Atorvastatin

CLINICAL USE

Hyperlipidaemia and hypercholesterolaemia

DOSE IN NORMAL RENAL FUNCTION

10–80 mg daily

PHARMACOKINETICS

Molecular weight :558.6 (1209.4 as calcium salt)

%Protein binding :>98

%Excreted unchanged in urine : Negligible

Volume of distribution (L/kg) :381 litres

half-life – normal/ESRD (hrs) :14 (active metabolite 20–30)/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Unknown dialysability. Dose as in normal renal function

CAV/VVHD :Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Antibacterials: erythromycin, clarithromycin or fusidic acid possibly increased risk of myopathy; concentration increased by clarithromycin – do not exceed 20 mg of atorvastatin;1 avoid concomitant use with telithromycin; increased risk of myopathy with daptomycin.

Anticoagulants: may transiently reduce anticoagulant effect of warfarin

Antifungals: increased risk of myopathy with itraconazole – do not exceed 40 mg of atorvastatin,1 posaconazole and possibly other imidazoles and triazoles – avoid concomitant useAntivirals: increased risk of myopathy with amprenavir, atazanavir, indinavir, lopinavir, nelfinavir, ritonavir or saquinavir; concentration reduced by efavirenz

Ciclosporin: increased risk of myopathy – do not exceed 10 mg of atorvastatin.

Lipid lowering agents: increased risk of myopathy with fibrates, gemfibrozil (avoid) and nicotinic acid

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Rhabdomyolysis with renal dysfunction secondary to myoglobinaemia has been reported with other statins

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