Torvas (Atorvastatin) is a synthetic lipid lowering agent that inhibits 3-hydroxy-3-methyglutaryl- coenzyme A (HMG-CoA) reductase. This (HMG-CoA) reductase enzyme catalyses the conversion of HMG-CoA to mevalonate, an early and rate-limiting step in cholesterol biosynthesis.

Torvas (Atorvastatin) is indicated as an adjunct to diet to reduce elevated total-C, LDL-C Apolipoprotein B (Apo-B) and TG levels in following diseases when response to diet and other non-pharmacological measures is inadequate.

• Torvas is also indicated to reduce total-C and LDL-C in patients with heterozygous and homozygous familial hypercholesterolaemia.
• Torvas is indicated to reduce elevated cholesterol and triglycerides in patient with mixed Dyslipidemia (Fredrickson Type Ia and Ib).
• Torvas is indicated for the treatment of patients with elevated serum triglyceride levels in hypertriglyceridaemia (Fredrickson Type IV)
• Torvas is indicated for the treatment of patients with dysbetalipoproteinaemia (Fredrickson Type III)
• Torvas is indicated for the reduction of cardiac ischaemic events in patients with asymptomatic or mild to moderate symptomatic coronary artery disease with elevated LDL-cholesterol level.
• Torvas has reduced total and LDL-cholesterol concentrations patients with hypercholesterolemia associated with or exacerbated by diabetes mellitus or renal transplantation.

Patients should be placed on a standard cholesterol-lowering diet before receiving Torvas and should continue on this diet during treatment with Torvas. The usual starting dose for all the indications is 10 mg once daily. The doses range is 10 to 80 mg once daily. Doses should be individualised according to baseline LDL-C levels, the goal of therapy, and patient response. Adjustment of dosage should be made at intervals of 4 weeks or more. Doses may be given at anytime of day with or without food. Children: In a paediatric population the dose of Torvas up to 80 mg/day is limited. Geriatric (>70 years) use: The safety and efficacy of Torvas in this population is as similar as < 70 years of age patients with the dose upto 80 mg/day. In patients with Renal Insufficiency: No dosage adjustment is required.

Torvas (Atorvastatin) is generally well-tolerated. Adverse reactions have usually been mild and transient such as headache, abdominal pain, dyspepsia, nausea, flatulence, constipation, myalgia, insomnia, rhabdomyolysis.

Liver effects: Liver function tests should be performed before the initiation of treatment and periodically thereafter. Should an increase in ALT or AST of greater than 3 times the upper limit of normal persist, reduction of dose or withdrawal of Atorvastatin is recommended. Atorvastatin should be used with caution in patients who consume substantial quantities of alcohol and/or have a history of liver disease. Skeletal muscle effects: Uncomplicated myalgia has been reported in Atorvastatin- treated patients. Atorvastatin therapy should be discontinued if markedly elevated CPK levels occur or myopathy is diagnosed or suspected. Should significant increases in CPK persist, reduction of dose or withdrawal of Atorvastatin is recommended. Rare cases of rhabdomyolysis with acute renal failure secondary to myoglobinuria have been reported with Atorvastatin and with other drugs in this class.

Torvas (Atorvastatin) should not be used in patient with hypersensitivity to any component of this medication. Atorvastatin is contraindicated in active liver disease or unexplained persistent elevations of serum transaminases. It is also contraindicated in patient with history of serious adverse reaction to prior administration of HMG-CoA reductase inhibitors.

The risk of myopathy during treatment with Atorvastatin is increased with concurrent administration of cyclosporin, fibric acid derivatives, erythromycin, azole antifungals, or niacin. No clinically significant interactions were seen when Atorvastatin was administered with antihypertensives and or hypoglycemic agents. Caution should also be exercised when Atorvastatin is administered with inhibitors of P450 3A4 (macrolide antibiotics and azole antifungals). The effect of inducers of cytochrome P450 3A4 (rifampicin or phenytoin) on Atorvastatin is unknown. Patients should be closely monitored if Atorvastatin is added to digoxin, erythromycin, oral contraceptives, colestipol, antacid and warfarin. No interaction was found with cimetidine.

Store Torvas in a cool and dry place away from light and moisture. Keep all medicines out of the reach of children.