Первичная гиперхолестеринемия (типы: IIa и IIb) при отсутствии эффекта от диетотерапии и других немедикаментозных методов (снижение веса, адекватная физическая активность) и лиц с высоким риском развития атеросклероза коронарного характера; комбинированная форма гиперхолестеринемии и гипертриглицеридемии при неэффективности диеты и адекватных физических ...
Миопатия и другие заболевания скелетной мускулатуры; повышение АЛТ, АСТ; индивидуальная гиперчувствительность; выраженная патология печёночной системы; возрастное ограничение – до 18 лет. Относительные противопоказания, при которых Симвастатин назначают с осторожностью: терапия иммуносупрессорами после трансплантации органов; злоупотребление алкоголем; ...
Гиполипидемический препарат. Активный компонент производится синтетическим путём при ферментации Aspergillus terreus. Действующее вещество представляет собой неактивный лактоном, который в результате гидролиза в организме человека переходит в гидроксикислотное производное. Основной метаболит ингибирует специфический фермент, который катализирует процесс формирования мевалоната из ГМГ-КоА. Данная реакция лежит в основе раннего синтезирования холестерина, что позволяет Симвастатину предотвращать накопление токсичных форм стеролов. ГМГ-КоА способен с лёгкостью метаболизироваться до ацетил-КоА, принимающего активное участие во многих процессах синтеза в теле человека. На фоне приёма Симвастатина снижается уровень триглицеридов, общего холестерина, «плохого» и «очень плохого» холестерина (ЛПНП и ЛПОНП). Эффект медикамента проявляется через 15 дней лечения, и становится заметным по лабораторным показателям через 1-1.5 месяца. Холестеринснижающий эффект сохраняется в течение всего курса лечения. После прекращения терапии уровень холестерина постепенно возвращается к первоначальному показателю.
Показания к применению
Первичная гиперхолестеринемия (типы: IIa и IIb) при отсутствии эффекта от диетотерапии и других немедикаментозных методов (снижение веса, адекватная физическая активность) и лиц с высоким риском развития атеросклероза коронарного характера; комбинированная форма гиперхолестеринемии и гипертриглицеридемии при неэффективности диеты и адекватных физических нагрузок; профилактика инфаркта миокарда; снижение сердечно-сосудистого риска (инсульт, транзиторная ишемическая атака); снижение риска после реваскуляризации; предотвращение прогрессирования атеросклероза сосудов сердца.
Противопоказания
Миопатия и другие заболевания скелетной мускулатуры; повышение АЛТ, АСТ; индивидуальная гиперчувствительность; выраженная патология печёночной системы; возрастное ограничение – до 18 лет. Относительные противопоказания, при которых Симвастатин назначают с осторожностью: терапия иммуносупрессорами после трансплантации органов; злоупотребление алкоголем; артериальная гипотензия; водно-электролитный дисбаланс; выраженная патология эндокринной системы; метаболические изменения; эпилепсия; травматические и хирургические вмешательства.
Способ применения и дозы
Перед назначением статинов уровень холестерина снижают специальной гипохолестериновой диетой. При неэффективности дополнительно назначают Симвастатин. Инструкция по применению Симвастатина: 1 раз в сутки по 1 таблетке на ночь, запивая водой. Не следует связывать приём медикамента с приёмом пищи. Суточная доза зависит от уровня холестерина и липидного профиля (от 10 до 80 мг). Начинать холестеринснижающую терапию лучше с малых доз, постепенно повышая количество Симвастатина каждые 4 недели, отслеживая лабораторные показатели. В большинстве случаев хороший эффект регистрируется на дозе 20 мг в день. Пациентам с наследственной (гомозиготной) формой гиперлипидемии назначают 40 мг 1 раз в день либо 80 мг на 3 приёма (утром и днём по 20 мг, вечером – 40 мг). При ИБС суточная доза варьирует в диапазоне 20-40 мг. При одновременной терапии фибратами, Гемфиброзилом, Даназолом, Циклоспорином, Наицином рекомендуется ежесуточно принимать не более 10 мг Симвастатина. При приёме Верапамила и Амиодарона ежедневно принимают не больше 20 мг статина.
Побочное действие
Пищеварительный тракт: панкреатит; метеоризм; эпигастральные боли; запоры; повышение КФК, АЛТ, АСТ; рвота; диайреный синдром; тошнота. Нервная система: расплывчатость зрения; мигренозная головная боль; астенический синдром; парестезии; головокружения; нарушение вкусового восприятия; мышечные судороги; бессонница; периферическая невропатия. Иммунопатологические реакции и аллергические ответы: приливы; васкулит; ангионевротический отёк; тромбоцитопения; ревматическая полимиалгия; эозинофилия; волчаночнопдобный синдром; фотосенсибилизация; крапивница; лихорадка; повышение СОЭ; гиперемия кожных покровов; артрит, одышка. Костно-мышечная система: мышечные судороги; миопатия; выраженная слабость; рабдомиолиз; миалгия. Дерматологические реакции: дерматомиозит; кожный зуд; алопеция. Иные реакции: снижение потенции; острая почечная недостаточность на фоне рабдомиолиза; учащённое сердцебиение; анемия. При проявлении других негативных реакций на фоне лечения рекомендуется помощь специалиста и самостоятельная отмена препарата Симвастатин.
Взаимодействие с другими лекарственными средствами
Миопатию могут вызывать следующие медикаменты: Нефазодон; ингибиторы ВИЧ-протеазы; Эритромицин; большие дозы никотиновой кислоты; противомикотические средства (Итраконазол, Кетоконазол); фибраты; иммунодепрессанты; Телитромицин; Кларитромицин. Высокие дозировки Симвастатина и совместный приём Даназола и Циклоспорина может привести к рабдомиолизу. Лекарственный препарат способен потенцировать эффект пероральных форм антикоагулянтов (Варфарин, Фенпрокумон), повышать риск кровотечений. Медикамент повышает концентрацию Дигоксина.
Особые указания
Первые дни терапии могут сопровождаться повышением АЛТ, АСТ, билирубина. Рекомендуется регулярный УЗИ-контроль (при приёме 80 мг – каждые 3 месяца). Повышение ферментов печёночной системы в 3 раза является показанием к прекращению лечения. Соблюдение гипохолестериновой диеты позволяет достичь наилучших результатов. Рекомендуется отказаться от грейпфрутового сока во время лечения. Медикамент не применяется при гипертриглицеридемии 1,4 и 5 типов. Лекарственное средство может спровоцировать миопатию, которая приводит к почечной недостаточности и рабдомиолизу. Медикамент эффективен и в монотерапии, и при совместном лечении секвестрантами желчных кислот.
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