Липримар®

General characteristics. Structure:

Active agent: аторвастатин calcium (10 mg, 20 mg, 40 mg or 80 mg of an atorvastatin are equivalent) Excipients: calcium carbonate, cellulose microcrystallic, lactoses monohydrate, croscarmellose sodium, polysorbate-80,  hypro rod,  magnesium  stearate;  film cover: опадрай  white YS-1-7040 (contains a gipromelloza, polyethyleneglycol, titanium dioxide, talc), an emulsion of a simetikon (contains симетикон, stearin emulsifier, sorbic acid, water), wax a candelilla (only for tablets dosages of 10 mg, 20 mg and 40 mg).

Pharmacological properties:

Pharmacodynamics. Atorvastatin – the selection competitive inhibitor of GMG-KOA-reduktazy, the key enzyme turning 3-gidroksi-3-metilglyutaril-KOA in мевалонат – the predecessor of steroids, including cholesterol; synthetic hypolipidemic means. At patients with a homozygous and heterozygous family hypercholesterolemia, single forms of a hypercholesterolemia and the mixed dislipidemiya аторвастатин reduces contents in a blood plasma of the general cholesterol  (Хс), cholesterol of lipoproteids of the low density (Hs-LPNP) and apolipoprotein B (apo-V), and also cholesterol of lipoproteids of very low density (Hs-LPONP) and triglycerides (TG), causes unstable increase in content of cholesterol of lipoproteids of the high density (Hs-LPVP). Atorvastatin reduces concentration of cholesterol and lipoproteids in a blood plasma, inhibiting GMG-KOA-reduktazu and synthesis of cholesterol in a liver and, increasing number of "hepatic" receptors of LPNP by surfaces of cells that leads to strengthening of capture and a catabolism of Hs-LPNP. Atorvastatin reduces education Hs-LPNP and number of particles of LPNP, causes the expressed and permanent increase in activity of LPNP-receptors in combination with favorable qualitative changes of LPNP-particles, and also reduces the Hs-LPNP level at patients with the homozygous hereditary family hypercholesterolemia steady against therapy by other hypolipidemic means. Atorvastatin in doses from 10 mg to 80 mg reduces the content of the general cholesterol by 30 % - 46 %, Hs-LPNP - for 41 % - 61 %, apolipoproteina-V - for 34 % - 50 % and TG - for 14 % - 33 %. Results of therapy are similar at patients to a heterozygous family hypercholesterolemia, single forms of a hypercholesterolemia and the mixed lipidemia, including, at patients to a non-insulin-dependent diabetes mellitus. At patients with the isolated gipertriglitseridemiya аторвастатин reduces the content of the general cholesterol, Hs-LPNP, Hs-LPONP, apo-V and TG also increases the Hs-LPVP level.         At patients with a disbetalipoproteinemiya аторвастатин reduces the content of cholesterol of lipoproteids of intermediate density. At patients with a giperlipoproteinemiya  of the IIa and IIb type across Frederikson average value of increase in contents Hs-LPVP at treatment atorvastatiny (10-80 mg) in comparison with an initial indicator makes 5,1% - 8,7% and does not depend on a dose. There is a considerable dozozavisimy decrease in size of ratios:  the general  cholesterol / Hs-LPVP and Hs-LPNP/ HS-LPVP for 29% of-44% and 37% of-55%, respectively. Limprimar in a dose of 80 mg authentically reduces risk of development of ischemic complications and rate of mortality by 16% after a 16 weeks course, and risk of repeated hospitalization concerning the stenocardia which is followed by symptoms of ischemia of a myocardium for 26%. With various initial concentration  of Hs-LPNP Liprimar® causes decrease in risk of ischemic complications and mortality (at patients with a myocardial infarction without tooth Q and unstable stenocardia, also as at men and women, and at patients aged younger and 65 years are more senior) in patients. Decrease in contents in a blood plasma of Hs-LPNP correlates with a drug dose better, than with its concentration in a blood plasma. The dose is selected taking into account therapeutic effect (see the section "Route of Administration and Doses"). The therapeutic effect is reached in 2 weeks after the beginning of therapy, reaches a maximum in 4 weeks and remains during the entire period of therapy. Prevention of cardiovascular complications In Anglo-Cкандинавском a research of cardiovascular complications (a lipidsnizhayushchy branch (ASCOT-LLA) of effect of an atorvastatin on deadly and nonlethal outcomes of the coronary heart disease (CHD) it is established that the effect of therapy atorvastatiny in a dose of 10 mg significantly exceeded effect of use of placebo in this connection the decision on the early termination of a research in 3,3 years instead of estimated 5 years was made. Atorvastatin authentically reduced risk of development of the following complications: Decrease in risk Coronary complications (and not fatal to THEM) 36% the General cardiovascular complications and procedures of revascularization of 20% the General cardiovascular complications of 29% the Stroke (fatal and not fatal) 26% of Essential decrease in indicators of the general mortality and mortality of the cardiovascular reasons was not noted by an ischemic heart disease from the death though positive tendencies were observed. Diabetes mellitus. In the integrated research of effect of an atorvastatin on deadly and nonlethal outcomes of cardiovascular diseases at a diabetes mellitus 2 types (CARDS) are shown that terapiyaatorvastatiny reduced risk of development of the following cardiovascular complications regardless of a sex, age of the patient or the initial Hs-LPNP level: Decrease in risk. The main cardiovascular complications (fatal and nefatalnyyostry, hidden by IT, death as a result of an ischemic heart disease aggravation, unstable stenocardia, shunting of a coronary artery, hypodermic transluminal coronary angioplasty, protseduryrevaskulyarization, a stroke) 37%   of 42% the Stroke (fatal and not fatal) 48% Atherosclerosis In a research of involution of coronary atherosclerosis at intensive lipidsnizhayushchy care (REVERSAL) atorvastatiny in a dose of 80 mg at patients with an ischemic heart disease are established to THEM to THEM (fatal and not fatal acute IT, hidden by IT) that average reduction of total amount of an atheroma (primary criterion of efficiency) since the beginning of a research made 0,4%. Recurrent stroke In the program of intensive decrease in level of cholesterol (SPARCL) it was established, чтоаторвастатин in a dose of 80 mg a day reduced risk of a repeated fatal or not fatal stroke at the patients who had a stroke or the tranzitorny ischemic attack (TIA) without ischemic heart disease in the anamnesis for 15% in comparison with placebo. At the same time the risk of the main cardiovascular complications and procedures of revascularization considerably decreased. Atorvastatiny it was noted reduction of risk of cardiovascular disturbances at therapy in all groups except that where patients with primary or recurrent hemorrhagic stroke entered (7 in a gruppeatorvastatin against 2 in group of placebo). Hemorrhagic stroke the patients receiving therapy atorvastatiny in a dose of 80 mg, the frequency of development of a hemorrhagic or ischemic stroke (265 against 311) or (123 against 204) had an ischemic heart disease less, than in control group. Secondary prevention of cardiovascular complications In treatment to the New Target Research (TNT) compared effect of an atorvastatin in doses of 80 mg/days and 10 mg/days on risk of development of cardiovascular complications in patients to clinically confirmed ischemic heart disease. Atorvastatin in a dose of 80 mg authentically reduced development of the following complications: Atorvastatin of 80 mg Primary final point the First important cardiovascular complication (an ischemic heart disease from the death and not fatal to THEM) 8,7% to THEM not fatal, not connected with the procedure 4,9% the Stroke (fatal and not fatal) 2,3% the Secondary final point the First hospitalization concerning congestive heart failure of 2,4% the First shunting of a coronary artery or other procedures of revascularization of 13,4% the First documentary stenocardia of 10,9% Pharmacokinetics. Absorption. Atorvastatin is quickly soaked up after intake: time of achievement its maximum concentration (TCmax) in a blood plasma reaches a maximum in 1-2 hours. At women the maximum concentration of an atorvastatin (Cmax) is 20% higher, and the area under a curve "concentration time" (AUC) – is 10% lower, than at men.   Extent of absorption and concentration in a blood plasma raise in proportion to a dose. Absolute bioavailability - about 14%, and system bioavailability of the inhibiting activity concerning GMG-KOA-reduktazy - about 30%. Low system bioavailability is caused by presistemny metabolism in a mucous membrane of digestive tract and/or at "the first passing" through a liver. Food reduces the speed and extent of absorption of drug a little (for 25 % and 9 %, respectively, what results of definition of Cmax and AUC testify to, however decrease in Hs-LPNP is similar to that at reception of an atorvastatin on an empty stomach. In spite of the fact that after reception of an atorvastatin in the evening its concentration in a blood plasma is lower (Cmax and AUC, approximately, for 30%), than after reception in the morning, decrease in the Hs-LPNP level does not depend on time of day in which accept drug. Distribution the Average volume of distribution of an atorvastatin makes about 381 l. Communication with proteins of a blood plasma not less than 98 %. The contents relation in erythrocytes/blood plasma makes about 0,25, i.e. аторвастатин badly gets into erythrocytes. Metabolism Atorvastatin is substantially metabolized with education orto-and para-hydroxylated derivatives and various products of β-oxidation.......... In vitro orto-and parahydroxylated metabolites have an inhibiting effect on GMG-KOA-reduktazu, comparable to that of an atorvastatin. About 70% of decrease of the activity of GMG-KOA-reduktazy happen due to action of the active circulating metabolites. Results of the researches in vitro give the grounds to assume that the isoenzyme of CYP3A4 cytochrome of a liver plays an important role in metabolism of an atorvastatin. In favor of this fact increase in concentration of drug in a blood plasma at a concomitant use of erythromycin which is inhibitor of this isoenzyme testifies. The researches in vitro also showed what аторвастатин is weak inhibitor of an isoenzyme of CYP3A4 cytochrome. Atorvastatin does not exert clinically significant impact on concentration in a blood plasma of a terfenadin who is metabolized, mainly, a CYP3A4 cytochrome isoenzyme therefore its significant effect on pharmacokinetics of other substrates of an isoenzyme of CYP3A4 cytochrome is improbable (see the section "Interaction with Other Medicines"). Removal Atorvastatin and his metabolites are removed, mainly, with bile after hepatic and/or extrahepatic metabolism (аторвастатин is not exposed to the expressed enterohepatic recirculation). The elimination half-life (T1/2) of drug makes about 14 h, at the same time the inhibiting effect of drug concerning GMG-KOA-reduktazy approximately is defined on 70% by activity of the circulating metabolites and about 20-30 hours thanks to their existence remain.  After intake in urine less than 2% of the accepted drug dose are found. Special groups of patients. Elderly patients. Concentration of an atorvastatin in a blood plasma of patients are more senior than 65 years above (Cmax approximately for 40%, AUC approximately for 30%), than at adult patients of young age. Distinctions in efficiency and safety of drug, or achievement of goals of hypolipidemic therapy at elderly patients in comparison with the general population are not revealed. Children. Drug pharmacokinetics researches at children were not conducted. Insufficiency of function of kidneys. The renal failure does not influence concentration of an atorvastatin in a blood plasma or its impact on indicators of lipidic exchange, in this regard change of a dose with a renal failure is not required from patients (see the section "Route of Administration and Doses"). Atorvastatin is not brought during a hemodialysis owing to intensive linkng with proteins of a blood plasma. Insufficiency of function of a liver Concentration of drug considerably increases (Cmax approximately by 16 times, AUC approximately by 11 times) at patients with alcoholic cirrhosis (a stage In on classification of Chayld-Pyyu) (see the section "Contraindications").

Indications to use:

Primary hypercholesterolemia (a heterozygous family and single hypercholesterolemia (IIa type across Frederikson); The Combined (mixed) lipidemia (IIa and IIb types across Frederikson); Disbetalipoproteinemiya (the III type across Frederikson) (as addition to a diet); Family endogenous gipertriglitseridemiya (the IV type across Frederikson), resistant to a diet; The Homozygous family hypercholesterolemia at insufficient efficiency of a dietotherapy and other not pharmacological methods of treatment; Primary prevention of cardiovascular complications at the patients without clinical signs of an ischemic heart disease but having several risk factors of its development – age is more senior than 55 years, nicotine addiction, arterial hypertension, a diabetes mellitus, low concentration of Hs-LPVP in a blood plasma, genetic predisposition, including against the background of a dislipidemiya; Secondary prevention of cardiovascular complications at patients with an ischemic heart disease for the purpose of decrease in total rate of mortality, a myocardial infarction, a stroke, repeated hospitalization concerning stenocardia and need for revascularization.

Route of administration and doses:

Inside. To accept at any time irrespective of meal. Before an initiation of treatment the drug Liprimarom® it is necessary to try to achieve control of a hypercholesterolemia by means of a diet, physical exercises and decrease in body weight from patients with obesity, and also therapy of a basic disease. At purpose of drug the patient needs to recommend a standard gipokholesterinemichesky diet to which he has to adhere during the entire period of therapy. The dose of drug varies from 10 mg to 80 mg of 1 times a day and is titrated taking into account the initial maintenance of Hs-LPNP, the purpose of therapy and individual effect on the carried-out therapy. The maximum daily dose of drug for a single dose makes 80 mg. In an initiation of treatment and/or during increase in a dose of the drug Liprimar® it is necessary to control each 2-4 weeks the level of lipids in a blood plasma and as appropriate to adjust a drug dose. Primary hypercholesterolemia and the combined (mixed) lipidemia For most of patients - 10 mg of 1 times a day; therapeutic action is shown within 2 weeks and usually reaches a maximum within 4 weeks. At prolonged treatment the effect remains. A homozygous family hypercholesterolemia In most cases appoint 80 mg of 1 times a day (decrease in maintenance of Hs-LPNP by 18-45%). Insufficiency of function of a liver At insufficiency of function of a liver a dose of Liprimara® needs to be reduced, at constant control of activity of "hepatic" transaminases: aspartate aminotransferases (nuclear heating plant) and alaninaminotranspherase (ALT). Insufficiency of function of kidneys the Renal failure does not influence concentration of an atorvastatin in a blood plasma or extent of decrease in maintenance of the Hs-LPNP level at therapy by the drug Liprimar® therefore dose adjustment of drug is not required. Elderly patients of Distinctions in efficiency, safety or therapeutic effect of the drug Liprimar® at elderly patients in comparison with the general population it is not revealed and dose adjustment is not required (see the section "Pharmacokinetics"). Use in a combination with other medicines In need of combined use with cyclosporine the dose of the drug Liprimar®  should not exceed 10 mg (see the section "Special Instructions").

Features of use:

Action on a liver. As well as when using other hypolipidemic means of this class, after treatment by the drug Liprimar®  noted moderated (more than by 3 times in comparison with the upper bound of norm) increase in activity of "hepatic" transaminases of nuclear heating plant and ALT. Permanent increase in serumal content of "hepatic" transaminases (more than by  3 times  in comparison with  the upper  bound of norm) was observed at 0,7% of the patients receiving препаратЛипримар®. Frequency of similar changes at use of drug in doses of 10 mg, 20 mg, 40 mg and 80 mg made  0,2%, 0,2%, 0,6% and 2,3%, respectively. Increase in activity of "hepatic" transaminases usually was not followed by jaundice or other clinical manifestations. At a drug Liprimar® dose decline, temporary or full drug withdrawal activity of "hepatic" transaminases was returned to initial level. Most of patients continued administration of drug of Liprimar® in a reduced dose without any clinical effects. Prior to therapy, in 6 weeks and 12 weeks later began uses of the drug Liprimar®ili after increase in its dose, and also during all course of treatment it is necessary to control indicators of function of a liver. Function of a liver should be investigated also at emergence of clinical signs of damage of a liver. In case of increase in level of "hepatic" transaminases their activity should be controlled until it is not normalized. If increase in activity of nuclear heating plant or ALT more than by 3 times in comparison with the upper bound of norm remains, the dose decline or drug withdrawal of Liprimar® is recommended (see the section "Side effect"). Липримар® it is necessary to apply with care at patients who consume significant amounts of alcohol and/or have a liver disease in the anamnesis. The active disease of a liver or constantly increased level of "hepatic" transaminases of a blood plasma of not clear genesis are a contraindication to  drug Liprimar® use (see the section "Contraindications"). Action on skeletal muscles At the patients receiving the drug Liprimar® the mialgiya was noted (see the section "Side effect"). The diagnosis of a myopathy (muscle pains or muscular weakness in combination with increase in activity of KFK more than by 10 times in comparison with the upper bound of norm) should be assumed at patients with a diffusion mialgiya, morbidity or weakness of muscles and/or the expressed increase in activity of KFK. Therapy by the drug Liprimarom® should be stopped in case of the expressed increase in activity of KFK, in the presence of the confirmed myopathy or estimated. The risk of a myopathy at treatment by other drugs of this class increased at simultaneous use of cyclosporine, fibrat, erythromycin, niacin in lipidsnizhayushchy doses (more than 1 g) or azolny antifungal means. Many of these drugs inhibit the metabolism mediated by a CYP3A4 cytochrome isoenzyme and/or transport of medicinal substances. It is known that a CYP3A4 cytochrome isoenzyme – the main isoenzyme of a liver participating in biotransformation of an atorvastatin. Appointing препаратЛипримар® in combination with fibrata, erythromycin, immunodepressants, azolny antifungal means or lipidsnizhayushchy doses of niacin, the doctor has to weigh carefully expected advantage of treatment and possible risk. It is regularly necessary to observe patients for the purpose of detection of pains or weakness in muscles, especially within the first months of therapy and during increase in a dose of any of the specified means. In case of need the combination therapy should consider the possibility of use of lower initial and maintenance doses of above-mentioned means. In similar situations it is possible to recommend periodic control of activity of KFK though such monitoring does not allow to prevent development of a heavy myopathy (see the section "Interaction with Other Medicines"). At use of the drug Liprimar® as well as other statines exceptional cases of a rabdomioliz with the acute renal failure caused by a myoglobinuria are described. At emergence of symptoms of a possible myopathy or existence of risk factor of development of a renal failure against the background of a rabdomioliz (for example, a heavy acute infection, arterial hypotension, extensive surgical intervention, injuries, metabolic, endocrine and electrolytic disturbances and uncontrollable spasms) therapy by the drug Liprimar® should be stopped temporarily or to cancel completely. Attention! Patients need to be warned that they should see immediately a doctor at emergence of inexplicable pains or muscular weakness, especially if they are followed by an indisposition or fever. Influence on ability to drive the car and difficult technique of Data on influence of an atorvastatin on ability to drive the car and zanimatsyapotentsialno the dangerous types of activity demanding the increased concentration of attention and speed of psychomotor reactions no.

Side effects:

Липримар® it is usually well transferred; side reactions, as a rule, easy and passing. The most frequent side reactions (≥ 1%):

From the central nervous system: sleeplessness, headache, asthenic syndrome.

From digestive tract: nausea, diarrhea, abdominal pain, dyspepsia, lock, meteorism.

From a musculoskeletal system and connecting fabric: mialgiya. Less frequent side reactions (≤ 1%):

From the central and peripheral nervous system: indisposition, dizziness, amnesia, paresthesias, peripheral neuropathy, hypesthesia.

From a digestive tract: vomiting, anorexia, hepatitis, pancreatitis, cholestatic jaundice.

From a musculoskeletal system and connecting fabric: dorsodynia, myotonia, miositis, myopathy, arthralgias, рабдомиолиз.

Allergic reactions: urticaria, skin itch, rash, anaphylactic reactions, violent rash, polymorphic exudative erythema (including Stephens-Johnson's syndrome), toxic epidermal necrolysis (Lyell's disease).

From a metabolism: hypoglycemia, hyperglycemia, increase in a serumal kreatinfosfokinaza (KFK).

From bodies  of a hemopoiesis: thrombocytopenia.

Others: impotence, peripheral hypostases, increase in body weight, stethalgia, secondary renal failure, alopecia, sonitus, increased fatigue.

Interaction with other medicines:

The risk of a myopathy during treatment by inhibitors of GMG-KOA-reduktazy increases at simultaneous use of cyclosporine, fibrat, erythromycin, a klaritromitsin, antifungal means – derivatives of an azol, – and niacin in lipidsnizhayushchy doses (see the section "Special Instructions"). CYP3A4 cytochrome isoenzyme inhibitors As аторвастатин it is metabolized by a CYP3A4 cytochrome isoenzyme, combined use of an atorvastatin with inhibitors of an isoenzyme of CYP3A4 cytochrome can lead to increase in concentration of an atorvastatin in a blood plasma. Extent of interaction and effect of potentiation are defined  by variability of impact on a CYP3A4 cytochrome isoenzyme. Inhibitors of transport protein OATP1B1 Atorvastatin and his metabolites are substrates of transport protein OATP1B1. OATP1B1 inhibitors (for example, cyclosporine) can increase bioavailability of an atorvastatin. So, combined use of an atorvastatin in a dose of 10 mg and cyclosporine in a dose of 5,2 mg/kg/days leads to  increase in concentration of an atorvastatin in a blood plasma by 7,7 times (see the section "Route of Administration and Doses"). Erythromycin / кларитромицин At simultaneous use of an atorvastatin and erythromycin (on 500 mg 4 times a day) or a klaritromitsina (on 500 mg 2 times a day) which inhibit a CYP3A4 cytochrome isoenzyme, increase in concentration of an atorvastatin in a blood plasma was observed (see the section "Special Instructions"). Inhibitors of proteases Simultaneous use of an atorvastatin with the inhibitors of proteases known as CYP3A4 cytochrome isoenzyme inhibitors, is followed by increase in concentration of an atorvastatin in a blood plasma (at simultaneous use with Cmax erythromycin of an atorvastatin increases by 40%). Diltiazem Combined use of an atorvastatin in a dose of 40 mg with diltiazem in a dose of 240 mg, leads to increase in concentration of an atorvastatin in a blood plasma. Cimetidinum of Clinically significant interaction of an atorvastatin with Cimetidinum it is not revealed. Itrakonazol Simultaneous use of an atorvastatin in doses from 20 mg to 40 mg and an itrakonazol  in a dose of 200 mg carried out to increase in AUC value of an atorvastatin. Grapefruit juice As grapefruit juice contains one or more components which inhibit a CYP3A4 cytochrome isoenzyme, its overconsumption (more than 1,2 l a day) can cause increase in concentration of an atorvastatin in a blood plasma.  Combined use of an atorvastatin with CYP3A4 cytochrome isoenzyme inductors (for example, efavirenzy or rifampicin) can lead CYP3A4 cytochrome isoenzyme inductors to decrease in concentration of an atorvastatin in a blood plasma. Owing to the dual mechanism  of interaction with rifampicin (the inductor of an isoenzyme of CYP3A4 cytochrome and inhibitor of transport protein  of hepatocytes OATP1B1), simultaneous use of an atorvastatin and rifampicin as the delayed reception of an atorvastatin after reception of rifampicin leads to essential decrease in concentration of an atorvastatin in a blood plasma is recommended. Antacids the Concomitant use in the suspension containing magnesium hydroxide and aluminum hydroxide reduced concentration of an atorvastatin in a blood plasma approximately by 35%, however extent of decrease in maintenance of Hs-LPNP at the same time did not change. Phenazone Atorvastatin does not influence phenazone pharmacokinetics therefore interaction with other drugs, the metabolized same isoenzymes of cytochrome, is not expected. Kolestipol Pri simultaneous use of a kolestipol concentration of an atorvastatin in a blood plasma decreased approximately by 25%; however the hypolipidemic effect of a combination of an atorvastatin and kolestipol surpassed that of each drug separately. Pri's digoxin repeated reception of digoxin and an atorvastatin in a dose of 10 mg equilibrium concentration of digoxin in a blood plasma did not change. However at use of digoxin in a combination with atorvastatiny in a dose of 80 mg/days concentration of digoxin increased approximately by 20%. The patients receiving digoxin in combination with atorvastatiny demand the corresponding observation. Pri's azithromycin simultaneous use of an atorvastatin in a dose of 10 mg of 1 times a day and azithromycin  in a dose of 500 mg of 1 times a day concentration of an atorvastatin in a blood plasma did not change. Oral contraceptives of Pri simultaneous use of the atorvastatin and oral contraceptive containing Norethisteronum and ethinylestradiol substantial increase of AUC of Norethisteronum and ethinylestradiol approximately for  30% and 20%, respectively was observed. This effect should be considered at the choice of an oral contraceptive for the woman accepting аторвастатин. Terfenadin Pri simultaneous use of an atorvastatin and terfenadin of clinically significant changes of pharmacokinetics of a terfenadin it is not revealed. Warfarin of Signs of clinically significant interaction of an atorvastatin with warfarin it is not revealed. Amlodipin Pri simultaneous use of an atorvastatin in a dose  of 80 mg and an amlodipina in a dose of 10 mg pharmacokinetics of an atorvastatin in an equilibrium state did not change. Other accompanying therapy In clinical trials аторвастатин applied in combination with anti-hypertensive means and estrogen within replacement therapy; signs of clinically significant undesirable interaction are noted; interaction researches with specific drugs were not conducted.

Contraindications:

Hypersensitivity to any component of drug. An active disease of a liver or increase in activity of "hepatic" transaminases in a blood plasma of not clear genesis more, than by 3 times in comparison with the upper bound of norm. Age up to 18 years (not enough clinical data on efficiency and safety of drug in this age group).

Overdose:

   There is no specific antidote for overdose treatment by the drug Liprimar®. In case of overdose it is necessary to carry out a symptomatic treatment as required. As drug actively contacts proteins of a blood plasma, the hemodialysis is inefficient.

Storage conditions:

List B. To store at a temperature not over 25 ºС. To store in the places unavailable to children.

Issue conditions:

According to the recipe

Packaging:

Tablets, film coated 10 mg, 20 mg, 40 mg and 80 mg of 7 or 10 tablets in the blister from opaque polypropylene / PVC and aluminum foil of the Tablet dosages of 10 mg and 20 mg: 2 blisters on 7 tablets; 3 or 10 blisters on 10 tablets in a cardboard pack together with the application instruction of the Tablet dosages of 40 mg and 80 mg: 2 or 4 blisters on 7 tablets; 3 or 10 blisters on 10 tablets in a cardboard pack together with the application instruction.