Novostat, 20 mg capsules 30 pcs

Synthetic hypolipidemic drug. Atorvastatin is a selective competitive inhibitor of Z-hydroxy-3-methylglutaryl-CoA reductase (HMG-CoA reductase), the key enzyme that converts 3-hydroxy-3-methylglutaryl-CoA to mevalonate – a precursor of sterols, including cholesterol.

. In patients with homozygous and heterozygous familial hypercholesterolemia, nonfamilial forms of hypercholesterolemia and mixed dyslipidemia, atorvastatin reduces plasma concentrations of total cholesterol (TC) low density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apo-B), as well as very low density lipoprotein cholesterol (VLDL-C) and triglycerides (TG), causes unstable increase of high density lipoprotein cholesterol (HDL-C) concentration.

Atorvastatin reduces plasma concentrations of cholesterol and lipoproteins by inhibiting HMG-CoA reductase and cholesterol synthesis in the liver and by increasing the number of “hepatic” LDL receptors on the cell surface, which leads to increased capture and catabolism of LDL-C.

Atorvastatin decreases formation of LDL-C and the number of LDL particles, causes a pronounced and sustained increase in LDL receptor activity in combination with favorable qualitative changes in LDL particles and decreases LDL-C concentration in patients with homozygous hereditary familial hypercholesterolemia that is resistant to therapy with other hypolipidemic agents.

Atorvastatin in doses from 10 mg to 80 mg reduces total cholesterol concentration by 30-46%, LDL-C by 41-61%, Apo-B by 34-50% and TG by 14-33%.

The results of therapy are similar in patients with heterozygous familial hypercholesterolemia, non-familial forms of hypercholesterolemia and mixed hyperlipidemia, including patients with type 2 diabetes.
In patients with isolated hypertriglyceridemia atorvastatin reduces the concentration of total cholesterol, LDL-C, LDL-C, apo-B and TG and increases HDL-C concentration.

In patients with dysbetalipoproteinemia atorvastatin decreases the concentration of intermediate density lipoprotein cholesterol. In patients with hyperlipoproteinemia of IIa and IIb type according to Fredrickson a mean value of increasing of HDL-C concentration during Atorvastatin treatment (10-80 mg) in comparison with initial index is 5,1-8,7% and it does not depend on dose. There is a significant dose-dependent decrease in the values of ratios: total cholesterol/CHD-LBP and CHD-LBP/CHD-LBP by 29-44% and 37-55%, respectively.

Atorvastatin at a dose of 80 mg significantly reduced the risk of coronary complications and the mortality rate by 16% after a 16-week course, and the risk of re-hospitalization for angina with signs of myocardial ischemia by 26%.

In patients with different baseline concentrations of LDL-C, atorvastatin causes decreased risk of ischemic complications and mortality (in patients with myocardial infarction without Q-wave and unstable angina, as well as in men and women, and in patients aged younger and over 65 years). The decrease in plasma concentration of LDL-C better correlates with the dose of the drug than with its plasma concentration.

The dose is chosen taking into account the therapeutic effect. The therapeutic effect is achieved 2 weeks after the start of therapy, reaches a maximum after 4 weeks and lasts for the duration of therapy.

Atorvastatin at a dose of 10 mg reduces fatal and nonfatal outcomes of coronary heart disease (CHD) compared to placebo in patients with arterial hypertension with three or more risk factors.

Pharmacokinetics

Intake

Atorvastatin is rapidly absorbed after oral administration: time to reach its maximum concentration (TSmax) in blood plasma is 1-2 h. In women maximal Atorvastatin concentration (Cmax) is 20% higher and area under the curve “concentration-time” (AUC) is 10% lower than in men.

The degree of absorption and plasma concentration increase in proportion to the dose. The absolute bioavailability is about 14% and the systemic bioavailability of HMG-CoA reductase inhibitory activity is about 30%. Low systemic bioavailability is due to presystemic metabolism in the mucosa of the gastrointestinal tract and/or during “primary passage” through the liver.

Eating slightly reduces speed and degree of drug absorption (by 25% and 9%, respectively, as evidenced by the results of Cmax and AUC determination), but decrease of LDL-C is similar to that of atorvastatin on an empty stomach. Despite the fact that after Atorvastatin administration in the evening its plasma concentration is lower (Cmax and AUC, approximately by 30%) than after administration in the morning, decrease of LDL-C concentration does not depend on the time of day, when the drug is taken.

Distribution

The mean volume of distribution of atorvastatin is about 381 liters. The binding to plasma proteins is at least 98%. The ratio of content in erythrocytes/plasma is about 0.25, i.e. atorvastatin poorly penetrates into erythrocytes.

Metabolism

Atorvastatin is largely metabolized with the formation of ortho- and parahydroxylated derivatives and various β-oxidation products. In vitro ortho- and parahydroxylated metabolites have an inhibitory effect on HMG-CoA reductase comparable with that of atorvastatin.

About 70% of the decrease of HMG-CoA reductase activity is due to the action of active circulating metabolites. Results of in vitro studies suggest that hepatic CYP3A4 isoenzyme plays an important role in atorvastatin metabolism. This fact is supported by increase of plasma concentration of atorvastatin in concomitant administration of erythromycin, which is an inhibitor of this isoenzyme.

In vitro studies have also shown that atorvastatin is a weak inhibitor of CYPCA4 isoenzyme. Atorvastatin has no clinically significant effect on plasma concentrations of terfenadine, which is metabolized primarily by CYP3A4 isoenzyme, therefore its significant effect on pharmacokinetics of other CYP3A4 isoenzyme substrates is unlikely.

Atorvastatin and its metabolites are excreted mainly through the intestine with bile after hepatic and/or extrahepatic metabolism (atorvastatin does not undergo marked intestinal-hepatic recirculation). The elimination half-life (T1/2) is approximately 14 hours, while the inhibitory effect of the drug against HMG-CoA reductase is approximately 70% determined by the activity of circulating metabolites and persists for about 20-30 hours due to their presence. After oral administration, less than 2% of the administered dose of the drug is detected in the urine.

Particular groups of patients

Elderly patients

Atorvastatin concentrations in plasma of patients over 65 years old are higher (Cmax approximately by 40%, AUC approximately by 30%) than those of adult patients of younger age.
No differences in efficacy and safety of the drug, or achievement of goals of hypolipidemic therapy in elderly patients compared to general population have been found.

Children

There have been no studies of pharmacokinetics of the drug in children.

Inadequate renal function

Atorvastatin concentration in plasma or effect on lipid metabolism indicators do not influence renal function impairment, therefore no dose change is required in patients with impaired renal function.Atorvastatin is not excreted during hemodialysis due to intensive binding to plasma proteins.

Hepatic impairment

The concentration of atorvastatin is significantly increased (Cmax approximately 16-fold, AUC approximately 11-fold) in patients with alcoholic cirrhosis (class B according to Child-Pugh classification).

Indications

Active ingredient

Composition

How to take, the dosage

Interaction

Special Instructions

Before starting therapy with Novostat, the patient should be prescribed a standard hypocholesterolemic diet, which must be followed during the entire period of treatment.

The use of HMG-CoA reductase inhibitors to reduce blood lipid concentrations may lead to changes in biochemical parameters reflecting liver function. Liver function should be monitored before initiation of therapy, 6 weeks, 12 weeks after initiation of Novostat and after each dose increase, as well as periodically, such as every 6 months.

Elevated serum hepatic enzyme activity may be observed during therapy with Novostat.
Patients with elevated enzyme activity should be monitored until enzyme activity returns to normal. In case of persistent increase of ALT or ACT activity to a level more than 3 times VGN, it is recommended to reduce the dose of Novostat or discontinue treatment.

Novostat should be used with caution in patients who abuse alcohol and/or have liver disease. Active liver disease or persistent elevation of aminotransferase activity of unclear genesis are contraindications to prescription of Novostat.

Treatment with Novostat, as well as other HMG-CoA reductase inhibitors, may cause myopathy. The diagnosis of myopathy (muscle pain and weakness combined with an increase in CPK activity of more than 10 times that of HGH) should be discussed in patients with widespread myalgia, muscle soreness or weakness and/or a marked increase in CPK activity.

Patients should be cautioned to inform their physician immediately of unexplained muscle pain or weakness if accompanied by malaise or fever. Novostat therapy should be discontinued if there is a marked increase in CPK activity or if there is confirmed or suspected myopathy.

The risk of myopathy during treatment with other drugs of this class was increased with concomitant use of cyclosporine, fibrates, erythromycin, nicotinic acid in lipid-lowering doses (more than 1 g/day) or azole antifungals. Many of these drugs inhibit cytochrome P4503A4-mediated metabolism and/or drug transport. Atorvastatin is biotransformed by the CYP3A4 isoenzyme.

When prescribing Novostat in combination with fibrates, erythromycin, immunosuppressive agents, azole antifungal agents or nicotinic acid in lipid-lowering doses (more than 1 g/day), the expected benefits and risks of treatment should be carefully weighed and patients should be regularly observed to detect muscle pain or weakness, especially during the first months of treatment and during dose increases of any drug. In such situations, periodic determination of CPK activity may be recommended, although such monitoring does not prevent the development of severe myopathy.

In the use of Novostat, as well as other drugs of this class, cases of rhabdomyolysis with acute renal failure due to myoglobinuria have been described. Novostat therapy should be temporarily discontinued or completely stopped if there are signs of possible myopathy or if there are risk factors of renal failure with rhabdomyolysis (such as severe acute infection, arterial hypotension, major surgery, trauma, severe metabolic, endocrine and electrolyte disorders and uncontrolled convulsions).

Before starting therapy with Novostat, an attempt should be made to achieve control of hypercholesterolemia through adequate diet therapy, increased physical activity, weight reduction in obese patients and treatment of other conditions. Patients should be warned to seek immediate medical attention if they experience unexplained muscle pain or weakness, especially if accompanied by malaise or fever.

In the use of HMG-CoA reductase inhibitors (statins), including atorvastatin, there have been cases of increased glycosylated hemoglobin and fasting plasma glucose concentrations. However, the risk of hyperglycemia is lower than the extent to which statins reduce the risk of vascular complications.

An adverse effect of atorvastatin on the ability to drive motor transport and engage in potentially hazardous activities requiring increased concentration and rapid psychomotor reactions has not been reported. However, taking into account the possibility of dizziness, caution should be exercised when performing the listed activities.

Contraindications

Hypersensitivity to any component of the drug.

Active liver disease or an increase in plasma “hepatic” transaminases of unclear origin of more than 3 times the upper limit of normal (ULN).

Above 18 years of age (insufficient clinical data on the effectiveness and safety of the drug in this age group).

The use in women of reproductive age who do not use adequate methods of contraception.

Pregnancy, period of breast-feeding.

Lactose intolerance, lactase deficiency, glucose-galactose malabsorption syndrome.

With caution: alcohol abuse, history of liver disease, severe electrolyte-water balance disorders, endocrine and metabolic disorders, arterial hypotension, severe acute infections (sepsis), uncontrolled epilepsy, extensive surgery, trauma, skeletal muscle disease, diabetes.

Side effects

Overdose

Similarities