ATV 20 mg

Description

Indications ATV is prescribed as an adjunct to dietary modifications to lower elevated total cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein B (Apo-B), and triglycerides in cases where dietary and other non-pharmacological interventions prove insufficient.

• Reduction of total cholesterol and LDL cholesterol in individuals with heterozygous and homozygous familial hypercholesterolemia.
• Management of elevated cholesterol and triglycerides in patients diagnosed with mixed dyslipidemia (Fredrickson Type Ia and Ib).
• Treatment of elevated serum triglyceride levels in hypertriglyceridemia (Fredrickson Type IV).
• Management of dysbetalipoproteinemia (Fredrickson Type III).
• Reduction of cardiac ischemic events in individuals with asymptomatic or mild to moderate symptomatic coronary artery disease with elevated LDL cholesterol.
• Management of hypercholesterolemia associated with or exacerbated by diabetes mellitus or renal transplantation.

Use only as directed by a registered physician.

Pharmacology Atorvastatin is a selective inhibitor of HMG-CoA reductase, an enzyme that plays a crucial role in converting HMG-CoA to mevalonate, a precursor in cholesterol synthesis. By inhibiting this enzyme, atorvastatin reduces cholesterol production in the liver and enhances LDL receptor activity, promoting LDL uptake and breakdown.

• Absorption: Rapidly absorbed after oral intake, reaching peak plasma concentrations within 1 to 2 hours. The extent of absorption increases proportionally with dosage. The absolute bioavailability of atorvastatin is approximately 14%, while systemic availability of HMG-CoA reductase inhibitory activity is around 30%.
• Distribution: The average volume of distribution is approximately 381 liters. Atorvastatin is 98% bound to plasma proteins and has limited penetration into red blood cells.
• Metabolism: Primarily metabolized into ortho- and parahydroxylated derivatives and beta-oxidation products. These metabolites contribute significantly to HMG-CoA reductase inhibition. Metabolism involves cytochrome P450 3A4, which may be inhibited by co-administered drugs like erythromycin.
• Excretion: Eliminated primarily via bile following hepatic and extrahepatic metabolism. The drug does not undergo enterohepatic recirculation. The plasma elimination half-life is about 14 hours, but the inhibitory effect on HMG-CoA reductase persists for 20 to 30 hours. Less than 2% is excreted in urine.

Dosage & Administration

• Primary Hypercholesterolemia & Combined Hyperlipidemia:
  • Adults: Usually, 10 mg once daily, adjustable in increments every four weeks up to a maximum of 80 mg daily.
  • Children (10-18 years): Start with 10 mg once daily, increasing as necessary at intervals of at least four weeks to a maximum of 20 mg daily.
• Familial Hypercholesterolemia:
  • Adults: Initially, 10 mg daily, increasing every four weeks up to 40 mg daily; further increments up to 80 mg daily may be required.
  • Children (10-18 years): Start with 10 mg daily, increasing to a maximum of 80 mg daily as necessary.
• Cardiovascular Event Prevention:
  • Adults: Start at 10 mg once daily and adjust as needed.

Patients should follow a cholesterol-lowering diet before and throughout treatment. Lipid levels should be monitored within 2 to 4 weeks of initiation, and dosage adjustments should be made accordingly.

Drug Interactions

• Increased Myopathy Risk: Concurrent use with cyclosporine, fibric acid derivatives, niacin, erythromycin, or azole antifungals may elevate the risk of muscle-related side effects.
• Antacid: Co-administration reduces atorvastatin plasma levels by approximately 35% without altering LDL cholesterol reduction.
• Colestipol: Lowers atorvastatin plasma levels by about 25%, but LDL cholesterol reduction is more significant when combined.
• Digoxin: Co-administration increases steady-state plasma digoxin levels by about 20%.
• Erythromycin: Increases atorvastatin plasma concentrations by approximately 40%.
• Oral Contraceptives: Increases norethindrone and ethinyl estradiol levels by 30% and 20%, respectively.
• Warfarin: No clinically significant effect on prothrombin time.

Contraindications

• Hypersensitivity to any component of atorvastatin.
• Active liver disease or unexplained persistent elevations in liver enzymes.
• History of severe adverse reactions to HMG-CoA reductase inhibitors.

Side Effects Common side effects include:

• Gastrointestinal issues: Constipation, flatulence, dyspepsia, and abdominal pain.
• General symptoms: Headache, back pain, rash, weakness, and muscle pain.

Pregnancy & Lactation

• Pregnancy: Contraindicated due to potential fetal harm. Atorvastatin may reduce fetal cholesterol levels, which are essential for development.
• Lactation: Unknown if excreted in human milk; therefore, contraindicated during breastfeeding.

Precautions & Warnings

• Liver Function: Regular monitoring is recommended. Use with caution in individuals with a history of liver disease or high alcohol consumption.
• Myopathy Risk: Discontinue if significantly elevated CPK levels occur or myopathy is diagnosed.

Use in Special Populations

• Elderly: Higher plasma concentrations observed, but enhanced LDL-lowering effects.
• Pediatrics: Pharmacokinetic data are limited.
• Gender: No significant difference in LDL reduction between men and women.
• Renal Impairment: No dose adjustment required.
• Hemodialysis: Not expected to significantly remove atorvastatin from circulation.
• Hepatic Insufficiency: Plasma concentrations markedly increased in individuals with liver disease.

Overdose Management There is no specific antidote for atorvastatin overdose. Symptomatic and supportive care should be provided. Liver function and serum CK levels should be monitored. Due to extensive plasma protein binding, hemodialysis is unlikely to enhance clearance.

Therapeutic Class

• Other anti-anginal & anti-ischemic drugs, statins.

Storage Conditions

• Store in a dry place away from light and heat.
• Keep out of reach of children.

Common Questions

• What is ATV 20 mg used for? ATV 20 mg is prescribed to manage high cholesterol and triglycerides, reducing cardiovascular risks.
• How should I take ATV 20 mg? Take once daily, at the same time each day, with or without food.
• Can ATV 20 mg cause weight loss? Weight loss is not a known side effect; consult a doctor if you experience unexplained weight changes.
• Can ATV 20 mg be used in children? It can be prescribed for children over 10 years old, but caution is required.
• Does ATV 20 mg cause memory loss? Memory loss is a rare side effect. Consult your doctor if you notice cognitive issues.