Download - Hyperlipidimia and Statins
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Thamonwan Theerabunchorn 04/03/2009
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OBJECTIVE
TO FIND OUT THESE :
1.What is hyperlipidimia ?
2.What happen after hyperlipidimia ?
3.What is/are differentiation
of each statin drug ?
4.How to beattle ?
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SO LOW SO GOOD
Normal
Abnormal
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HDL
SO HIGH
SO GOOD
Abnormal
Normal
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Normal
Abnormal
LDL < 130 mg/dL
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Normal
Abnormal
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ภาวะไขมันในเลอืดสูง
สะสมตามหลอดเลอืดแดงต่าง ๆ
หัวใจ สมอง
ปลายมือปลายเท้า
CARDIOVASCULAR DISEASE
(*** CVD ***)
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Normal artery
• smooth
• flexible
Abnormal artery
• rough
• rigid
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CVD at Heart Artery
• Myocardial Infraction
• Anginapectoris
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CVD at Peripheral Artery
• เหน็บชา มือ เท้า• แผล / ตดิเชือ้
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CVD at Cerebral Artery
• อมัพฤก / อมัพาต• ความจ าเส่ือม
• ปากเบีย้ว พูดไม่ชัด
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RISK FACTOR
POSITIVE NEGATIVE
• AGE
• Low HDL Cholesterol
• Cigarette smoking
• Hypertention
• Genetics
• High HDL Cholesterol
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RISK FACTOR
MEN WOMENCITERIA
• AGE
• Low HDL Cholesterol
• Cigarette smoking
• Hypertention
• Genetics
• >,= 45 years
• < 40 mg/dl
• YES !
• BP > 140/90 mm Hg
or
taking
hypertensive
medicind
• YES !
• >,= 55 years
• < 40 mg/dl
• YES !
• BP > 140/90 mm Hg
or
taking
hypertensive
medicind
• YES !
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GOAL & MANAGEMENT
Risk category : CHD (10 – year risk > 20 percent)
• LDL goal : < 100 mg/dl
• Therapeutic Life Style Change (TLC) : LDL >,= 100 mg/dl
• Drug Therapy : LDL >,= 130 mg/dl
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GOAL & MANAGEMENT
Risk category : 2 or more risk factors (10 – year risk < 20 percent)
• LDL goal : < 130 mg/dl
• Therapeutic Life Style Change (TLC) : LDL >,= 130 mg/dl
• Drug Therapy :
1. LDL >,= 130 mg/dl for 10 – year risk of 10 to 20 percent
2. LDL >,= 160 mg/dl for 10 – year risk of < 10 percent
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GOAL & MANAGEMENT
Risk category : 0 – 1 risk factor
• LDL goal : < 160 mg/dl
• Therapeutic Life Style Change (TLC) : LDL >,= 160 mg/dl
• Drug Therapy : LDL >,= 190 mg/dl
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STATIN DRUG THERAPY
• Mechanism of Action
HMG-CoA
Mevalonate
HMG – CoA Reductase
Statin Drug
Statin = HMG-CoA Reductase Inhibitor
Cholesterol&
Ubiquinone (CoQ10)
1
2 3
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TYPE OF STATIN
TYPE I TYPE II
Rosuvastatin
Atorvastatin
(Fermentation Derivative) (Synthetics Group)
etc. : Lovastatin, Pravastatin : Fluvastatinetc.
Simvastatin
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Check ListDifferentiation
Simvastatin Atorvastatin Rosuvastatin
ED-List Yes No No
Cost(baht)/Tablet
(at start dose)0.40 - 0.80 30 - 35 40
Dose(mg/day)
required
to acchive
30% - 40%
LDL-Reduction
20 - 40 10 5 -10
Efficacy
of
LDL Reduction
(%)
35 - 41 39 39 - 45
D/I
(Drug
Interaction)CYP3A4 CYP3A4
CYP2C9
CYP2C19
notice
coz ADR related to dose then low dose low ADR
So
Atorvastatin & Rosuvastatin are ALTERNATIVE of Simvastatin
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DRUG INTERAC WITH HEPATIC ENZYME
CYP3A4 CYP3C9 CYP3C19
• Macrolides (azithromycin, clarithromycin,
erythromycin)
• Antifungals (itraconazole, ketoconazole, terbinafine)
• Calcium Antagonists (mibefradil, diltiazem,
verapamil, nifedipine, Lacidipine)
• Protease inhibitors (indinavir, ritonavir, nelfinavir,
saquinavir, amprenavir)
• Wafarin
• Sildenafil
• Cyclosporine• Tacrolimus
• Amiodarone
• Quinidine• Nefazodone
• Alprenolol
• Diclofenac
• Hexobabital
• Phenyltoin
• Tolbutamide
• Warfarin
• Diazepam
• Ibuprofen
• Mephenytoin
• Methylphenobabital
• Omeprazole
• Phenytoin
• Proguanyl
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ADVERSE DRUG REACTION
ADR(+++v+++)
+!!!!!!!!+
+!!!!+V
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ADVERSE DRUG REACTION (ADR)
• ปวดท้อง ท้องผูก ท้องเสีย คล่ืนไส้ อาเจียร และปวดศรีษะ
• อ่อนเพลีย • กล้ามเนือ้เป็นตะคริว • ปวดกล้ามเนือ้และข้อ ทัง้นี ้ถ้าเกิดภาวะไฟเบอร์ของกล้ามเนือ้ลายแตก ร่วมกับการมีหรือไม่มีภาวะไตวายเฉียบพลับจนสามารถตรวจพบสาร myoglobin ในปัสสาวะควรหยุดใช้ยาทันที
อาการที่พบบ่อย ได้แก่
อาการที่พบได้บ้าง ได้แก่
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HMG-CoA
HMG – CoA Reductase
Statin Drug
Cholesterol
&UBIQUINONE
1
2
MACHANISM OF MYOPHATY
Muscle Cell
Disturbance
MYOPHATY• ปวดกล้ามเนือ้
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SIMVASTATIN BRAND IN THE MARKET
…BERLIN CO LTD,.
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SIMVASTATIN BRAND IN THE MARKET
…SILOM MEDICAL
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… GOVERNMENT PHARMACEUTICAL ORGANIZATION
GPO’s BRAND
Can
YOU
Remember
?
WHAT ABOUT OURS
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… GOVERNMENT PHARMACEUTICAL ORGANIZATION
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COMPETETIVE CHECK LIST
Check List
Differentiation
GPO Berlin Silom
StrengthCover All
(10,20,40,80 mg)
Cover All
(10,20,40,80 mg)
Cover All
(10,20,40,80 mg)
Price Flexibility Yes Yes Yes
Shelf Life 2 ปี เบือ้งต้น 3 ปี 3 ปี
Packaging Alu-Alu & Strip Alu-PVDC Alu-PVDC
Climate Change
ToleranceYes No No
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