see section “Side Effects”). Atorvastatin should be used with caution in patients who consume significant amounts of alcohol and/or have a history of liver disease. Active liver disease or persistently increased activity of “liver” transaminases in the blood plasma of unknown origin are a contraindication to the use of Atorvastatin (see section “Contraindications”).

Action on skeletal muscles

Myalgia was observed in patients receiving atorvastatin (see section "Side effects"). The diagnosis of myopathy (muscle pain and weakness in combination with an increase in CPK activity more than 10 times the upper limit of normal) should be considered in patients with diffuse myalgia, muscle soreness or weakness and/or a marked increase in CPK activity (more than 10 times the upper limit of normal). times compared to the upper limit of normal). Therapy with Atorvastatin should be discontinued in the event of a marked increase in CPK activity or in the presence of confirmed or suspected myopathy. The risk of myopathy during treatment with drugs of this class increased with simultaneous use of potent inhibitors of the CYP3A4 isoenzyme (cyclosporine, telithromycin, clarithromycin, delavirdine, stiripentol, ketoconazole, voriconazole, itraconazole, posaconazole and HIV protease inhibitors, including ritonavir, lopinavir, atazanavir, indinavir, darunavir and etc.), gemfibrozil or other fibrates, boceprevir, erythromycin, nicotinic acid in lipid-lowering doses (more than 1 g/day), ezetimibe, azole antifungals, colchicine, telaprevir or the tipranavir/ritonavir combination. Many of these drugs inhibit CYP3A4-mediated metabolism and/or drug transport. It is known that the CYP3A4 isoenzyme is the main liver isoenzyme involved in the biotransformation of atorvastatin. When prescribing Atorvastatin in combination with fibrates, erythromycin, immunosuppressants, azole antifungals or nicotinic acid in lipid-lowering doses (more than 1 g/day), the doctor must carefully weigh the expected benefits of treatment and the possible risks. Patients should be monitored regularly for muscle pain or weakness, especially during the first months of treatment and during periods of increasing dosage of any of these drugs. If combination therapy is necessary, the use of these drugs in lower initial and maintenance doses should be considered. The simultaneous use of atorvastatin and fusidic acid is not recommended, therefore it is recommended to temporarily discontinue atorvastatin during treatment with fusidic acid. In such situations, periodic determination of CPK activity can be recommended, although such monitoring does not prevent the development of severe myopathy (see section “Interaction with other drugs”).

Before treatment

Atorvastatin should be prescribed with caution to patients with factors predisposing to the development of rhabdomyolysis. Monitoring of CPK activity should be carried out in the following cases before starting atorvastatin therapy:

- renal dysfunction;

- hypothyroidism;

- the patient has a history or family history of hereditary muscle disorders; past toxic effects of HMG-CoA reductase inhibitors (statins) or fibrates on muscle tissue;

- history of liver disease and/or in patients who drink alcohol in significant quantities;

- in patients over the age of 70 years, the need for CPK control should be assessed, given the fact that they already have factors predisposing to the development of rhabdomyolysis;

- situations in which an increase in the concentration of atorvastatin in the blood plasma is expected, such as interactions with other drugs (see section “Interactions with other drugs”).

In such situations, the risk/benefit ratio should be assessed and medical monitoring of the patient's condition should be carried out.

In the case of a significant (more than 5 times the upper limit of normal) increase in CPK, atorvastatin therapy should not be prescribed.

When using atorvastatin, as well as other HMG-CoA reductase inhibitors (statins), rare cases of rhabdomyolysis with acute renal failure caused by myoglobinuria have been described. A risk factor for the development of rhabdomyolysis may be pre-existing renal impairment. Such patients should be provided with more careful monitoring of the musculoskeletal system. If symptoms of possible myopathy occur or there are risk factors for the development of renal failure secondary to rhabdomyolysis (for example, severe acute infection, hypotension, major surgery, trauma, metabolic, endocrine and fluid disturbances, and uncontrolled seizures), therapy with Atorvastatin should be temporarily discontinued or cancel completely.

In the differential diagnosis of chest pain, one should take into account the possibility of an increase in serum CPK activity when using the drug Atorvastatin.

Attention! Patients should be warned to seek immediate medical attention if they experience unexplained pain or muscle weakness, especially if accompanied by malaise or fever.

Stroke Prevention Through Active Cholesterol Lowering
( SPARCL )
In a retrospective analysis of stroke subtypes, a higher incidence of hemorrhagic stroke was observed in patients without coronary artery disease with a recent stroke or transient ischemic attack initially treated with atorvastatin 80 mg. compared with patients receiving placebo. A particularly high risk was observed in patients with a history of hemorrhagic stroke or lacunar infarction at the start of the study. For this group of patients, the benefit/risk ratio of taking atorvastatin at a dose of 80 mg is not well defined, and therefore the potential risk of hemorrhagic stroke should be carefully assessed before starting treatment.

After a special analysis of a clinical trial involving 4,731 patients without coronary artery disease who had a stroke or transient ischemic attack (TIA) within the previous 6 months who were prescribed atorvastatin at a dose of 80 mg/day, a higher incidence of hemorrhagic stroke was found in the atorvastatin 80 mg group. compared with the placebo group (55 in the atorvastatin group versus 33 in the placebo group). Patients with hemorrhagic stroke at study entry had a higher risk of recurrent hemorrhagic stroke (7 in the atorvastatin group versus 2 in the placebo group). However, patients receiving atorvastatin 80 mg/day had fewer strokes of any type (265 vs. 311) and fewer cardiovascular events (123 vs. 204).

Diabetes

Some evidence suggests that HMG-CoA reductase inhibitors (statins), as a class, may lead to elevated plasma glucose concentrations, and some patients at high risk for developing diabetes mellitus may develop a hyperglycemic state requiring treatment as in diabetes mellitus. However, this risk does not outweigh the benefits of therapy with HMG-CoA reductase inhibitors (statins) in terms of vascular risks, so this cannot be a reason to discontinue therapy. Patients at risk (fasting blood glucose concentration from 5.6 to 6.9 mmol/l, body mass index more than 30 kg/m2, increased concentration of triglycerides in blood plasma, arterial hypertension) should be under medical supervision, including monitoring of blood biochemical parameters, in accordance with local recommendations.

Interstitial lung disease

During therapy with certain HMG-CoA reductase inhibitors (statins), especially during long-term therapy, isolated cases of interstitial lung disease have been reported. Shortness of breath, nonproductive cough, and deterioration in general health (fatigue, weight loss, and fever) may occur. If interstitial lung disease is suspected in a patient, atorvastatin therapy should be discontinued.

Endocrine function

When using HMG-CoA reductase inhibitors (statins), including atorvastatin, there have been cases of increased glycosylated hemoglobin (HbAl) and fasting plasma glucose concentrations. However, the risk of hyperglycemia is lower than the degree of reduction in the risk of vascular complications while taking HMG-CoA reductase inhibitors (statins).

The drug Atorvastatin contains lactose, and therefore its use in patients with lactase deficiency, lactose intolerance and glucose-galactose malabsorption syndrome is contraindicated.

Peculiarities

Before starting treatment with Atorvastatin, it is recommended to reduce cholesterol through a special diet.

Before starting the administration of the drug Atorvastatin, it is recommended to try on your own to normalize the cholesterol level in the patient’s plasma. This process is carried out through a transition to a specific gentle diet and nutritional adjustments.

The initial use of the drug in some cases provokes the development of pain in the muscles and joints, which leads to the formation of myopathy. If such signs of disease development are detected, the drug should be abruptly stopped.

While using Atorvastatin, it is not recommended to drive a vehicle or perform activities that require alertness. The medicine tends to negatively affect brain activity for a short period of time.