Precautions and warnings

At high doses or in patients with a history of renal impairment, atorvastatin can cause myopathy and, in rare cases, rhabdomyolysis with acute renal failure related to myoglobinuria. When used with CYP3A4 inhibitors, which can raise Atorvastatin plasma concentrations, use with caution. If signs of myopathy or rhabdomyolysis are present, reduce or stop taking Atorvastatin. Atorvastatin has been linked to liver biochemical abnormalities; LFT should be examined prior to and at 12 weeks after treatment commencement and dosage increment; patients who drink a lot of alcohol or have a history of liver disease should be cautious. The use of dihydropyridine calcium channel blockers has been linked to an increase in angina and/or myocardial infarction, particularly in patients with severe obstructive coronary artery disease. Amlodipine can produce oedema in the legs in a dose-dependent manner. Patients with severe aortic stenosis should be cautious since symptomatic hypotension may arise. Elderly.

Drug Interactions

Amlodipine and Atorvastatin metabolism may be accelerated by Rifamycins. Norethindrone and Ethinyl estradiol's AUC may be increased by atorvastatin.

Possibly lethal: When used with fabric acid derivatives, lipid-modifying dosages of niacin, cyclosporine, or powerful CYP3A4 inhibitors, atorvastatin increases the risk of myopathy (for example, clarithromycin, HIV protease inhibitors, itraconazole). Cyclosporine (an OATP1B1 inhibitor) may boost Atorvastatin bioavailability considerably.

Contraindications

Active liver disease or persistently high hepatic transaminases with no apparent cause. Lactation and pregnancy.

Mode of actions

Amlodipine is a dihydropyridine calcium channel blocker that relaxes the smooth muscle of the peripheral and coronary arteries. During depolarization, it prevents Ca ions from entering the voltage-sensitive channels of vascular smooth muscle and heart, causing coronary vasodilation. It decreases peripheral vascular resistance, lowering blood pressure as a result. Amlodipine also decreases coronary spasms in patients suffering from vasospastic angina. HMG-CoA reductase, the enzyme that catalyzes the conversion of HMG-CoA to mevalonate, which is a rate-limiting step in cholesterol production, is specifically and competitively inhibited by atorvastatin.

Dosage & Administration

Adult: PO HTN or angina and hyperlipidaemia:

Amlodipine: Initially 5 mg once daily, titrate over 1-2 wk; max: 10 mg/day. Atorvastatin: Initially 10-20 mg once daily (anytime of the day), patients who require >45 % reduction in LDL cholesterol may be initiated at 40 mg once daily. Titrate dose at intervals of at least 4 week; max: 80 mg/day.

Pregnancy & Lactation

This medicine must not be used during pregnancy. It can be absorbed through the skin and lungs caused can damage your unborn child’s organs and cause congenital disabilities. Strict two effective types of birth control starting one month before and during treatment and for three years after stopping this medicine. Discuss with your doctors if you are not sure which types of birth control are effective for you. You must need to take pregnancy tests regularly during your treatment with this medicine and for at least three years after taking this medicine. If it seems that you do become pregnant stop taking this medicine and call your doctor immediately. If you really become pregnant, miss a menstrual period, or have sex without using two forms of birth control. In some cases, your doctor can prescribe emergency contraception to prevent pregnancy. People on this medicine should not donate blood during the treatment and for three years afterward.

This medicine is also contraindicated breast milk. Breastfeeding is not recommended while using this medication and for three years afterward.

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