The 10-year heart attack risk calculation has been "programmed" in such a way as to make patients out of virtually everyone. Sinatra points out that the complexity of estimating risk based on age, race, blood pressure, smoking habits, and other criteria, as the calculator claims to do, is quite likely to lead to overzealous prescribing. Steven Nissen used the calculator to evaluate some of his own patients—men who had no known risk markers—it became clear just how flawed this measure really is. Accordingly, in June 2013 the NBI initiated collaboration with the ACC and AHA to work with other organizations to complete and publish the 4 guidelines noted above and make them available to the widest possible constituency. Hypertrlyceridemia, hyperlipidemia, mixed dyslipidemia, slowing progression of atherosclerosis, primary dysbetalipoproteinemia 10-20 mg PO q Day initially; may titrate; not to exceed 40 mg/day Dosage range: 5-40 mg/day Homozygous familial hypercholesterolemia: Initiate with 20 mg PO q Day; may titrate; not to exceed 40 mg/day Primary prevention of cardiovascular disease in individuals with no cliniy evident heart disease but who are at risk because of combined effect of risk factors listed below Approval based on JUPITER trial (Justification for the Use of statins in Prevention: an Intervention Trial Evaluation Rosuvastatin) Initial: 10-20 mg PO q Day Dosage range 5-40 mg/day Patients of Asian descent: Initiate with 5 mg/day Coadministration with other lipid-lowering therapy: Consider dose reduction if combined with niacin or fenofibrate, because of increased risk for skeletal muscle effects Coadministration with cyclosporine: Not to exceed 5 mg/day Coadministration with gemfibrozil: Avoid if possible; if used together, do not exceed 10 mg/day Coadministration with ritonavir, lopinavir/ritonavir, or atazanavir/ritonavir: Not to exceed 10 mg/day Indicated to reduce LDL-C, Total-C, non HDL-C and Apo B in children and adolescents aged 7 to 17 yr with homozygous familial hypercholesterolemia, either alone or with other lipid-lowering treatments (eg, LDL apheresis) Arthralgia (10%) Diabetes mellitus, new onset (3%) Pharyngitis (9%) Headache (6%) Asthenia (up to 5%) Dizziness (4%) CPK increased (3%) Nausea (3%) Abdominal pain (2%) ALT increased (2%) Constipation (2%) Flulike illness (2%) UTI (2%) Nonserious and reversible cognitive side effects may occur Increased blood sugar and glycosylated hemoglobin (Hb A1c) levels reported with statin intake; in some instances these increases may exceed the threshold for the diagnosis of diabetes mellitus Chronic liver disease Measure liver enzymes before initiating and if sns or symptoms of liver injury occur Consider lower initial dose (5 mg q Day) in patients with risk of myopathy Increased risk of rhabdomyolysis, especially at hhest approved dose of 40 mg/day; reserve hhest dose only for patients who fail to achieve desired cholesterol level at 20 mg/day Use 5 mg/day starting dose in people of Asian ancestry, who may build up hher drug levels and be at hher risk of myopathy Rare reports of immune-mediated necrotizing myopathy (IMNM), characterized by increased serum creatine kinase that persists despite discontinuing statin Discontinue if CK levels are markedly elevated Contraindicated Because HMG-Co A reductase inhibitors decrease cholesterol synthesis and possibly the synthesis of other biologiy active substances derived from cholesterol (eg, cell membranes), rosuvastatin may cause fetal harm when administered to pregnant women Contraindicated Limited data indicate that rosuvastatin is present in human milk; because statins have the potential for serious adverse reactions in nursing infants, women who require rosuvastatin treatment should not breastfeed their infants Hepatic influx and efflux transporters (single-nucleotide polymorphisms [SNPs] within the solute carrier organic anion transporter 1B1 (SLCO1B1) gene, encoding the organic anion transporter polypeptide 1B1 (OATP1B1) influx transporter) SLCO1B1 (OATP1B1) CC genotype snificantly increases AUCs of parent drug and metabolites compared with the CT or TT genotypes This polymorphism is proposed to reduced transport into the liver, the main site of statin metabolism and elimination, resulting in elevated plasma concentrations SLCO1B1 polymorphism is thought to have a lesser effect on the more hydrophilic statins (eg, rosuvastatin, fluvastatin) compared with those that are more lipophilic (eg, atorvastatin, pravastatin, simvastatin) Other genetic polymorphisms of elimination (eg, CYP450, P-glycoprotein) for each individual drug must also be considered, to explain variability for statin clearance among patients that exhibit SCLO1B1 polymorphism SLCO1B1 CC genotype is most common in Caucasians and Asians (15%); decrease dose by 50% in people of Asian descent Risk of myopathy is 2.6- to 4.3-fold hher if the C allele is present and 16.9-fold hher in CC homozygotes than in TT homozygotes The above information is provided for general informational and educational purposes only.
Lipitor 5 new indications
To reduce the rate of MI and stroke in patients with: non-ST-segment elevation acute coronary syndrome (unstable angina/non-ST-elevation MI) or acute ST-elevation MI; history of recent MI, recent stroke, or established peripheral arterial disease; see full labeling. This content has not been reviewed within the past year and may not represent Web MD's most up-to-date information.
Albert, Ph D, CCNS, CCRN, FAHA, Biykem Bozkurt, MD, Ph D, FACC, FAHA, Ralph G. Recognizing that the Expert Panels/Work s did not consider evidence beyond 2011 (except as specified in the methodology), the ACC, AHA, and collaborating societies plan to begin updating these guidelines starting in 2014.
Lipitor 5 new indications
Lipitor 5 new indications
Unique formulations, new indications, and the 'rediscovery' of already approved drugs are just a few of the innovations pharmacists can expect as drug makers revitalize their product portfolios. Some treatments may cause unwanted or dangerous reactions in people with allergies, hh blood pressure, or pregnancy.
The Echo® Elemonics Hydrogen Infusion Machine filters, infuses and elementally balances your drinking water. VIAGRA TABLETS
Lipitor 5 new indications:
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