Divastin E | 10 mg+10 mg | Tablet | 10 pcs

Atorvastatin: In animal models, atorvastatin lowers plasma cholesterol and lipoprotein levels by inhibiting HMG-CoA reductase and cholesterol synthesis in the liver and by increasing the number of hepatic LDL receptors on the cell surface to enhance uptake and catabolism of LDL; atorvastatin also reduces LDL production and the number of LDL particles.

Ezetimibe: Ezetimibe reduces blood cholesterol by inhibiting the absorption of cholesterol by the small intestine. The molecular target of ezetimibe has been shown to be the sterol transporter, Niemann-Pick C1-Like 1 (NPC1L1), which is involved in the intestinal uptake of cholesterol and phytosterols. In a 2-week clinical study in 18 hypercholesterolemic patients, ezetimibe inhibited intestinal cholesterol absorption by 54%, compared with placebo. Ezetimibe had no clinically meaningful effect on the plasma concentrations of the fat-soluble vitamins A, D, and E and did not impair adrenocortical steroid hormone production. Ezetimibe does not inhibit cholesterol synthesis in the liver or increase bile acid excretion. Ezetimibe localizes at the brush border of the small intestine and inhibits the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver. This causes a reduction of hepatic cholesterol stores and an increase in clearance of cholesterol from the blood; this distinct mechanism is complementary to that of statins.

The dosage range is 10/10 mg to 80/20 mg daily. The recommended starting dose is 10/10 mg or 20/10 mg daily. This can be administered as a single dose at any time of the day, with or without food. The recommended starting dose for patients who require a larger reduction in LDL-C (greater than 55%) is 40/10 mg daily. After initiation and/or upon titration of this medicine, lipid levels should be analyzed within 2 or more weeks and dosage adjusted accordingly.

Patients with Homozygous Familial Hypercholesterolemia: The dosage in patients with homozygous familial hypercholesterolemia is 40/10 mg or 80/10 mg daily. This should be used as an adjunct to other lipid-lowering treatments (e.g., LDL apheresis) in these patients or if such treatments are unavailable.

Patients with Hepatic Impairment: This is contraindicated in patients with active liver disease or unexplained persistent elevations in hepatic transaminase levels.

Patients with Renal Impairment: A history of renal impairment may be a risk factor for statin-associated myopathy. These patients need closer monitoring for skeletal muscle effects. In patients with renal impairment, no dosage adjustment is necessary.

The risk of myopathy during treatment with statins is increased with concurrent administration of fibric acid derivatives, lipid-modifying doses of niacin, cyclosporine, or strong CYP3A4 inhibitors (e.g., clarithromycin, HIV protease inhibitors, and itraconazole). The coadministration of Divastin E with cyclosporine should be avoided. Due to an increased risk of myopathy/rhabdomyolysis when HMG-CoA reductase inhibitors are coadministered with gemfibrozil, concomitant administration of Divastin E with gemfibrozil should be avoided. The risk of skeletal muscle effects may be enhanced when Divastin E is used in combination with niacin. Patients taking digoxin should be monitored appropriately. The increase in AUC values for norethindrone and ethinyl estradiol should be considered when selecting an oral contraceptive for a woman taking Divastin E. Caution should be exercised when prescribing Divastin E with colchicine. If Divastin E is added to warfarin, a coumarin anticoagulant, the International Normalized Ratio (INR) should be appropriately monitored.

Active liver disease or unexplained persistent elevations of hepatic transaminase levels. Hypersensitivity to any component of this preparation.

Common side effects are rhabdomyolysis, myopathy, liver enzyme abnormalities, myalgia, abdominal pain, increased hepatic enzymes.

Pregnancy Category X. This tablet is contraindicated in women who are or may become pregnant. Serum cholesterol and triglycerides increase during normal pregnancy. Lipid-lowering drugs offer no benefit during pregnancy, because cholesterol and cholesterol derivatives are needed for normal fetal development. Atherosclerosis is a chronic process, and discontinuation of lipid-lowering drugs during pregnancy should have little impact on long-term outcomes of primary hypercholesterolemia therapy. It is not known whether atorvastatin is excreted in human milk, but a small amount of another drug in this class does pass into breast milk.

Cases of myopathy, including rhabdomyolysis, have been reported with atorvastatin coadministered with colchicine, and caution should be exercised when prescribing Divastin E with colchicine. Divastin E therapy should be temporarily withheld or discontinued in any patient with an acute, serious condition suggestive of myopathy or having a risk factor predisposing to the development of renal failure secondary to rhabdomyolysis.

Liver Enzymes: It is recommended that liver enzyme tests be obtained prior to initiating therapy with Divastin E and repeated as clinically indicated. If serious liver injury with clinical symptoms and/or hyperbilirubinemia or jaundice occurs during treatment with Divastin E, promptly interrupt therapy. If an alternate etiology is not found, do not restart Divastin E. Active liver disease or unexplained persistent transaminase elevations are contraindications to the use of Divastin E.

Endocrine Function: Caution should be exercised if Divastin E is administered concomitantly with drugs that may decrease the levels or activity of endogenous steroid hormones, such as ketoconazole, spironolactone, and cimetidine.

Pediatric Use: Safety and effectiveness have not been established in pediatric patients.

Geriatric Use: In geriatric patients, no dosage adjustment is necessary.

No specific treatment of overdosage can be recommended. In the event of an overdose, the patient should be treated symptomatically, and supportive measures instituted as required.

Other lipid regulating drugs

Do not store above 30°C. Keep in a dry place. Protect from light and keep out of the reach of children.