atorvastatin, acetylsalicylic acid and perindopril

C10BX12

Forms & Strengths

Fixed-dose combination capsules: Atorvastatin/Perindopril arginine/Acetylsalicylic acid (mg): 10/2.5/81, 10/5/81, 10/10/81, 20/2.5/81, 20/5/81, 20/10/81

Adult Dosing

One capsule once daily, taken orally preferably before a meal
Dose titration of individual components (atorvastatin, perindopril, acetylsalicylic acid) is recommended prior to switching to the fixed-dose combination

Pediatric Dosing

Safety and efficacy in pediatric patients have not been established; use is not recommended

Indications

Secondary prevention of major cardiovascular events in patients with established cardiovascular disease (coronary artery disease and/or history of stroke) requiring treatment with atorvastatin, perindopril, and acetylsalicylic acid simultaneously

Mechanism of Action

Atorvastatin: Inhibits HMG-CoA reductase, decreasing hepatic cholesterol synthesis and upregulating LDL receptors
Perindopril: ACE inhibitor that suppresses the renin-angiotensin-aldosterone system, reducing vasoconstriction and aldosterone secretion
Acetylsalicylic acid: Irreversibly inhibits cyclooxygenase-1 (COX-1), blocking thromboxane A2-mediated platelet aggregation

Contraindications

Hypersensitivity to atorvastatin, perindopril (or other ACE inhibitors), acetylsalicylic acid (or other salicylates/NSAIDs), or any excipient
Active liver disease or unexplained persistent elevations of serum transaminases
History of angioedema related to previous ACE inhibitor therapy
Hereditary or idiopathic angioedema
Pregnancy (especially second and third trimesters) and lactation
Co-administration with aliskiren-containing products in patients with diabetes mellitus or renal impairment
Patients with asthma, rhinitis, or nasal polyps exacerbated by salicylates/NSAIDs
Active peptic ulcer disease or bleeding disorders

Adverse Reactions

Atorvastatin: Myalgia, arthralgia, nasopharyngitis, hyperglycemia, elevated liver transaminases
Perindopril: Persistent dry cough, dizziness, headache, hypotension, hyperkalemia, renal impairment
Acetylsalicylic acid: Dyspepsia, gastrointestinal ulceration/bleeding, increased bleeding time, nausea, hypersensitivity reactions

Drug Interactions

Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) increase atorvastatin exposure and myopathy risk
Potassium-sparing diuretics, potassium supplements, or ARBs increase risk of hyperkalemia with perindopril
Lithium: Decreased elimination and increased toxicity risk when co-administered with perindopril
Anticoagulants (e.g., warfarin) and other antiplatelet agents increase the risk of severe bleeding with acetylsalicylic acid
NSAIDs may reduce the antihypertensive effect of perindopril and increase renal impairment and gastrointestinal bleeding risks
Antacids and bile acid sequestrants may decrease absorption of individual components

Curated Content: Needs Vetting Before Put to Clinical Use