Introduction

Atova 20 belongs to a group of medicines called statins. It is used to lower cholesterol and to reduce the risk of heart disease. Cholesterol is a fatty substance that builds up in your blood vessels and causes narrowing, which may lead to a heart attack or stroke. Atova 20 is a widely prescribed medicine and is regarded as safe for long-term use when taken as per doctor's advice. It can be taken with a meal or on an empty stomach. You can take it at any time of the day but try to take it at the same time each day. Most people with high cholesterol do not feel ill, but stopping your medicine may increase your cholesterol levels, making your condition worse and increasing your risk of heart disease and stroke. It is important to have your cholesterol levels checked regularly. This medicine is only one part of the treatment program which should also include a healthy diet, regular exercise, smoking cessation, moderation of alcohol intake and weight reduction. You can eat normally while taking this medicine, but try to avoid foods that are high in fat. Common side effects of this medicine include headache, constipation, muscle pain, nausea, indigestion, diarrhea and nasopharyngitis (inflammation of the throat and nasal passages). These are usually mild and disappear after a short time. Consult your doctor if they persist or if you notice any yellowing of your eyes or get repeated or unexplained muscle pains. This medicine should not be used in some conditions such as liver disease. Also, pregnant women and breastfeeding mothers should not take this medicine as it may harm the developing baby. Diabetic patients should monitor their blood sugar levels while taking this medicine, as it may lead to an increase in blood sugar levels. Your doctor may check your liver function before starting the treatment and monitor it regularly thereafter.

Uses of Atova 20

• High cholesterol
• Prevention of heart attack

Side effects of Atova 20

• Constipation
• Headache
• Muscle pain

How to use Atova 20

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Atova 20 may be taken with or without food, but it is better to take it at a fixed time.

How Atova 20 works

Atova 20 is a lipid-lowering medication (statin). It works by blocking an enzyme (HMG-CoA-reductase) that is required in the body to make cholesterol. It thus lowers "bad" cholesterol (LDL) and triglycerides, raising the level of "good" cholesterol (HDL).

What if you forget to take Atova 20?

If you miss a dose of Atova 20, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not take two doses within 12 hour.

Indication

Oral Mixed dyslipidaemia, Heterozygous familial hypercholesterolaemia, Nonfamilial hypercholesterolaemia Adult: Initially, 10 or 20 mg once daily, may be adjusted at 4-wk interval. May initiate 40 mg once daily in patients who require >45% reduction in LDL-cholesterol. Max: 80 mg/day. Elderly: No dosage adjustment needed.

Administration

May increase risk of myopathy and rhabdomyolysis w/ CYP3A4 potent inhibitor (e.g. HIV or HCV protease inhibitors, itraconazole, clarithromycin), fenofibrate, colchicines, fixed combination of lopinavir/ritonavir. May decrease plasma concentration w/ CYP3A4 inducer (e.g. rifampicin, efavirenz). May significantly increase AUC and peak plasma concentration of digoxin. Increased AUC for norethindrone and ethinyl estradiol. Potentially Fatal: Increased risk of myopathy or rhabdomyolysis w/ ciclosporin, gemfibrozil, telaprevir, tipranavir.

Adult Dose

Patients who consume substantial quantities of alcohol. History of liver disease. Patients with risk factors for myopathy or rhabdomyolysis. Hypothyroidism should be properly managed prior to starting statin therapy. Children <10 yr. Premenarcheal females. Lactation: Because of the potential for adverse reactions in nursing infants, women taking this drug should not breastfeed; contraindicated in nursing mothers.

Renal Dose

Atorvastatin competitively inhibits HMG-CoA reductase, the enzyme that catalyses the conversion of HMG-CoA to mevalonate. This results in the induction of the LDL receptors and stimulation of LDL catabolism, leading to lowered LDL-cholesterol levels.

Contraindication

Oral Mixed dyslipidaemia, Heterozygous familial hypercholesterolaemia, Nonfamilial hypercholesterolaemia Child: Heterozygous familial hypercholesterolaemia: 10-17 yr 10 mg once daily, may increase at intervals of at least 4 wk to max 20 mg/day.

Mode of Action

Atorvastatin can be administered as a single dose at any time of the day, with or without food. Avoid excessive consumption (>1 L/day) of grapefruit juice.

Precaution

Primary hypercholesterolemia (heterozygous familial and nonfamilial), Mixed Dyslipidemia, Homozygous familial hypercholesterolemia, Hypertriglyceridemia, Familial hypercholesterolemia, Cardiovascular event prevention, Primary dysbetalipoproteinemia

Side Effect

Renal Insufficiency: Renal disease does not affect the plasma concentrations or LDL-C reduction of atorvastatin; thus, dosage adjustment in patients with renal dysfunction is not necessary.

Pregnancy Category Note

>10% Diarrhea (5-14%),Nasopharyngitis (4-13%),Arthralgia (4-12%) 1-10% Insomnia (1-5%),Urinary tract infection (4-8%),Nausea (4-7%),Dyspepsia (3-6%),Increased transaminases (2-3%),Muscle spasms (2-5%),Musculoskeletal pain (2-5%),Myalgia (3-8%),Limb pain (3-8%),Pharyngolaryngeal pain (1-4%) Frequency Not Defined Angina,Syncope,Dyspnea,Myopathy,Anaphylaxis,Stevens-Johnson syndrome,Myositis Potentially Fatal: Thrombocytopenia. Rhabdomyolysis with acute renal failure.

Interaction

Hypersensitivity, active liver disease or unexplained persistent elevations of serum transaminase, porphyria, pregnancy, lactation.