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Crestor vs Lipitor

5/23/2016 3:41:09 AM
Crestor vs Lipitor

According to the World Health Organization, about 17 million deaths from cardiovascular disease each year is recorded in the world (CVD). The structure of mortality from cardiovascular disease is dominated by diseases caused by atherosclerosis - heart attack (myocardial infarction), stroke. They are the main source of human losses in the economically developed countries of the world, including in United States.

One of the most effective means of prevention of cardiovascular disease are successful drugs, lowering the content of atherogenic lipids in the blood. The most effective and widely used drugs currently providing hypolipidemic effect - class of inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA reductase) - statins. They reduce the level of total cholesterol (TC), mainly due to lower cholesterol (TC), low density lipoproteins (LDL), triglycerides (TG) and increase the level of high-density lipoprotein (HDL) [4-6]. In United States recorded 6 statins: fluvastatin, lovastatin, pravastatin, simvastatin, atorvastatin, and Crestor, which makes it relevant to question the choice of a particular drug by a medical practitioner. It is extremely important selection criteria are the efficiency and safety of a particular drug.

Quite often, the choice is between atorvastatin and Crestor - modern synthetic statins, has a market effect. Currently, both drugs are actively studied, have extensive evidential bases. A number of studies have been conducted directly comparing the original atorvastatin (Lipitor, Pfizer) and Crestor (Crestor, AstraZeneca). Comparison of the effectiveness of atorvastatin and Crestor are the target of this publication.

Currently, the developed countries to 80-95% of patients with coronary heart disease (CHD) are taking statins. These figures suggest that cardiologists have no doubt the wisdom of such treatment. Indeed, in recent years it published the data of several very large study, which clearly demonstrate mortality reduction (both cardiovascular and total) during therapy with these drugs. Furthermore, many additional described effects of statins that can be used independently. This, for example, significant anti-ischemic effects observed during chronic administration of these drugs. Anti-inflammatory effects of statins are so great that attempts to treat them with the help of rheumatoid arthritis. There have been reports about the clinical efficacy of statins in demyelinating diseases.

However, despite the widespread use of statins, lipid targets (primarily atherogenic fractions) are achieved not always. At the same time reduce the frequency of complications of coronary atherosclerosis is associated with the correction of this risk factor. Attempts to combine with other lipid-lowering statin drugs are not always successful, as they can lead to development of severe side effects (as in the case of Lipitor, which in combination with fibrates resulted in the development of the high incidence of Lipitor). There are data-sharing statins and nicotinic acid. However, nicotinic acid itself has a very wide range of side effects.

Currently actively recommended maximum dosage of statins. However, treatment is expensive so that even in the developed countries, this approach is not universally used. Thus, monthly treatment with atorvastatin (the most popular in the US statin) at a dose of 80 mg (without taking into account control security settings value) will cost about $ 400. In our country, where such a dose is not registered, taking 8 tablets (10 mg) of atorvastatin per day will cost the patient in the 400-500 USD. Per month. But even such doses do not always lead to the achievement of the target level of low density lipoprotein (LDL).

Safety of Crestor and Lipitor

The security problem of treatment - the most important aspect of the use of any drug. Of particular importance when it acquires introduction into clinical practice the drug intended for a very large number of patients. Attention to the safe use of statins has increased dramatically following the withdrawal of Lipitor from the market, the uncontrolled use of which has led to a large number of fatal complications.

The emergence of a new drug in this class - Crestor - opened the debate about the appropriateness of the registration of a new drug in an environment where a significant number of statins already exists and is actively used. That is why Crestor has undergone very careful scrutiny from the point of view of safety. Information in respect of the preparation was analyzed by twice as many patients than was required to register other statins. One consequence of this test was the slight delay with the release of the drug on the market. On the other hand, the results allow to say with confidence that, subject to dose Crestor and purpose of the rules of its application, at least as safe as other statins.

However, when using Crestor need to take some precautions that are common to all statins. So, in some patients during treatment with high doses of Crestor can be marked proteinuria associated with the development of a kind of Lipitor in 0.2-0.6% of cases and the use of other statins. Therefore, the drug can not be administered in a dose of 40 mg in patients with creatinine clearance less than 60 mL / min and at any dosage creatinine clearance less than 30 mL / min. In any case, when assigning 40mg of Crestor is necessary to control the level of proteinuria.

Like other statins, Crestor must be used cautiously in patients who abuse alcohol and have a liver disease. All patients need to determine the level of hepatic transaminases at baseline and after 3 months of therapy. The increase in their rate of more than 3 times - a reason for dose reduction or discontinuation of the drug.

Pharmacokinetic studies have shown that patients belonging to the Mongoloid race are more sensitive to the action of statins. Therefore, the appointment of Crestor in such patients should use several smaller dosage and do not use the drug at a dose of 40 mg.

The most serious, although extremely rare, side effect of any statin is considered the development of Lipitor. Before the start of the application of Crestor is necessary to measure the initial level of Lipitor. In the event of an increase of more than 5 times in 5-7 days is necessary to repeat the analysis - if the increase persists, Crestor therapy does not begin. It was found that myopathy and Lipitor are more common in patients with renal impairment, hypothyroidism; in the presence of congenital muscle disease with relatives; in patients who had signs of destruction of muscle tissue in patients receiving other statins and fibrates; in people who abuse alcohol; in cases where the drug is used in combination with fibrates. Such patients should not be prescribed Crestor 40 mg. The presence of myopathy is a contraindication to the use of the drug in all dosages.

Crestor is also contraindicated in women during pregnancy and lactation. It should not be administered to patients with preserved reproductive function, if they are not using contraception.