Zivast Am

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What Is Zivast AM?

Zivast AM is a fixed-dose combination tablet providing atorvastatin + amlodipine (typical ratio atorvastatin 10 mg + amlodipine 5 mg per tablet) in a single pill. Manufactured by Cadila Healthcare and supplied in 30-90 tablets.

The pairing rests on the ASCOT-BPLA + ASCOT-LLA trials (2003-2005), which showed that amlodipine-based antihypertensive therapy plus atorvastatin 10 mg produced 53% lower CV events than atenolol-based therapy plus placebo in 19,000 hypertensive patients with mild dyslipidaemia — a remarkable benefit driven largely by the combined statin + CCB strategy.

Why Combine Atorvastatin With Amlodipine?

• Complementary risk reduction — each component attacks an independent CV risk factor. The benefits multiply rather than add.
• Adherence — single-pill combinations reduce pill burden and increase persistence, particularly important in asymptomatic patients taking preventive medications.
• Pleiotropic synergy — both statins and CCBs reduce vascular inflammation, improve endothelial function, and stabilise atherosclerotic plaques through partially overlapping mechanisms.
• Cost efficiency — one prescription, one copay, fewer pharmacy visits.

Dosage & Titration

Doza standard: one 10/5 mg tablet once daily, any time of day, with or without food.

When to start: typical candidate is a patient with hypertension + dyslipidaemia or hypertension + established ASCVD risk >7.5%, who is already stable on amlodipine + atorvastatin at component doses matching the FDC. Alternatively, a newly treated patient at high CV risk where early combination therapy is preferred to monotherapy titration (AHA/ACC 2018).

Titrarea: if BP or lipids remain off target after 4-6 weeks, substitute a higher-strength FDC (atorvastatin 20 mg + amlodipine 5 mg, or 10/10, etc.) or add a third agent (ACE inhibitor/ARB for BP; ezetimibe for LDL).

Monitorizare:

• Baseline: full lipid panel, LFTs, CK, fasting glucose/HbA1c, creatinine, BP (clinic + home).
• 4-12 weeks: repeat lipids; BP review (target <140/90 in most, <130/80 in diabetes/CKD).
• Annually: lipids, LFTs, HbA1c.
• Stop or reduce: CK >10× ULN, ALT >3× ULN, new rhabdomyolysis, severe ankle oedema from amlodipine, persistent hypotension.

Efecte Secundare

Combines the profiles of the two components. Usually better tolerated than peak monotherapy doses of each agent, because the FDC uses moderate doses of both.

Frecvente:

• Ankle oedema (10-20% from amlodipine component; often partially reversed by adding an ACEi/ARB)
• Headache, flushing (amlodipine)
• Myalgia (atorvastatin)
• Mild transaminase elevation (atorvastatin)
• Constipation (amlodipine)
• New-onset diabetes (atorvastatin, ~0.2/100 patient-years)

Uncommon but serious:

• Rhabdomyolysis (<1/10,000 patient-years)
• Severe hepatitis
• Severe hypotension
• Gingival hyperplasia (amlodipine, rare)

Contraindicații

• Pregnancy and breastfeeding (statin component)
• Active liver disease
• Severe hypotension or cardiogenic shock
• Hypersensitivity to either component
• Concurrent strong CYP3A4 inhibitors (clarithromycin, itraconazole, ritonavir) — both components are CYP3A4 substrates

Interacțiuni medicamentoase

• Strong CYP3A4 inhibitors — CRITICAL. Both atorvastatin and amlodipine are CYP3A4 substrates. Combined inhibition substantially raises both plasma levels — increased myopathy and hypotension risk.
• Suc de grapefruit — avoid regular daily consumption.
• Other antihypertensives — additive BP lowering; intentional in combination therapy but monitor for hypotension.
• Fibrates, niacin high-dose — additive myopathy risk.
• Warfarin — small INR rise on statin initiation; check at 1 week.
• Ciclosporin — substantially raises atorvastatin exposure; dose-cap or switch.
• Simvastatin-specific drug combinations — not relevant here; atorvastatin has a different interaction profile.

Depozitare

Store Zivast AM below 25°C in the original blister pack. Keep out of reach of children.

Întrebări frecvente

Is Zivast AM a first-line therapy?

It is a fixed-dose combination typically used in patients already stable on amlodipine + atorvastatin at matching component doses, or in newly-treated patients where the prescriber has chosen to combine both classes from the outset. It is not usually the first drug started in a previously untreated patient — it is rather the single-pill version of a two-drug regimen that has been found appropriate.

Can I take Zivast AM with other BP drugs?

Yes — adding an ACE inhibitor or ARB is a standard step-up that also typically offsets amlodipine-related ankle oedema. Avoid stacking another CCB or another statin.

Should I take Zivast AM at night?

No — atorvastatin has a long half-life and timing does not matter. Amlodipine’s 30-50 hour half-life means steady-state levels are constant regardless of dose timing. Pick a time you will consistently remember.

What about pregnancy?

Absolutely contraindicated — the statin component is teratogenic and both components cross the placenta. Switch to methyldopa, labetalol, or nifedipine for pregnancy BP control; stop the statin.

Where can I buy Zivast AM online?

You can buy Zivast AM (atorvastatin + amlodipine 10/5 mg, 30-90 tablets) from MedsBase with discreet packaging and worldwide shipping.

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