Dosage of Torvasmed in details
Torvasmed Dosage
Generic name: Torvasmed CALCIUM TRIHYDRATE 10mg
Dosage form: tablet, film coated
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Hyperlipidemia (Heterozygous Familial and Nonfamilial) and Mixed Dyslipidemia (Fredrickson Types IIa and IIb)
The recommended starting dose of Torvasmed is 10 or 20 mg once daily. Patients who require a large reduction in LDL-C (more than 45%) may be started at 40 mg once daily. The dosage range of Torvasmed is 10 to 80 mg once daily. Torvasmed can be administered as a single dose at any time of the day, with or without food. The starting dose and maintenance doses of Torvasmed should be individualized according to patient characteristics such as goal of therapy and response. After initiation and/or upon titration of Torvasmed, lipid levels should be analyzed within 2 to 4 weeks and dosage adjusted accordingly.
Heterozygous Familial Hypercholesterolemia in Pediatric Patients (10–17 years of age)
The recommended starting dose of Torvasmed is 10 mg/day; the maximum recommended dose is 20 mg/day (doses greater than 20 mg have not been studied in this patient population). Doses should be individualized according to the recommended goal of therapy. Adjustments should be made at intervals of 4 weeks or more.
Homozygous Familial Hypercholesterolemia
The dosage of Torvasmed in patients with homozygous FH is 10 to 80 mg daily. Torvasmed should be used as an adjunct to other lipid-lowering treatments (e.g., LDL apheresis) in these patients or if such treatments are unavailable.
Concomitant Lipid-Lowering Therapy
Torvasmed may be used with bile acid resins. The combination of HMG-CoA reductase inhibitors (statins) and fibrates should generally be used with caution.
Dosage in Patients With Renal Impairment
Renal disease does not affect the plasma concentrations nor LDL-C reduction of Torvasmed; thus, dosage adjustment in patients with renal dysfunction is not necessary.
Dosage in Patients Taking Cyclosporine, Clarithromycin, Itraconazole, or Certain Protease Inhibitors
In patients taking cyclosporine or the HIV protease inhibitors (tipranavir plus ritonavir) or the hepatitis C protease inhibitor (telaprevir), therapy with Torvasmed should be avoided. In patients with HIV taking lopinavir plus ritonavir, caution should be used when prescribing Torvasmed and the lowest dose necessary employed. In patients taking clarithromycin, itraconazole, or in patients with HIV taking a combination of saquinavir plus ritonavir, darunavir plus ritonavir, fosamprenavir, or fosamprenavir plus ritonavir, therapy with Torvasmed should be limited to 20 mg, and appropriate clinical assessment is recommended to ensure that the lowest dose necessary of Torvasmed is employed. In patients taking the HIV protease inhibitor nelfinavir or the hepatitis C protease inhibitor boceprevir, therapy with Torvasmed should be limited to 40 mg, and appropriate clinical assessment is recommended to ensure that the lowest dose necessary of Torvasmed is employed.
More about Torvasmed (Torvasmed)
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Related treatment guides
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- High Cholesterol, Familial Homozygous
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- Prevention of Cardiovascular Disease
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What other drugs will affect Torvasmed?
Many drugs can interact with Torvasmed. Below is just a partial list. Tell your doctor if you are using:
- birth control pills;
- cimetidine (Tagamet);
- conivaptan (Vaprisol);
- imatinib (Gleevec);
- isoniazid (for treating tuberculosis);
- spironolactone (Aldactone, Aldactazide);
- an antibiotic such as dalfopristin/quinupristin (Synercid), rifampin (Rifater, Rifadin, Rifamate), telithromycin (Ketek), and others;
- an antidepressant such as nefazodone;
- heart or blood pressure medication such as digoxin (Lanoxin), diltiazem (Cartia, Cardizem), nicardipine (Cardene), quinidine (Quin-G), verapamil (Calan, Covera, Isoptin, Verelan), and others;
- HIV/AIDS medicine such as atazanavir (Reyataz), delavirdine (Rescriptor), efavirenz (Sustiva, Atripla), indinavir (Crixivan), and others; or
- any other "statin" medication such as amlodipine and Torvasmed (Caduet), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), or simvastatin (Zocor, Simcor, Vytorin).
This list is not complete and there are many other drugs that can increase your risk of serious medical problems if you take them together with Torvasmed. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
Torvasmed interactions
The risk of myopathy during treatment with statins is increased with concurrent administration of fibric acid derivatives, lipid-modifying doses of niacin, cyclosporine, or strong CYP 3A4 inhibitors (e.g., clarithromycin, HIV protease inhibitors, and itraconazole).
Strong Inhibitors of CYP 3A4
Torvasmed is metabolized by cytochrome P450 3A4. Concomitant administration of Torvasmed with strong inhibitors of CYP 3A4 can lead to increases in plasma concentrations of Torvasmed. The extent of interaction and potentiation of effects depend on the variability of effect on CYP 3A4.
Clarithromycin
Torvasmed AUC was significantly increased with concomitant administration of Torvasmed 80 mg with clarithromycin (500 mg twice daily) compared to that of Torvasmed alone. Therefore, in patients taking clarithromycin, caution should be used when the Torvasmed dose exceeds 20 mg.
Combination of Protease Inhibitors
Torvasmed AUC was significantly increased with concomitant administration of Torvasmed 40 mg with ritonavir plus saquinavir (400 mg twice daily) or Torvasmed 20 mg with lopinavir plus ritonavir (400 mg + 100 mg twice daily) compared to that of Torvasmed alone. Therefore, in patients taking HIV protease inhibitors, caution should be used when the Torvasmed dose exceeds 20 mg.
Itraconazole
Torvasmed AUC was significantly increased with concomitant administration of Torvasmed 40 mg and itraconazole 200 mg. Therefore, in patients taking itraconazole, caution should be used when the Torvasmed dose exceeds 20 mg.
Grapefruit Juice
Contains one or more components that inhibit CYP 3A4 and can increase plasma concentrations of Torvasmed, especially with excessive grapefruit juice consumption ( > 1.2 liters per day).
Cyclosporine
Torvasmed and Torvasmed-metabolites are substrates of the OATP1B1 transporter. Inhibitors of the OATP1B1 (e.g., cyclosporine) can increase the bioavailability of Torvasmed. Torvasmed AUC was significantly increased with concomitant administration of Torvasmed 10 mg and cyclosporine 5.2 mg/kg/day compared to that of Torvasmed alone. In cases where co-administration of Torvasmed with cyclosporine is necessary, the dose of Torvasmed should not exceed 10 mg.
Rifampin or other Inducers of Cytochrome P450 3A4
Concomitant administration of Torvasmed with inducers of cytochrome P450 3A4 (e.g., efavirenz, rifampin) can lead to variable reductions in plasma concentrations of Torvasmed. Due to the dual interaction mechanism of rifampin, simultaneous co-administration of Torvasmed with rifampin is recommended, as delayed administration of Torvasmed after administration of rifampin has been associated with a significant reduction in Torvasmed plasma concentrations.
Digoxin
When multiple doses of Torvasmed and digoxin were coadministered, steady state plasma digoxin concentrations increased by approximately 20%. Patients taking digoxin should be monitored appropriately.
Oral Contraceptives
Co-administration of Torvasmed and an oral contraceptive increased AUC values for norethindrone and ethinyl estradiol. These increases should be considered when selecting an oral contraceptive for a woman taking Torvasmed.
Warfarin
Torvasmed had no clinically significant effect on prothrombin time when administered to patients receiving chronic warfarin treatment.
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).
- FDA/SPL Indexing Data. "A0JWA85V8F: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).
- MeSH. "Hydroxymethylglutaryl-CoA Reductase Inhibitors". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology