Torvacard - instructions for use, reviews, analogs and formulations (tablets 10 mg, 20 mg and 40 mg) of statin drug for lowering cholesterol and preventing cardiovascular diseases in adults, children and in pregnancy

In this article, you can read the instructions for using the drug Torquard. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of statin Torquard in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Torvacard in the presence of existing structural analogues.Use to reduce cholesterol and prevent cardiovascular diseases in adults, children, as well as during pregnancy and breast-feeding.

Torquard - a hypolipidemic drug from the group of statins. A selective competitive inhibitor of HMG-CoA reductase, an enzyme that converts 3-hydroxy-3-methylglutaryl coenzyme A into mevalonic acid, a precursor of steroids, including cholesterol. In the liver, triglycerides and cholesterol are included in the VLDL, enter the plasma of blood and are transported to peripheral tissues. VLDL is formed from LDLP during interaction with LDL receptors. Atorvastatin (the active substance of the drug Torvacard) lowers cholesterol (Xc) and lipoprotein levels in the blood plasma by inhibiting HMG-CoA reductase, synthesizing cholesterol in the liver, and increasing the number of LDL receptors in the liver on the cell surface, which leads to increased LDL capture and catabolism .

Atorvastatin reduces the formation of LDL, causes a pronounced and persistent increase in the activity of LDL receptors. Torvacard reduces LDL in patients with homozygous familial hypercholesterolemia, which usually does not respond to other lipid-lowering medications.

Reduces the level of total cholesterol by 30-46%, LDL by 41-61%, apolipoprotein B - by 34-50% and triglycerides by 14-33%; causes an increase in the concentration of Xc-HDL and apolipoprotein A. Dozozavisimo reduces the level of LDL in patients with homozygous hereditary hypercholesterolemia, resistant to therapy with other lipid-lowering agents.

Composition

Atorvastatin calcium + excipients.

Pharmacokinetics

Absorption is high. Food slightly reduces the speed and duration of absorption of the drug (by 25% and 9%, respectively), but the reduction in LDL cholesterol is similar to that with atorvastatin without food. The concentration of atorvastatin when used in the evening is lower than in the morning (about 30%). A linear relationship between the degree of absorption and the dose of the drug has been revealed. Metabolized mainly in the liver. It is excreted through the intestine with bile after hepatic and / or extrahepatic metabolism (it does not undergo significant intestinal hepatic recirculation). The inhibitory activity against HMG-CoA reductase is maintained for about 20-30 hours due to the presence of active metabolites. Less than 2% of the dose taken internally is determined in the urine.It is not excreted by hemodialysis.

Indications

• in combination with a diet to reduce elevated levels of total XC, Xc-LDL, apolipoprotein B, and triglycerides and an increase in HDL-C in patients with primary hypercholesterolemia, heterozygous familial and non-family hypercholesterolemia, and combined hyperlipidemia (types 2a and 2b according to Fredrickson) ;
• in combination with a diet for the treatment of patients with elevated serum triglyceride levels (type 4 according to Fredrickson) and patients with disbetalipoproteinemia (type 3 according to Fredrickson), in which diet therapy does not provide an adequate effect;
• to reduce the levels of total cholesterol and LDL-C in patients with homozygous familial hypercholesterolemia, when diet therapy and other non-pharmacological methods of treatment are not effective enough (as an adjunct to lipid lowering therapy, including autogemotransfusion of blood purified from LDL);
• diseases of the cardiovascular system (in patients who have elevated risk factors for CHD - elderly age over 55 years, smoking, hypertension, diabetes, peripheral vascular disease, stroke, left ventricular hypertrophy, protein / albuminuria, IHD in close relatives ), incl.on the background of dyslipidemia - secondary prophylaxis in order to reduce the total risk of death, myocardial infarction, stroke, repeated hospitalization for angina pectoris and the need for a revascularization procedure.

Forms of release

Tablets coated with 10 mg, 20 mg and 40 mg.

Instructions for use and reception scheme

Before the appointment of Torvacard, the patient should be recommended a standard lipid-lowering diet, which he must continue to observe during the entire period of therapy.

The initial dose is an average of 10 mg once a day. The dose varies from 10 to 80 mg once a day. The drug can be taken at any time of the day, regardless of the time of eating. The dose is selected taking into account the baseline levels of LDL-C, the purpose of therapy and the individual effect. At the beginning of treatment and / or during an increase in the dose of Torvacard, it is necessary to monitor the levels of lipids in the blood plasma every 2-4 weeks and adjust the dose accordingly. The maximum daily dose is 80 mg per 1 dose.

With primary hypercholesterolemia and mixed hyperlipidemia, in most cases it is sufficient to administer a dose of 10 mg of Torvacard once a day.A significant therapeutic effect is observed after 2 weeks, as a rule, and the maximum therapeutic effect is usually observed after 4 weeks. With prolonged treatment, this effect persists.

Side effect

• headache;
• asthenia;
• insomnia;
• dizziness;
• drowsiness;
• nightmarish dreams;
• amnesia;
• depression;
• peripheral neuropathy;
• ataxia;
• paresthesia;
• nausea, vomiting;
• constipation or diarrhea;
• flatulence;
• abdominal pain;
• anorexia or increased appetite;
• myalgia;
• arthralgia;
• myopathy;
• myositis;
• backache;
• cramps of the calf muscles of the legs;
• itching;
• rash;
• hives;
• angioedema;
• anaphylactic shock;
• bullous eruptions;
• polyiform exudative erythema, incl. Stevens-Johnson syndrome;
• toxic epidermal necrolysis (Lyell's syndrome);
• hyperglycemia;
• hypoglycemia;
• chest pain;
• peripheral edema;
• impotence;
• alopecia;
• noise in ears;
• increase in body weight;
• malaise;
• weakness;
• thrombocytopenia;
• secondary renal failure.

Contraindications

• active liver disease or an increase in the activity of transaminases in the blood serum (more than 3 times as compared with VGN) of an unknown genesis;
• hepatic failure (severity A and B on the Child-Pugh scale);
• hereditary diseases such as lactose intolerance, lactase deficiency or glucose-galactose malabsorption (due to the presence of lactose in the composition);
• pregnancy;
• lactation period;
• women of reproductive age who do not use adequate methods of contraception;
• children and adolescents under 18 years of age (efficacy and safety not established);
• hypersensitivity to the components of the drug.

Application in pregnancy and lactation

Torquard is contraindicated in pregnancy and lactation (breastfeeding).

Because cholesterol and substances synthesized from cholesterol are important for the development of the fetus, the potential risk of inhibiting HMG-CoA reductase exceeds the benefit of using the drug during pregnancy. When using lovastatin (inhibitor of HMG-CoA reductase) with dextroamphetamine in 1 trimester of pregnancy, births of children with bone deformity, tracheo-esophageal fistula, atresia of the anus are known. In the case of diagnosing a pregnancy during therapy with Torvacard, the drug should be stopped immediately, and the patients are warned about the potential risk to the fetus.

If it is necessary to use the drug during lactation, taking into account the possibility of undesirable phenomena in infants, it is necessary to solve the problem of stopping breastfeeding.

Use in women of reproductive age is possible only if reliable methods of contraception are used. The patient should be informed of the possible risk of treatment for the fetus.

Use in children

The drug is contraindicated for use in children and adolescents under 18 years (efficacy and safety not established).

special instructions

Before starting therapy, Torvacard should try to achieve control of hypercholesterolemia by adequate diet therapy, increased physical activity, weight loss in obese patients and treatment of other conditions.

The use of HMG-CoA reductase inhibitors to reduce lipid levels in the blood can lead to a change in biochemical indicators that reflect liver function. The liver function should be monitored before starting therapy, 6 weeks, 12 weeks after the commencement of taking Torvacard and after each dose increase, and periodically (for example, every 6 months).An increase in the activity of hepatic enzymes in the serum can be observed during therapy with Torvacard (usually in the first 3 months). Patients who have an elevated transaminase level should be monitored prior to returning the enzyme level back to normal. In the event that ALT or AST values ​​are more than 3 times higher than ULN, it is recommended to lower the dose of Torvacard or stop treatment.

Treatment with the drug Torvacard can cause myopathy (pain and weakness in the muscles in combination with an increase in the activity of CKM more than 10 times compared with VGN). Torvacard can cause an increase in serum CK, which should be taken into account in the differential diagnosis of chest pain. Patients should be warned that they should immediately consult a doctor if unexplained pain or weakness in the muscles occurs, especially if they are accompanied by a malaise or fever. Therapy with Thorvacard should be temporarily discontinued or completely eliminated if there is evidence of possible myopathy or the presence of a risk factor for developing renal failure against rhabdomyolysis (eg, severe acute infection, arterial hypotension,serious surgical intervention, trauma, severe metabolic, endocrine and electrolyte disorders and uncontrolled convulsions).

Impact on the ability to drive and work with machinery

The adverse effect of Torquard on the ability to drive vehicles and engage in other activities that require concentration and speed of psychomotor reactions were not reported.

Drug Interactions

With the simultaneous use of cyclosporine, fibrates, erythromycin, clarithromycin, immunosuppressive and antifungal drugs of the azole group, nicotinic acid and nicotinamide, drugs inhibiting metabolism mediated by the 3A4 CYP450 isoenzyme and / or drug transport, the concentration of atorvastatin in the blood plasma (and the risk of myopathy) increases. By prescribing these drugs, the expected benefit and risk of treatment should be carefully weighed, patients regularly monitored to identify pain or weakness in the muscles, especially during the first months of treatment and during the period of increasing the dose of any drug, periodically to determine the activity of CKK, although this control does not allow prevent the development of severe myopathy.Therapy with Thorvacard should be discontinued in the event of a marked increase in the activity of CK or in the presence of confirmed or suspected myopathy.

Torvacard had no clinically significant effect on the concentration of terfenadine in the blood plasma, which is metabolized mainly by the 3A4 CYP450 isoenzyme; in this connection, it seems unlikely that atorvastatin can significantly affect the pharmacokinetic parameters of other 3A4 CYP450 isoenzyme substrates. With the simultaneous use of atorvastatin (10 mg once a day) and Azithromycin (500 mg once a day), the concentration of atorvastatin in the blood plasma does not change.

With simultaneous ingestion of atorvastatin and preparations containing magnesium and aluminum hydroxides, the concentration of atorvastatin in the blood plasma decreased by about 35%, however, the degree of decrease in the level of LDL-C was not changed.

With simultaneous application of colestipol, concentrations of atorvastatin in blood plasma decreased by approximately 25%. However, the hypolipidemic effect of the combination of atorvastatin and colestipol was superior to that of each drug individually.

With simultaneous application of Torvacard does not affect the pharmacokinetics of phenazone, therefore interaction with other drugs metabolized by the same isoenzymes CYP450 is not expected.

When studying the interaction of atorvastatin with warfarin, cimetidine, phenazone, no signs of clinically significant interaction were found.

Simultaneous use with drugs that reduce the concentration of endogenous steroid hormones (including cimetidine, ketoconazole, spironolactone), increases the risk of reducing endogenous steroid hormones (caution should be exercised).

There was no clinically significant undesirable interaction of atorvastatin with hypotensive drugs, as well as with estrogens.

With the simultaneous use of Torvacard in a dose of 80 mg per day and oral contraceptives containing norethindrone and ethinyl estradiol, there was a significant increase in the concentrations of norethindrone and ethinylestradiol by approximately 30% and 20%, respectively. This effect should be considered when choosing an oral contraceptive for women receiving Torvacard.

With simultaneous use of atorvastatin in a dose of 80 mg and Amlodipine at a dose of 10 mg, the pharmacokinetics of atorvastatin did not change in the equilibrium state.

With repeated administration of Digoxin and atorvastatin at a dose of 10 mg, the equilibrium concentrations of digoxin in the blood plasma did not change. However, when using digoxin in combination with atorvastatin at a dose of 80 mg per day, the digoxin concentration increased by about 20%. Patients receiving digoxin in combination with atorvastatin should be monitored.

Studies of interactions with other drugs have not been conducted.

Analogues of the drug Torvacard

Structural analogs for the active substance:

• Anistat;
• Atokord;
• Atomax;
• Atorvastatin;
• Atorvox;
• Atoris;
• The Vasator;
• Lipon;
• Lipofford;
• Liprimar;
• Liptonorm;
• Torvazine;
• Tulip.

Analogues for the pharmacological group (statins):

• Akorta;
• Aktalipid;
• Anistat;
• Apexstatin;
• Atherostat;
• Atokord;
• Atomax;
• Atorvastatin;
• Atorvox;
• Atoris;
• The Vasator;
• Vazilip;
• Zocor;
• Zokor forte;
• Zorstat;
• Cardiostatin;
• The Cross;
• Leskol;
• Leskol Fort;
• Lipobay;
• Lipon;
• Lipostat;
• Lipofford;
• Liprimar;
• Liptonorm;
• Lovacor;
• Lovastatin;
• Lovasterol;
• Mevakor;
• Medostatin;
• Mertenil;
• Ovenkor;
• Pravastatin;
• Rovacor;
• Rosuvastatin;
• Rosewood;
• Rosulip;
• Roxer;
• Simva Hexal;
• Simvard;
• Simvakol;
• Simvale;
• Simvastatin;
• Simvastol;
• Symvor;
• Simgal;
• Simlo;
• Sinquard;
• Tevastor;
• Torvazine;
• Tulip;
• Holvasim;
• Holletar.

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