Actions of Torid 20 in details
Pharmacology: Torid 20 is a selective, competitive inhibitor of HMG-CoA reductase, the rate-limiting enzyme that converts 3-hydroxy-3-methylglutaryl-coenzyme A to mevalonate, a precursor of sterols, including cholesterol. In animal models, Torid 20 lowers plasma cholesterol and lipoprotein levels by inhibiting HMG-CoA reductase and cholesterol synthesis in the liver and by increasing the number of hepatic low-density lipoprotein (LDL) receptors on the cell-surface to enhance uptake and catabolism of LDL. Torid 20 also reduces LDL production and the number of LDL particles.
Pharmacokinetics: Torid 20 is rapidly absorbed after oral administration; maximum plasma concentrations occur within 1-2 hrs. The absolute bioavailability of Torid 20 (parent drug) is approximately 14% and the systemic availability of HMG-CoA reductase inhibitory activity is approximately 30%.
Mean volume of distribution of Torid 20 is approximately 381 L. Torid 20 is 98% bound to plasma proteins. Torid 20 is extensively metabolized to ortho- and parahydroxylate derivatives and various β-oxidation products. Approximately 70% of circulative inhibitory activity for HMG-CoA reductase is attributed to active metabolites. Torid 20 and its metabolites are eliminated primarily in bile following hepatic and/or extrahepatic metabolism. Mean plasma elimination half-life (t½) of Torid 20 in humans is approximately 14 hrs, but the t½ of inhibitory activity for HMG-CoA reductase is 20-30 hrs due to the contribution of active metabolites. Less than 2% of a dose of Torid 20 is recovered in urine following oral administration.
How should I take Torid 20?
Take Torid 20 only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it or for a longer time than your doctor ordered.
In addition to Torid 20, your doctor may change your diet to one that is low in fat, sugar, and cholesterol. Carefully follow your doctor's orders about any special diet.
Take Torid 20 at the same time each day.
Swallow the tablet whole. Do not break, crush, or chew it. Take Torid 20 with or without food.
Do not drink large amounts of alcohol with Torid 20. This could cause unwanted effects on the liver.
Tell your doctor if you regularly drink grapefruit juice. Drinking large amounts of grapefruit juice (more than 1.2 liters each day) while you take Torid 20 may increase your risk of muscle injury and could result in kidney problems.
Dosing
The dose of Torid 20 will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of Torid 20. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form (tablets):
- For high cholesterol:
- Adults—At first, 10 or 20 milligrams (mg) once a day. Some patients may need to start at 40 mg per day. Your doctor may increase your dose as needed. However, the dose is usually not more than 80 mg per day.
- Children 10 to 17 years of age—At first, 10 mg once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 20 mg per day.
- Children younger than 10 years of age)—Use and dose must be determined by your doctor.
- For high cholesterol:
Missed Dose
If you miss a dose of Torid 20, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
However, do not take 2 doses of Torid 20 within 12 hours.
Storage
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Torid 20 administration
Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Do not break an Torid 20 tablet unless your doctor has told you.
Torid 20 is usually taken once a day, with or without food. Take the medicine at the same time each day. Your doctor may occasionally change your dose to make sure you get the best results.
You may need to stop using Torid 20 for a short time if you have:
- uncontrolled seizures;
- an electrolyte imbalance (such as high or low potassium levels in your blood);
- severely low blood pressure;
- a severe infection or illness; or
- surgery or a medical emergency.
To be sure this medicine is helping your condition, your blood will need to be tested often. Visit your doctor regularly.
Torid 20 is only part of a complete program of treatment that also includes diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely. You may need to take Torid 20 on a long-term basis for the treatment of high cholesterol.
Store at room temperature away from moisture, heat, and light.
Torid 20 pharmacology
Mechanism Of Action
Torid 20 is a selective, competitive inhibitor of HMG-CoA reductase, the rate-limiting enzyme that converts 3-hydroxy-3-methylglutaryl-coenzyme A to mevalonate, a precursor of sterols, including cholesterol. Cholesterol and triglycerides circulate in the bloodstream as part of lipoprotein complexes. With ultracentrifugation, these complexes separate into HDL (high-density lipoprotein), IDL (intermediate-density lipoprotein), LDL (low-density lipoprotein), and VLDL (very-low-density lipoprotein) fractions. Triglycerides (TG) and cholesterol in the liver are incorporated into VLDL and released into the plasma for delivery to peripheral tissues. LDL is formed from VLDL and is catabolized primarily through the high-affinity LDL receptor. Clinical and pathologic studies show that elevated plasma levels of total cholesterol (total-C), LDL-cholesterol (LDL-C), and apolipoprotein B (apo B) promote human atherosclerosis and are risk factors for developing cardiovascular disease, while increased levels of HDL-C are associated with a decreased cardiovascular risk.
In animal models, Torid 20 lowers plasma cholesterol and lipoprotein levels by inhibiting HMG-CoA reductase and cholesterol synthesis in the liver and by increasing the number of hepatic LDL receptors on the cell surface to enhance uptake and catabolism of LDL; Torid 20 also reduces LDL production and the number of LDL particles. Torid 20 reduces LDL-C in some patients with homozygous familial hypercholesterolemia (FH), a population that rarely responds to other lipid-lowering medication(s).
A variety of clinical studies have demonstrated that elevated levels of total-C, LDL-C, and apo B (a membrane complex for LDL-C) promote human atherosclerosis. Similarly, decreased levels of HDL-C (and its transport complex, apo A) are associated with the development of atherosclerosis. Epidemiologic investigations have established that cardiovascular morbidity and mortality vary directly with the level of total-C and LDL-C, and inversely with the level of HDL-C.
Torid 20 reduces total-C, LDL-C, and apo B in patients with homozygous and heterozygous FH, nonfamilial forms of hypercholesterolemia, and mixed dyslipidemia. Torid 20 also reduces VLDL-C and TG and produces variable increases in HDL-C and apolipoprotein A-1. Torid 20 reduces total-C, LDL-C, VLDL-C, apo B, TG, and non-HDL-C, and increases HDL-C in patients with isolated hypertriglyceridemia. Torid 20 reduces intermediate density lipoprotein cholesterol (IDL-C) in patients with dysbetalipoproteinemia.
Like LDL, cholesterol-enriched triglyceride-rich lipoproteins, including VLDL, intermediate density lipoprotein (IDL), and remnants, can also promote atherosclerosis. Elevated plasma triglycerides are frequently found in a triad with low HDL-C levels and small LDL particles, as well as in association with non-lipid metabolic risk factors for coronary heart disease. As such, total plasma TG has not consistently been shown to be an independent risk factor for CHD. Furthermore, the independent effect of raising HDL or lowering TG on the risk of coronary and cardiovascular morbidity and mortality has not been determined.
Pharmacodynamics
Torid 20, as well as some of its metabolites, are pharmacologically active in humans. The liver is the primary site of action and the principal site of cholesterol synthesis and LDL clearance. Drug dosage, rather than systemic drug concentration, correlates better with LDL-C reduction. Individualization of drug dosage should be based on therapeutic response.
Pharmacokinetics
Absorption
Torid 20 is rapidly absorbed after oral administration; maximum plasma concentrations occur within 1 to 2 hours. Extent of absorption increases in proportion to Torid 20 dose. The absolute bioavailability of Torid 20 (parent drug) is approximately 14% and the systemic availability of HMGCoA reductase inhibitory activity is approximately 30%. The low systemic availability is attributed to presystemic clearance in gastrointestinal mucosa and/or hepatic first-pass metabolism. Although food decreases the rate and extent of drug absorption by approximately 25% and 9%, respectively, as assessed by Cmax and AUC, LDL-C reduction is similar whether Torid 20 is given with or without food. Plasma Torid 20 concentrations are lower (approximately 30% for Cmax and AUC) following evening drug administration compared with morning. However, LDL-C reduction is the same regardless of the time of day of drug administration.
Distribution
Mean volume of distribution of Torid 20 is approximately 381 liters. Torid 20 is ≥98% bound to plasma proteins. A blood/plasma ratio of approximately 0.25 indicates poor drug penetration into red blood cells. Based on observations in rats, Torid 20 is likely to be secreted in human milk.
Metabolism
Torid 20 is extensively metabolized to ortho- and parahydroxylated derivatives and various beta-oxidation products. In vitro inhibition of HMG-CoA reductase by ortho- and parahydroxylated metabolites is equivalent to that of Torid 20. Approximately 70% of circulating inhibitory activity for HMG-CoA reductase is attributed to active metabolites. In vitro studies suggest the importance of Torid 20 metabolism by cytochrome P450 3A4, consistent with increased plasma concentrations of Torid 20 in humans following co-administration with erythromycin, a known inhibitor of this isozyme. In animals, the ortho-hydroxy metabolite undergoes further glucuronidation.
Excretion
Torid 20 and its metabolites are eliminated primarily in bile following hepatic and/or extrahepatic metabolism; however, the drug does not appear to undergo enterohepatic recirculation. Mean plasma elimination half-life of Torid 20 in humans is approximately 14 hours, but the half-life of inhibitory activity for HMG-CoA reductase is 20 to 30 hours due to the contribution of active metabolites. Less than 2% of a dose of Torid 20 is recovered in urine following oral administration.
Specific Populations
Geriatric
Plasma concentrations of Torid 20 are higher (approximately 40% for Cmax and 30% for AUC) in healthy elderly subjects (age ≥65 years) than in young adults. Clinical data suggest a greater degree of LDL-lowering at any dose of drug in the elderly patient population compared to younger adults.
Pediatric
Pharmacokinetic data in the pediatric population are not available.
Gender
Plasma concentrations of Torid 20 in women differ from those in men (approximately 20% higher for Cmax and 10% lower for AUC); however, there is no clinically significant difference in LDL-C reduction with Torid 20 between men and women.
Renal Impairment
Renal disease has no influence on the plasma concentrations or LDL-C reduction of Torid 20; thus, dose adjustment in patients with renal dysfunction is not necessary.
Hemodialysis
While studies have not been conducted in patients with end-stage renal disease, hemodialysis is not expected to significantly enhance clearance of Torid 20 since the drug is extensively bound to plasma proteins.
Hepatic Impairment
In patients with chronic alcoholic liver disease, plasma concentrations of Torid 20 are markedly increased. Cmax and AUC are each 4-fold greater in patients with Childs-Pugh A disease. Cmax and AUC are approximately 16-fold and 11-fold increased, respectively, in patients with Childs-Pugh B disease.
TABLE 3. Effect of Co-administered Drugs on the Pharmacokinetics of Torid 20
| Co-administered drug and dosing regimen | Torid 20 | ||
| Dose (mg) | Change in AUC* | Change in Cmax* | |
| Significantly different from simvastatin, ANCOVA, p ≤0.05 |
The impact on clinical outcomes of the differences in lipid-altering effects between treatments shown in Table 7 is not known. Table 7 does not contain data comparing the effects of Torid 20 10 mg and higher doses of lovastatin, pravastatin, and simvastatin. The drugs compared in the studies summarized in the table are not necessarily interchangeable.
Hypertriglyceridemia (Fredrickson Type IV)
The response to Torid 20 in 64 patients with isolated hypertriglyceridemia treated across several clinical trials is shown in the table below (Table 8). For the Torid 20-treated patients, median (min, max) baseline TG level was 565 (267
References
- DailyMed. "AMLODIPINE BESYLATE; ATORVASTATIN CALCIUM: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- NCIt. "Atorvastatin Calcium Anhydrous: NCI Thesaurus (NCIt) provides reference terminology for many systems. It covers vocabulary for clinical care, translational and basic research, and public information and administrative activities.". https://ncit.nci.nih.gov/ncitbrowser... (accessed September 17, 2018).
Reviews
The results of a survey conducted on ndrugs.com for Torid 20 are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Torid 20. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.User reports
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Information checked by Dr. Sachin Kumar, MD Pharmacology
