Liprimar tabs 20mg #100

Instruction for Liprimar

You can buy Liprimar here

Liprimar is a lipid-lowering drug.

Release form and composition

Liprimar is produced in the form of film-coated tablets: white, elliptical, at a break - a white core; engraved on both sides, depending on the dosage - "10" and "PD 155" / "20" and "PD 156" / "40" and "PD 157" / "80" and "PD 158" (10 and 20 mg - 10 pcs. in blisters, 3 and 10 blisters in a cardboard box; 7 pcs. in blisters, 2 blisters in a cardboard box; 40 and 80 mg - 10 pcs. in blisters, 10 blisters in a cardboard box pack; 7 pcs. in blisters, 2 or 4 blisters in a cardboard box).
The composition of 1 tablet includes:
    Active ingredient: atorvastatin - 10, 20, 40 or 80 mg (in the form of calcium salt);
    Auxiliary components: calcium carbonate - 33/66/132/264 mg, microcrystalline cellulose - 60/120/240/480 mg, lactose monohydrate - 32.8 / 65.61 / 131.22 / 262.44 mg, croscarmellose sodium - 9/18/36/72 mg, polysorbate 80 - 0.6 / 1.2 / 2.4 / 4.8 mg, hyprolose - 3/6/12/24 mg, magnesium stearate - 0.75 / 1.5 / 3/6 mg;
    Film casing: Opadry white YS-1-7040 (hypromellose - 66.12%, polyethylene glycol - 18.9%, titanium dioxide - 13.08%, talc - 1.9%) - 4.47 / 8.94 / 17 , 88 / 35.76 mg, simethicone emulsion (simethicone - 30%, stearic emulsifier - 0.075%, sorbic acid, water) - 0.03 / 0.06 / 0.12 / 0.24 mg, candelilla wax - 0, 08 / 0.16 / 0.32 / 0 mg.

Pharmacodynamics

Atorvastatin is a selective competitive inhibitor of HMG-CoA reductase, which is a key enzyme that converts 3-hydroxy-3-methylglutaryl-CoA into mevalonate, a precursor of steroids, including cholesterol. Liprimar belongs to hypolipidemic drugs of synthetic origin.
The use of atorvastatin in patients with mixed dyslipidemia, non-familial forms of hypercholesterolemia, as well as heterozygous and homozygous familial hypercholesterolemia leads to a decrease in the plasma levels of triglycerides (TG), very low density lipoprotein cholesterol (LDL-C), apoliprotein B low density lipoprotein cholesterol (LDL-C) and total cholesterol (cholesterol). Also, when taking Liprimar, the concentration of high-density lipoprotein cholesterol (HDL-C) increases.
Atorvastatin inhibits the production of cholesterol in the liver, inhibits HMG-CoA reductase and increases the number of hepatic LDL receptors on the outer membranes of cells, which causes an increase in the capture and catabolism of LDL-C, and also helps to reduce the level of cholesterol and LDL-C in blood plasma.
Liprimar reduces the number of LDL-C particles and inhibits the formation of LDL-C, leads to a pronounced and persistent increase in the activity of LDL-receptors, combined with favorable qualitative transformations of LDL-particles, and also reduces the level of LDL-C in patients with homozygous familial hypercholesterolemia of hereditary etiology, resistant to treatment with other lipid-lowering drugs.
When taken in the dose range of 10–80 mg, atorvastatin reduces the concentration of triglycerides by 14–33%, apo-B by 34–50%, LDL-C by 41–61% and cholesterol by 30–46%. The results of treatment are practically similar in patients with non-familial forms of hypercholesterolemia, heterozygous familial hypercholesterolemia and mixed hyperlipidemia, including patients with type 2 diabetes mellitus.
In patients with isolated hypertriglyceridemia, the active ingredient Liprimar reduces the level of TG, apo-B, VLDL-C, LDL-C and total cholesterol and increases the level of HDL-C. In patients with dysbetalipoproteinemia, when taking Liprimar, the concentration of intermediate density lipoprotein cholesterol (IDL-cholesterol) decreases.
In patients with type IIa and IIb hyperlipoproteinemia, according to Fredrickson's classification, during therapy with atorvastatin (dose range 10-80 mg), the HDL-C concentration on average increases by 5.1-8.7% compared to the initial value, and this effect does not is dose-dependent. The value of the ratios of cholesterol-LDL / cholesterol-HDL and total cholesterol / cholesterol-HDL decreases significantly (the decrease is determined by the dose of Liprimar taken) by 37-55% and 29-44%, respectively. Taking atorvastatin at a dose of 80 mg significantly reduces the risk of ischemic complications and reduces mortality by 16% after completing a course of treatment lasting 16 weeks, and the risk of re-hospitalization associated with angina pectoris, which is accompanied by signs of myocardial ischemia, decreases by 26% [according to the results studies, there is a decrease in the severity of symptoms of myocardial ischemia during intensive lipid-lowering therapy (MIRACL)]. In patients with different initial levels of LDL-C [patients with unstable angina and myocardial infarction without Q wave, regardless of gender (men and women) and age (younger and older than 65 years)], atorvastatin significantly reduces the risk of ischemic complications and mortality. A decrease in the concentration of LDL-C in blood plasma demonstrates a better correlation with the dose of Liprimar than with the concentration of its active component in the blood plasma. The dose should be adjusted to the clinical effect.
The therapeutic effect of the use of Liprimar is recorded 2 weeks after the start of treatment, reaches a peak after 4 weeks and lasts throughout the entire course of therapy.
In patients with arterial hypertension and three or more risk factors, taking atorvastatin at a dose of 10 mg reduces the risk of developing nonfatal (fatal) heart attacks compared to placebo. The results of the Anglo-Scandinavian study on the assessment of the outcome of heart disease (ASCOT-LLA) are known, according to which the appointment of Liprimar at a dose of 10 mg reduces the risk of developing certain complications as follows:
    stroke (non-fatal / fatal) - by 26%;
    coronary complications (non-fatal myocardial infarction and ischemic heart disease, accompanied by a fatal outcome) - by 36%;
    general cardiovascular complications - by 29%;
    general cardiovascular complications and revascularization procedures - by 20%.
According to the results of the study of atorvastatin use in type 2 diabetes mellitus (CARDS), the use of Liprimar in patients with this disease reduces the risk of cardiovascular complications, regardless of age and gender or the initial concentration of LDL-C as follows:
    stroke (non-fatal / fatal) - by 48%;
    painless myocardial ischemia, non-fatal (fatal) myocardial infarction - by 42%;
    major cardiovascular complications (stroke, revascularization procedures, painless myocardial ischemia, non-fatal and fatal myocardial infarction, percutaneous transluminal coronary angioplasty, death due to exacerbation of coronary artery disease, coronary artery bypass grafting, unstable angina pectoris) - by 37%.
A study of the effect of intensive lipid-lowering therapy on the reversal of coronary atherosclerosis (REVERSAL) showed that in patients with coronary heart disease, taking atorvastatin in a daily dose of 80 mg causes a decrease in the total volume of atheroma by 0.4% after 1.8 months of treatment.
The appointment of atorvastatin in a daily dose of 80 mg reduces the risk of nonfatal (fatal) stroke in patients who have had a transient ischemic attack or stroke with no history of coronary artery disease by 16% compared to taking placebo [according to the results of a study on the prevention of stroke with an intensive decrease in cholesterol (SPARCL)]. This significantly reduces the risk of major cardiovascular complications and the need for revascularization procedures. A decrease in the risk of disorders from the cardiovascular system during treatment with atorvastatin is observed in all groups of patients, with the exception of that which included patients with primary or recurrent hemorrhagic stroke.
In patients with coronary artery disease, taking Liprimar at a dose of 80 mg compared to a dose of 10 mg significantly reduces the risk of complications as follows (in accordance with the results of a TNT treatment study until new target lipid concentrations are reached):
    documented angina pectoris - by 10.9%;
    cardiovascular complications (non-fatal myocardial infarction and ischemic heart disease, accompanied by a fatal outcome) - by 8.7%;
    coronary artery bypass grafting or other revascularization procedures - by 13.4%;
    non-fatal myocardial infarction not caused by the procedure - by 4.9%;
    hospitalization associated with congestive heart failure - by 2.4%;
    nonfatal (fatal) stroke - by 2.3%.

Pharmacokinetics

After oral administration, atorvastatin is absorbed at a high rate. Its maximum concentration (Cmax) in blood plasma is reached in 1–2 hours, and in women it is 20% higher, and the area under the concentration-time curve (AUC) is 10% lower than in male patients. With an increase in the dose, there is a proportional increase in the degree of absorption and concentration of the active substance in the blood plasma. The bioavailability of atorvastatin in tablet form is 95-99% of this indicator for parenteral administration. The absolute ability of the drug to be absorbed is approximately 14%, and the systemic bioavailability of the inhibitory effect on HMG-CoA reductase is approximately 30%. A low systemic indicator is explained by the processes of presystemic metabolism occurring in the mucous membrane of the gastrointestinal tract and / or during the first passage through the liver. Food intake slightly slows down the degree and rate of absorption of atorvastatin (by 9% and 25%, respectively, as evidenced by the results of determining the AUC and maximum concentration), however, the decrease in the level of LDL-C is similar to that when taking the drug on an empty stomach. Despite the fact that taking atorvastatin in the evening causes a decrease in its content in blood plasma (AUC and maximum concentration by about 30%) compared to taking in the morning, the decrease in the level of LDL-C is not determined by the time of day at which Liprimar is taken.
The volume of distribution of atorvastatin is on average 381 liters. The degree of binding of the active component of Liprimar with blood plasma proteins reaches at least 98%. The ratio of its concentration in erythrocytes and blood plasma is approximately 1/4, which indicates an insignificant degree of penetration of atorvastatin into erythrocytes.
Atorvastatin is extensively metabolized, forming various β-oxidation products, as well as para- and orthohydroxylated derivatives. In vitro, para- and orthohydroxylated metabolites are characterized by an inhibitory effect on HMG-CoA reductase, comparable to that of atorvastatin. Approximately 70% of the decrease in HMG-CoA reductase activity is due to the action of active circulating metabolites. The results of in vitro studies suggest that the hepatic isoenzyme CYP3A4 plays a key role in the metabolism of the active substance Liprimar. This fact is confirmed by an increase in the content of atorvastatin in the blood plasma in the case of combined administration of the drug with erythromycin, which is an inhibitor of this isoenzyme. In vitro studies have also confirmed that atorvastatin is a weak inhibitor of the CYP3A4 isoenzyme. For him, a clinically significant effect on the blood plasma content of terfenadine, which is metabolized mainly by the CYP3A4 isoenzyme, is uncharacteristic; therefore, the significant role of atorvastatin in the formation of pharmacokinetic parameters of other substrates of the CYP3A4 isoenzyme is considered unlikely.
Atorvastatin and its metabolites are excreted mainly in the bile after extrahepatic and / or hepatic metabolism (pronounced enterohepatic recirculation is uncharacteristic for atorvastatin). The half-life is approximately 14 hours. The inhibitory effect of Liprimar on HMG-CoA reductase is approximately 70% dependent on the activity of circulating metabolites and lasts for 20-30 hours due to their presence. After oral administration, less than 2% of the taken dose of atorvastatin is determined in urine.
The content of atorvastatin in blood plasma in patients over 65 years of age is higher (AUC by about 30%, the maximum concentration by about 40%) than in adult patients of a younger age. Differences in the efficacy and safety of Liprimar or in achieving the goals of lipid-lowering treatment in elderly patients compared with the general population were not found.
For 8 weeks, an open study was conducted in children aged 6 to 17 years with an initial concentration of LDL-C over 4 mmol / L, suffering from heterozygous familial hypercholesterolemia. They took atorvastatin in the form of film-coated tablets at a dosage of 10 or 20 mg, or in the form of chewable tablets 5 or 10 mg once a day, respectively. The only significant covariate in the pharmacokinetic model of the atorvastatin-treated population was body weight. The apparent drug clearance in children was almost identical to that in adult patients when measured allometric by body weight. In the range of action of atorvastatin and its metabolite o-hydroxyatorvastatin, a consistent decrease in the concentrations of cholesterol and LDL-C was recorded.
Renal dysfunction does not alter the content of atorvastatin in the blood plasma or its effect on the parameters of lipid metabolism. Thus, there is no need for dose adjustment in patients with impaired renal function. Studies of the use of Liprimar in patients with end-stage renal failure have not been conducted. The elimination of atorvastatin by hemodialysis is practically impossible due to the intense binding to proteins contained in the blood plasma.
The concentration of atorvastatin increases significantly (AUC approximately 11 times, the maximum concentration approximately 16 times) in patients with alcoholic cirrhosis (class B according to the Child-Pugh scale).
Hepatic uptake of all HMG-CoA reductase inhibitors, including atorvastatin, is carried out using the OATP1B1 transporter. Patients with the SLCO1B1 genetic polymorphism are at risk of increased drug exposure, which may increase the risk of rhabdomyolysis. The polymorphism of the gene encoding OATP1B1 (SLCO1B1 c.521CC) is due to an increase in exposure (AUC) of the active substance by 2.4 times compared with patients who do not have this genotypic change (p.521TT). In such patients, there is also sometimes a violation of the uptake of atorvastatin by the liver, due to genetic disorders. The possible consequences regarding the effectiveness of Liprimar and associated with this fact are not well understood.
Studies were conducted on the effect of a number of drugs on the pharmacokinetic parameters of atorvastatin, in which the changes in AUC & and Cmax & for atorvastatin were determined, where & is the coefficient of change [(IB) / B] (B - normal values ​​of pharmacokinetic parameters, I - values ​​of pharmacokinetic parameters during interaction) ... They gave the following results:
    40 mg of atorvastatin once + fenofibrate at a dosage of 160 mg once a day for 7 days: AUC & increases by 0.03; Cmax & - by 0.02;
    10 mg of atorvastatin 1 time per day for 28 days + cyclosporine at a constant daily dose of 5.2 mg / kg: AUC & increases by 8.7; Cmax & - by 10.7;
    40 mg of atorvastatin once + gemfibrozil at a dosage of 600 mg 2 times a day for 7 days: AUC & increases by 0.35; Cmax & decreases by less than 1%;
    10 mg of atorvastatin once + tipranavir at a dosage of 500 mg 2 times a day or ritonavir at a dosage of 200 mg 2 times a day for 7 days: AUC & increases by 9.4; Cmax & - by 8.6;
    40 mg of atorvastatin once + rifampicin at a dosage of 600 mg once a day for 5 days (separate administration): AUC & increases by 0.8; Cmax & - by 0.4 (since rifampicin is characterized by a dual mechanism of interaction, its simultaneous administration with atorvastatin is recommended; later administration of the latter after rifampicin leads to a significant decrease in the content of atorvastatin in the blood plasma);
    40 mg of atorvastatin once + rifampicin at a dosage of 600 mg once a day for 7 days (simultaneous use): AUC & increases by 0.3; Cmax & - by 2.7 (since rifampicin is characterized by a double mechanism of interaction, its simultaneous administration with atorvastatin is recommended; later administration of the latter after rifampicin leads to a significant decrease in the content of atorvastatin in the blood plasma);
    20 mg of atorvastatin once + telaprevir at a dosage of 750 mg every 8 hours for 10 days: AUC & increases by 7.88; Cmax & - by 10.6;
    10 mg of atorvastatin for 3 days + efavirenz at a dosage of 600 mg once a day for 14 days: AUC & decreases by 0.41; Cmax & - by 0.01;
    40 mg of atorvastatin once + boceprevir at a dosage of 800 mg 3 times a day for 7 days: AUC & increases by 2.3; Cmax & - 2.66;
    10 mg of atorvastatin 1 time per day for 15 days + Maalox TS at a dosage of 30 ml 1 time per day for 17 days: AUC & decreases by 0.33; Cmax & - by 0.34;
    20 mg of atorvastatin 1 time per day for 4 days + lopinavir at a dosage of 400 mg 2 times a day or ritonavir at a dosage of 100 mg 2 times a day for 14 days: AUC & increases by 5.9; Cmax & - by 4.7;
    40 mg of atorvastatin 1 time per day for 28 weeks + colestipol at a dosage of 10 mg 2 times a day for the same time period: the change in AUC & is not established, and Cmax & decreases by 0.26 (the sample was taken once 8-16 hours after taking a medicine);
    40 mg of atorvastatin 1 time per day for 4 days + saquinavir or ritonavir at a dosage of 400 mg 2 times a day for 15 days: AUC & increases by 3.9; Cmax & - by 4.3 (the doses of ritonavir and saquinavir used in this study differ from those recommended in clinical practice; it should be borne in mind that the increase in the exposure of atorvastatin during the course of treatment is presumably higher than that registered in this study, therefore it is necessary to take atorvastatin in lowest dose);
    10 mg of atorvastatin 1 time per day for 14 days + cimetidine at a dosage of 300 mg 4 times a day for 14 days: AUC & decreases by 0.001; Cmax & - by 0.11;
    80 mg of atorvastatin 1 time per day for 8 days + clarithromycin at a dosage of 500 mg 2 times a day for 9 days: AUC & increases by 4.4; Cmax & - by 5.4;
    80 mg of atorvastatin as a single dose + amlodipine at a dose of 10 mg as a single dose: AUC & increases by 0.15; Cmax & decreases by 0.12;
    10 mg of atorvastatin 1 time per day for 4 days + darunavir at a dosage of 300 mg 2 times a day or ritonavir at a dosage of 100 mg 2 times a day for 9 days: AUC & increases by 3.4; Cmax & - by 2.25;
    10 mg of atorvastatin once + erythromycin at a dosage of 500 mg 4 times a day for 7 days: AUC & increases by 0.33; Cmax & - by 0.38;
    40 mg of atorvastatin once + diltiazem at a dosage of 240 mg once a day for 28 days: AUC & increases by 0.51; Cmax & is 0;
    40 mg of atorvastatin once + itraconazole at a dosage of 200 mg once a day for 4 days: AUC & increases by 3.3; Cmax & - by 20%;
    40 mg of atorvastatin once + grapefruit juice in a volume of 240 ml once a day times)]: AUC & increases by 0.37; Cmax & - by 0.16;
    10 mg of atorvastatin 1 time per day for 4 days + fosamprenavir at a dosage of 1400 mg 2 times a day for 14 days: AUC & increases by 2.3; Cmax & - by 4.04;
    10 mg of atorvastatin 1 time per day for 4 days + fosamprenavir at a dosage of 700 mg 2 times a day or ritonavir at a dosage of 100 mg 2 times a day for 14 days: AUC & increases by 2.53; Cmax & - 2.84;
    10 mg of atorvastatin 1 time per day for 28 days + nelfinavir at a dosage of 1250 mg 2 times a day for 14 days: AUC & increases by 0.74; Cmax & - by 2.2.
The effect of atorvastatin on the pharmacokinetic parameters of other drugs was also studied. As a result, the following information was obtained:
    10 mg of atorvastatin 1 time per day for 4 days + fosamprenavir at a dosage of 1400 mg 2 times a day for 14 days: AUC & fosamprenavir decreases by 0.27; Cmax & - by 0.18;
    10 mg of atorvastatin once a day for 4 days + fosamprenavir at a dosage of 700 mg 2 times a day or ritonavir at a dosage of 100 mg 2 times a day for 14 days: their AUC & and Cmax & remain unchanged;
    80 mg of atorvastatin once a day for 15 days + a single dose of 600 mg of antipyrine: AUC & antipyrine increases by 0.03; Cmax & decreases by 0.11;
    10 mg of atorvastatin once + tipranavir at a dosage of 500 mg 2 times a day or ritonavir at a dosage of 200 mg 2 times a day for 7 days: AUC & and Cmax & of tipranavir and ritonavir remain unchanged;
    40 mg of atorvastatin once a day for 22 days + oral contraceptives once a day for 2 months (at a dose of ethinylestradiol 35 mcg, norethindrone 1 mg): AUC of ethinyl estradiol increases by 0.19 and norethindrone - by 0.28; Cmax of ethinylestradiol increases by 0.3 and norethindrone - by 0.23;
    80 mg of atorvastatin once a day for 14 days + digoxin at a dosage of 0.25 mg once a day for 20 days: AUC & digoxin increases by 0.15; Cmax & - by 0.2.

Indications for use

Primary hypercholesterolemia, including heterozygous nonfamilial and familial hypercholesterolemia (according to Fredrickson's classification - type IIa);
    Mixed (combined) hyperlipidemia (according to Fredrickson's classification - types IIa and IIb);
    Dysbetalipoproteinemia (according to Fredrickson's classification - type III) (as an addition to the diet);
    Endogenous familial hypertriglyceridemia (according to Fredrickson's classification - type IV), showing resistance to diet;
    Familial homozygous hypercholesterolemia with insufficient effectiveness of diet and other non-pharmacological therapeutic methods;
    Cardiovascular complications in patients without clinical signs of coronary heart disease, but with several risk factors for its occurrence, including arterial hypertension, age over 55 years, nicotine addiction, low concentrations of HDL-C (high density lipoprotein cholesterol) in blood plasma, diabetes mellitus , genetic predisposition, incl. against the background of dyslipidemia (for primary prevention);
    Cardiovascular complications in patients with coronary heart disease to reduce the total mortality rate, stroke, myocardial infarction, re-hospitalization for angina pectoris and the need for revascularization (for secondary prevention).

Contraindications

Absolute:
    Active liver disease or an increase in serum transaminase activity (more than 3 times in comparison with the upper limit of the norm) of unclear etiology;
    Age up to 18 years (due to the lack of clinical data on the safety and effectiveness of the drug for this age group of patients);
    Pregnancy and lactation period;
    Hypersensitivity to the components of the drug.
Relative (Liprimar should be used with caution):
    Alcohol abuse;
    History of liver disease.
During therapy, women of reproductive age need to use adequate methods of contraception.

Instructions for the use of Liprimar: method and dosage

Before starting the use of Liprimar, it is necessary to try to achieve control of hypercholesterolemia with diet, exercise and weight loss in obese patients, as well as therapy for the underlying disease.
When prescribing the drug, the patient should be advised to follow the standard cholesterol-lowering diet during the entire course.
Liprimar is taken orally, once a day, regardless of food intake and time of day.
Depending on the initial content of LDL-C, the purpose of treatment and individual response, the dose can vary from 10 mg to 80 mg (maximum).
At the beginning of therapy and / or during dose increases every 2-4 weeks, it is necessary to control the plasma lipid content and, in accordance with this, adjust the dose.
For most patients, the daily dose of the drug for combined (mixed) hyperlipidemia and primary hypercholesterolemia is 10 mg. As a rule, the therapeutic effect is manifested within 14 days, reaching a maximum within a month. With prolonged therapy, the effect persists.
With homozygous familial hypercholesterolemia, the drug is prescribed in a daily dose of 80 mg.
For patients with hepatic insufficiency, the dose of the drug is reduced under constant monitoring of the activity of aspartate aminotransferase and alanine aminotransferase.
Functional impairments of the kidneys do not affect the concentration of atorvastatin in the blood plasma or the degree of decrease in the content of cholesterol-LDL, therefore, such patients do not need dose adjustment.
When administered simultaneously with cyclosporine, the maximum dose of Liprimar is 10 mg.

Side effects

As a rule, Liprimar is well tolerated, the resulting disorders are transient and mild.
During therapy, the following side effects may develop (≥1% - often; ≤1% - infrequently):
    Central nervous system: often - headache, insomnia, asthenic syndrome; infrequently - peripheral neuropathy, dizziness, malaise, paresthesia, amnesia, hypesthesia;
    Digestive system: often - constipation, dyspepsia, nausea, abdominal pain, diarrhea, flatulence; infrequently - anorexia, vomiting, pancreatitis, hepatitis, cholestatic jaundice;
    Musculoskeletal system: often - myalgia; infrequently - myopathy, back pain, muscle cramps, arthralgia, myositis, rhabdomyolysis;
    Hematopoietic system: infrequently - thrombocytopenia;
    Metabolism: infrequently - hyperglycemia, hypoglycemia, increased serum creatine phosphokinase;
    Allergic reactions: infrequently - toxic epidermal necrolysis (Lyell's syndrome), skin rash, urticaria, pruritus, bullous rash, anaphylactic reactions, exudative erythema multiforme (including Stevens-Johnson syndrome);
    Others: infrequently - increased fatigue, peripheral edema, impotence, weight gain, tinnitus, chest pain, secondary renal failure, alopecia.

Overdose

Signs of atorvastatin overdose are increased side effects.
If necessary, it is recommended to carry out symptomatic therapy, control the activity of creatine phosphokinase and regular liver function tests. Since the active substance is actively involved in the processes of binding to blood plasma proteins, the use of hemodialysis for its excretion is considered ineffective.
The specific antidote for atorvastatin is unknown.

Special instructions

After the use of Liprimar, there may be a moderate increase in the serum activity of alanine aminotransferase and aspartate aminotransferase, a persistent increase in the serum level of hepatic transaminases (without the development of jaundice or other clinical manifestations). With a decrease in the dose, withdrawal of the drug (temporary or complete), the activity of hepatic transaminases usually returns to its initial level. In most cases, patients can continue therapy at a reduced dose without any clinical consequences.
Liver function indicators should be monitored before starting treatment, 6 and 12 weeks after starting the drug or after increasing the dose, as well as throughout the course of therapy.
The drug is canceled with a pronounced increase in the activity of creatine phosphokinase, in the presence of suspected or confirmed myopathy. When the drug is prescribed simultaneously with immunosuppressants, fibrates, erythromycin, antifungal drugs (derivatives of azoles) or nicotinic acid in lipid-lowering doses, it should be borne in mind that this increases the likelihood of myopathy developing. It is necessary to regularly monitor the condition of patients to detect muscle weakness or pain, especially during the first months of therapy and during periods of increasing doses of any drug. If it is necessary to carry out a combination therapy, it is necessary to consider the possibility of using these drugs in lower initial and maintenance doses.
When using Liprimar, rare cases of rhabdomyolysis with acute renal failure caused by myoglobinuria are described. If signs of possible myopathy appear or there are risk factors for the appearance of renal failure against the background of rhabdomyolysis (for example, in severe acute infection, arterial hypotension, trauma, metabolic, endocrine and electrolyte disturbances and uncontrolled seizures, major surgical intervention), therapy is recommended to be completely canceled or temporarily interrupted ...
If you experience unexplained muscle weakness or pain, especially if it is accompanied by fever or malaise, you should consult a specialist.

Influence on the ability to drive vehicles and complex mechanisms

There is no information on the effect of the drug on the ability to drive vehicles and perform potentially hazardous types of work that require increased concentration and immediate psychomotor reactions. However, due to the possibility of dizziness, care must be taken when engaging in the above activities.

Application during pregnancy and lactation

During the course of therapy, women of reproductive age who are taking Liprimar should use reliable contraception. The appointment of the drug is contraindicated in patients who do not protect themselves from pregnancy. There is information about rare cases of congenital anomalies after intrauterine exposure to HMG-CoA reductase inhibitors (statins) on the fetus. Animal studies support fertility toxicity.
It is unacceptable to prescribe Liprimar to nursing mothers, since there is no reliable information on the penetration of atorvastatin into breast milk. If it is necessary to use the drug during lactation, breastfeeding should be canceled in order to avoid an increase in the risk of developing undesirable effects in infants.

Childhood use

In pediatric practice, it is contraindicated to use Liprimar for the treatment of children and adolescents under the age of 18 years, due to the lack of clinical data on the effectiveness and safety of therapy in this age group. An exception is the treatment of heterozygous familial hypercholesterolemia, in which the use of atorvastatin in children from 10 years of age is indicated.

With impaired renal function

According to the instructions, Liprimar should be used with caution to treat patients with impaired renal function, since the condition is one of the risk factors for the development of rhabdomyolysis.

For violations of liver function

It is contraindicated to take the drug in patients with liver disease in the active phase, as well as with an increase in the activity of hepatic transaminases of unknown origin in blood plasma by more than 3 times compared with the upper limit of the norm.
Liprimar is prescribed with caution to patients with a history of liver disease and / or alcohol abuse.

Use in the elderly

When using Liprimar in elderly patients, differences in safety and efficacy compared with the general population have not been identified, so there is no need for dose adjustment.
Since the risk of developing rhabdomyolysis increases over the age of 70, the drug should be used with caution.

Drug interactions

With the simultaneous use of Liprimar with some drugs, the following effects may occur:
    Cyclosporine, fibrates, erythromycin, clarithromycin, antifungal drugs (derivatives of azoles) and nicotinic acid in lipid-lowering doses: increased risk of myopathy;
    Inhibitors of the isoenzyme CYP3A4: an increase in the concentration of atorvastatin in blood plasma;
    OATP1B1 inhibitors (eg, cyclosporine): increase the bioavailability of atorvastatin;
    Erythromycin, clarithromycin, CYP3A4 inhibitors, diltiazem, grapefruit juice: increased plasma concentration of atorvastatin;
    Itraconazole: an increase in the AUC value (total concentration of a substance in the blood plasma) of atorvastatin;
    Inducers of the cytochrome CYP3A4 isoenzyme: decrease in the concentration of atorvastatin in the blood plasma;
    Colestipol: a decrease in the concentration of atorvastatin in plasma, however, the hypolipidemic effect of the combination of drugs is superior to that of each of them separately;
    Digoxin: an increase in its concentration when taking the drug in high doses (monitoring of the condition of patients is necessary);
    Oral contraceptives containing norethisterone and ethinyl estradiol: an increase in the AUC of these substances.

Terms and conditions of storage

Keep out of reach of children at temperatures up to 25 ° C.
Shelf life is 3 years.

Reviews about Liprimar

The drug is often prescribed to patients suffering from various disorders in the functioning of the cardiovascular system. There are a variety of reviews about Liprimar, in particular, many patients report a high effectiveness of treatment. However, some patients do not quite correctly understand how to take the drug due to insufficient explanation of the treatment regimen by the doctor. Therefore, they try to independently select or adjust the doses of atorvastatin, which leads to unwanted side effects (bruising and bruising, blood thinning, etc.).
Experts consider Liprimar to be one of the most effective drugs, provided that the dosage and duration of the course of therapy are strictly adhered to. They also advise during treatment to engage in feasible physical exercise, diet and regular blood tests.

Terms of sell

You can buy Liprimar without a doctor's prescription.