Livazo tablets coated. 1 mg 28 pcs. (Pytavastatyn)

Pharmacological action

Pitavastatin competitively inhibits HMG-CoA reductase, limiting the rate of action of the enzyme in cholesterol biosynthesis, inhibits the synthesis of cholesterol (Ch) in the liver. As a result, the expression of LDL receptors in the liver is increased, contributing to the capture of circulating LDL in the blood, lowering total cholesterol and LDL cholesterol (LDL-C) in the blood. Its persistent inhibition of hepatic synthesis of Chs reduces the secretion of LDL into the blood, reducing the level of triglycerides in blood plasma.

Livazo lowers elevated LDL-C, total Chs and triglycerides, and increases HDL cholesterol (HDL-C). The drug reduces the level of apolipoproteins (Apo-B) and leads to a variable increase in Apo-A1.

Pharmacokinetics

Absorption

Pitavastatin is rapidly absorbed in the upper gastrointestinal tract, Cmax in plasma is reached within 1 hour after oral administration. Absorption is independent of food intake. The drug, unchanged, undergoes enterohepatic circulation and is well absorbed in the small intestine. The absolute bioavailability of pitavastatin is 51%.

Cmax of pitavastatin in blood plasma decreased by 43% with a high-fat meal, but the AUC remained unchanged.

Distribution of

Pitavastatin is more than 99% bound to plasma proteins, mainly albumin and 1-acid glucoprotein, with an average Vd of about 133 l. Pitavastatin is actively transported to hepatocytes, the site of action and metabolism, by many liver carriers, including OATP1B1 and OATP1B3. Plasma AUC varies with an approximately 4-fold range between the highest and lowest values. Studies of SLCO1B1 (the gene that encodes OATP1B1) suggest that the polymorphism of this gene may explain the large fluctuation in AUC. Pitavastatin is not a substrate for P-glucoprotein.

Metabolism

Pitavastatin unchanged is the majority of the drug in plasma. The main metabolite is an inactive lactone, which is formed via the ether-type pitavastatin glucuronide conjugate with UDP glucuronosyl transferase (UGT1A3 and 2B7). In vitro studies using 13 isoforms of human cytochrome P450 (CYP) show that pitavastatin metabolism via CYP is minimal CYP2C9 (and to a lesser extent CYP2C8) is responsible for the metabolism of pitavastatin to minor metabolites.

Excretion

Unchanged pitavastatin is rapidly excreted from the liver into bile, but undergoes enterohepatic recirculation, which determines the duration of its action. Less than 5% of pitavastatin is excreted in the urine. T1 / 2 from blood plasma ranges from 5.7 h (1 dose) to 8.9 h (equilibrium), the geometric mean of oral clearance is 43.4 l / h after a single dose.

Indications

Primary hypercholesterolemia, including heterozygous familial hypercholesterolemia (type IIa hyperlipidemia according to the Fredrickson classification) or mixed hypercholesterolemia (type IIl hyperlipidemia according to the Fredrickson classification), hypertriglyceridemia (type IV hyperlipidemia but the Fredrickson classification) as an adjunct to dietary methods, such as diet, and exercises, weight loss) are insufficient.

Contraindications

Severe hepatic insufficiency (more than 9 points on the Child-Pugh scale) or class C according to the Child-Pugh classification, liver disease and active phase, including a persistent increase in the activity of hepatic transaminases in blood serum (more than 3 times compared with VGN) myopathy concomitant use of cyclosporine pregnancy, the period of breastfeeding, lack of adequate methods of contraception in women of childbearing age under 18 years of age (efficacy and safety have not been established) hypersensitivity to pitavastatin, auxiliary components of the drug and other HMG-CoA reductase inhibitors (statins).

Special instructions

Effect on

muscles Along with other inhibitors of HMG-CoA reductase inhibitors (statins) it causes the development of myalgia, myopathy, less often rhabdomyolysis. Patients should be warned that they should immediately consult a doctor if any symptoms in their muscles appear. When patients develop muscle pain or muscle weakness, especially if they are accompanied by malaise or fever, creatine kinase levels must be determined.

Creatine kinase should not be measured after exercise or if there are any other possible reasons for the increase in creatine kinase, which can be confusing when interpreting the results. After detecting an increased concentration of creatine kinase (more than 5 times compared with VGN) for 5-7 days, a control analysis is required and, if necessary, stop taking the drug.

Before treatment with

, Livazo is prescribed with caution to patients with predisposing risk factors for rhabdomyolysis. In the following cases, a creatine kinase level measurement is required to establish standard baseline data: -

renal failure - reduced

thyroid function - personal or family history of hereditary

muscle disorders - previous muscle toxicity from fibrates or other

statins - history of liver disease or abuse alcohol

- elderly patients (over 70 years old) with other predisposing risk factors for rhabdomyolysis.

During treatment with

If severe muscle symptoms occur, therapy should be discontinued, even if creatine kinase levels are less than 5 times lower than those with VGN. If the symptoms stop, and the creatine kinase level returns to normal, then you can resume taking Livazo at a dose of 1 mg / day and with careful monitoring.

Liver effects

Livazo should be used with caution in patients with a history of liver disease or in patients who abuse alcohol. Before starting treatment with Livazo and periodically during the entire course of therapy, it is necessary to monitor liver function indicators. Treatment should be discontinued in patients with a persistent increase in plasma transaminases (ALT and AST) more than 3 times compared with VGN.

Impact on the kidneys

Livazo should be used with caution in patients with moderate or severe renal failure. Increasing the dose should be carried out only with careful monitoring of renal function after a gradual titration of the dose. A dose of 4 mg is not recommended for patients with severe renal failure.

Interstitial pulmonary disease

Interstitial pulmonary disease has been reported during the use of certain statins, especially with long-term therapy. Severe symptoms may include shortness of breath, unproductive cough, and poor general health (fatigue, weight loss, and fever). In case of suspected development of interstitial lung disease in a patient, statin therapy should be discontinued.

Influence on the ability to drive vehicles and control mechanisms

There is no data on the impact on the ability to drive a vehicle and control moving mechanisms.

Composition

Active ingredient: calcium pitavastatin, which corresponds to the content of pitavastatin 1 mg,

Excipients: lactose monohydrate, low-substituted hyprolose, hypromellose, magnesium aluminum metasilicate, magnesium stearate.

Composition of the film membrane: White opadray, including hypromellose, titanium dioxide, triethyl acetate, colloidal silicon dioxide.

Side effects

Frequency is defined as: very often ( 1/10), often ( 1/100 to <1/10), infrequently ( 1/1000 to <1/100), rarely ( 1/10 000 to <1/1000), very rarely (<1/10 000) and is unknown.

Often: headache, constipation, diarrhea, indigestion, nausea, myalgia, joint pain.

Infrequently: anemia, anorexia, insomnia, dizziness, dullness of taste, drowsiness, tinnitus, abdominal pain, dry mouth, vomiting, increased transaminases (AST, ALT), pruritus, rash, muscle cramps, pollakiuria, asthma malaise weakness, peripheral edema.

Rarely: decreased visual acuity, burning mouth syndrome, acute pancreatitis, cholestatic jaundice, impaired liver function, impaired liver function, myopathy, rhabdomyolysis, urticaria, erythema.

The following side effects have been identified with certain statins: sleep disturbance, including nightmares, memory loss, sexual dysfunction, depression, isolated cases of interstitial lung disease, especially with prolonged therapy.

Overdose

In case of an overdose, the symptoms of adverse reactions may intensify.

There is no specific antidote. Symptomatic treatment and supportive measures should be taken as needed.

Liver function and creatine kinase levels need to be monitored. Hemodialysis is ineffective.

Storage conditions

The drug should be stored in its original packaging, protected from light, out of the reach of children, at a temperature not exceeding 25 ° C.

Expiration

4 years.

Deystvuyuschee substances

Pytavastatyn

Dosage form

tablets



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