阿托伐他汀
基本信息
【外文名】Lipitor , Atorvastatin Calcium
药理毒理
本品为HMG-CoA还原酶选择性抑制剂，通过抑制HMG-CoA还原酶和胆固醇在肝脏的生物合成而降低血浆胆固醇和脂蛋白水平，并能通过增加肝细胞表面低密度脂蛋白（LDL）受体数目而增加LDL的摄取和分解代谢。本品也能减少LDL的生成和其颗粒数。本品还能降低某些纯合子型家族性高胆固醇血症（FH）的低密度脂蛋白胆固醇（LDL-C）水平，而一类型的人群对其他类型的降脂药物治疗很少有应答。
本品能降低纯合子和杂合子家族性高胆固醇血症、非家族性高胆固醇血症以及混合性脂类代谢障碍患者的血浆总胆固醇（TC）、LDL-C和载脂蛋白B（ApoB），还能降低极低密度脂蛋白胆固醇（VLDL-C）和三酰甘油（TG）的水平，并能不同程度地提高血浆高密度脂蛋白胆固醇（HDL-C）和载脂蛋白A1（ApoA1）的水平。
适应证
杂合子家族性或非家族性高胆固醇血症和混合性高脂血症，也用于纯合子高胆固醇血症。
不良反应
本品可被较好地耐受，不良反应多为轻度和一过性，最常见的是便秘、腹胀、消化不良和腹痛⑴。因本品的不良反应而停药者＜2%。其他有ALT升高（0.7%），发生在用药16周内。
相互作用
本品与含有炔诺酮和炔雌醇的口服避孕药合用时，能分别使诺酮和炔雌醇的AUC增加30%和20%；与红霉素合用时，本品的血浆浓度约增高40%；与地高辛合用时，多次给药后，地高辛的稳态血药浓度增加约20%，应对地高辛浓度进行监测，与考来烯胺（消胆胺）合用时，本品的血浆浓度降低约25%，但降低LDL-C的效果较单用本品或考来替泊的效果都大。本品与环孢菌素、烟酸、红霉素及吡咯类抗真菌药合用，发生肌病的危险性增加。
用法用量
po，可在任何时间单剂量服用，进食或非进食时均可。起始剂量为10mg,qd，剂量范围为10～80mg.d-1。根据治疗目标和治疗反应采取个体化治疗方案。对肾功能不全患者，不必调整剂量。
注意事项
活动性肝病或原因不明的转氨酶持续升高患者及对本品的任何成分过敏者、孕妇和哺乳期妇女禁用。
①使用本品治疗前、治疗6周及12周或增加药物剂量后进行肝功能检测，并在以后定期测定肝功能。②治疗过程中出现弥漫性肌痛、肌肉触痛或无力，特别是伴有全身不适或发热时，或/和肌酸磷酸激酶（CPK）水平明显升高，应考虑肌病的可能性。如为肌病，应停止本品的治疗。③使用本品前，应通过适当饮食、运动和减轻肥胖的体重等方法控制高胆固醇血症，并治疗其他原发疾病。④本品过量无特殊治疗。一旦发生过量，应予以对症及相应
7的支持疗法，血液透极不能显著增加其清除。⑤开始治疗和/或增加剂量后2～4周应监测血脂水平，并据此对剂量进行相应的调整。⑥对纯合子高胆固醇血症患者，除非无法进行其他治疗，本品应作为其他降脂治疗措施（LDL血浆分离置换）基础上进行的治疗手段。
【规格】片剂：10mg，20mg,40mg。
国药准字J20030048
英文名称
Atorvastatin
适应症
1.Atorvastatin blocks the production of cholesterol (a type of fat) in your body.
2.Atorvastatin is used to reduce the amounts of LDL (bad) cholesterol, total cholesterol, triglycerides (another type of fat), and apolipoprotein B (a protein needed to make cholesterol) in your blood. Atorvastatin is also used to increase the level of HDL (good) cholesterol in your blood. These actions are important in reducing the risk of hardening of the arteries, which can lead to heart attacks, stroke, and peripheral vascular disease.
3.Atorvastatin may also be used for purposes other than those listed in this medication guide.
用法用量
1.Take atorvastatin exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.
2.Take each dose with a full glass of water.
3.Atorvastatin can be taken with or without food.
4.Atorvastatin is usually taken once a day. Try to take your dose at the same time each day. Follow your doctor's instructions.
5.Your doctor may want to monitor your liver function with blood tests before starting treatment with atorvastatin, at twelve weeks after both the start of your treatment and any increase in dose, and periodically (every 6 months) thereafter. Depending on the results of these tests, your doctor can determine how much monitoring you will require.
6.Grapefruit and grapefruit juice may interact with atorvastatin. The interaction could lead to potentially dangerous effects. Discuss the use of grapefruit and grapefruit juice with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
7.Eat a low-fat, low-cholesterol diet. To realize beneficial effects from atorvastatin, avoid fatty, high-cholesterol foods.
8.Do not stop taking atorvastatin without first talking to your doctor. It may be weeks or months before beneficial effects are seen from this medication.
9.Store atorvastatin at room temperature away from moisture and heat.
注意事项
1.Do not take atorvastatin without first talking to your doctor if you have liver disease.
2.Alcohol and atorvastatin can both damage your liver. Discuss with your doctor the amount of alcohol that you drink so that it can be determined if atorvastatin is the best choice for lowering your cholesterol.
3.Do not take atorvastatin if you are pregnant, if you are planning a pregnancy, or if you are breast-feeding a baby.
4.Contact your doctor immediately if you experience unexplained muscle pain, tenderness, or weakness, especially if it is accompanied by a fever or flulike symptoms or yellowing of your skin or eyes.
If Miss a Dose: 1.Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose of this medication.
Contraindications: 1.Do not take atorvastatin without first talking to your doctor if you have liver disease.
2.Before taking atorvastatin, tell your doctor if you
- drink alcoholic beverages,
- have a chronic muscular disease,
- require major surgery, or
- have a blood disorder.
3.You may not be able to take atorvastatin, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
4.Atorvastatin is in the FDA pregnancy category X. This means that atorvastatin will cause birth defects if it is taken during pregnancy. Cholesterol is very important for the proper development of a baby. Do not take atorvastatin if you are pregnant or are planning a pregnancy.
5.It is not known whether atorvastatin passes into breast milk. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.
Special Concerns: 1.Alcohol and atorvastatin can both damage your liver. Discuss with your doctor the amount of alcohol that you drink so that it can be determined if atorvastatin is the best choice for lowering your cholesterol.
2.Grapefruit and grapefruit juice may interact with atorvastatin. The interaction could lead to potentially dangerous effects. Discuss the use of grapefruit and grapefruit juice with your doctor. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.
不良反应
1.If you experience any of the following serious side effects, stop taking atorvastatin and seek emergency medical attention or call your doctor immediately:
- an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
- muscle aches, pain, or weakness;
- "flu-like" symptoms;
- decreased urine or rust-colored urine;
- blurred vision; or
- yellowing of your skin or eyes.
2.Other, less serious side effects may be more likely to occur. Continue to take atorvastatin and talk to your doctor if you experience
- headache;
- upset stomach or flatulence; or
- a rash.
3.Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
相互作用
1.Do not take atorvastatin without first talking to your doctor if you are taking any of the following medicines:
- cyclosporine (Sandimmune, Neoral);
- gemfibrozil (Lopid);
- niacin (Nicolar, Nicobid, Nicotinex, others);
- clarithromycin (Biaxin);
- erythromycin (E-Mycin, E.E.S., Ery-Tab, Ilotycin, Eryc, PCE, Ilosone, others); or
- fluconazole (Diflucan), itraconazole (Sporanox), or ketoconazole (Nizoral).
2.The medications listed above interact with atorvastatin and may cause damage your muscles.
3.Before taking atorvastatin, tell your doctor if you are taking any of the following medicines:
- other cholesterol-lowering drugs such as cholestyramine (Questran) or colestipol (Colestid); or
- digoxin (Lanoxin, Lanoxicaps).
4.You may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.
5.Drugs other than those listed here may also interact with atorvastatin. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.
药物过量
1.Seek emergency medical attention.
2.The symptoms of an overdose of atorvastatin are not known.
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