Atorvast-Natrapharm Indications/Uses

An adjunct to lifestyle changes, including diet for the reduction of elevated total cholesterol (total-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and apolipoprotein B (apo B), the total cholesterol: high-density lipoprotein cholesterol (TC:HDL-C) ratio and for increasing HDL-C; in hyperlipidemic and dyslipidemic conditions including: Primary hypercholesterolemia (type IIa); combined (mixed) hyperlipidemia (type IIb), including familial combined hyperlipidemia, regardless of whether cholesterol or TG are the lipid abnormality of concern; dysbetalipoproteinemia (type III); hypertriglyceridemia (type IV); familial hypercholesterolemia (homozygous and heterozygous).
For homozygous familial hypercholesterolemia, atorvastatin should be used as an adjunct to treatments eg, LDL apheresis or as monotherapy if such treatments are not available.
An adjunct to diet to reduce total-C, LDL-C and apo B levels in boys and postmenarchal girls 10-17 years with heterozygous familial hypercholesterolemia, if after an adequate trial of diet therapy the following findings are still present: LDL-C remains ≥4.9 mmol/L (190 mg/dL) or ≥4.1 mmol/L (160 mg/dL), and there is a positive family history of premature cardiovascular disease (CVD) or ≥2 other CVD risk factors are present in the pediatric patient.
Prior to initiating therapy with atorvastatin, secondary causes should be excluded for elevations in plasma lipid levels (eg, poorly controlled diabetes mellitus, hypothyroidism, nephrotic syndrome, dysproteinemias, obstructive liver disease and alcoholism) and a lipid profile performed to measure total-C, LDL-C, HDL-C and TG. For patients with TG <4.52 mmol/L (<400 mg/dL), LDL-C can be estimated using the following equation: (See equation.)

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For patients with TG levels >4.52 mmol/L (>400 mg/dL), this equation is less accurate and LDL-C concentrations should be measured directly or by ultracentrifugation.
Patients with high or very high TG levels ie, >2.2 mmol/L (200 mg/dL) or >5.6 mmol/L (500 mg/dL), respectively, may require TG-lowering therapy (fenofibrate, bezafibrate or nicotinic acid) alone or in combination with atorvastatin.
In general, combination therapy with fibrates must be undertaken cautiously and only after risk-benefit analysis (see Precautions and Interactions).
Elevated serum TG are most often observed in patients with the metabolic syndrome [abdominal obesity, atherogenic dyslipidemia (elevated TG, small dense LDL particles and low HDL-C), insulin resistance with or without glucose intolerance, raised blood pressure and prothrombic and pro-inflammatory states].
When drugs are prescribed attention to therapeutic lifestyle changes (reduced intake of saturated fats and cholesterol, weight reduction, increased physical activity, ingestion of soluble fibers) should always be maintained and reinforced.
Prevention of Cardiovascular Disease: To reduce the risk of myocardial infarction in adult hypertensive patients without clinically evident coronary heart disease (CHD), but with at least 3 additional risk factors for CHD eg, age ≥55 years, male sex, smoking, type 2 diabetes, left ventricular hypertrophy, other specified abnormalities on electrocardiogram (ECG), microalbuminuria or proteinuria, ratio of plasma total-C to HDL-C ≥6 or premature family history of CHD.
To reduce the risk of myocardial infarction and stroke in adult patients with type 2 diabetes mellitus and hypertension without clinically evident CHD, but with other risk factors eg, age ≥55 years, retinopathy, albuminuria or smoking.
To reduce the risk of myocardial infarction in patients with clinically evident CHD.