Pencard

Pencard

Pencard is a potent, convenient and recent trend of combined lipid-lowering agent (Atorvastatin & Ezetimibe) which has an extra efficacy and safety features than statin monotherapy in terms of LDL-C reduction and other lipid profile improvement, leading to higher protection and better quality of life for patients at high risk of cardiovascular events including diabetic patients

Active Ingredient

Pencard, Antihyperlipidemic agent, is a combination of Atorvastatin 20mg plus Ezetimibe 10mg

Mechanism of Action

- Atorvastatin is HMG-Co A reductase inhibitor, which inhibits synthesis of cholesterol in the liver
- Ezetimibe interferes with the active absorption of cholesterol from the intestinal lumen into the enterocyte, it binds to the Niemann-Pick C1 Like 1 (NPC1L1) transporter, which is a cholesterol transporter protein

Indications & Uses

• • Primary hyperlipidemia and mixed hyperlipidemia to reduce elevated LDL-C, TC, Apo B, TG and to increase HDL-C
• • MI and stroke prophylaxis in patients with type-2 Diabetes Miletus
• • Reduction of angina risk in patients with clinically evident CHD
• • Homozygous Familial Hypercholesterolemia (HoFH)

Dosage & Administration

• The recommended dose of Pencard 10/20 is one tablet once daily, At any time of the day, with or without food

Forms & Strengths

A box of 10 oral tablet, contains 20mg of Atorvastatin & 10mg of Ezetimibe

Contraindications & Cautions

- Active liver disease & unexplained persistent elevations of liver enzyme “Serum Transaminase” (≥ 3 x ULN)
- Myopathy
- Pregnancy & Lactation
- Hypersensitivity to any component

Pregnancy & Breastfeeding

FDA pregnancy category X - Contraindicated

F.A.Q

What is the advantages of Pencard as an Anti-hyperlipidemic?

- Pencard inhibits Cholesterol Synthesis and Absorption
- Pencard shows improvement in all lipid profile compared to Atorvastatin or Rosuvastatin Monotherapy
- Pencard Reduces cholesterol absorption especially in diabetic patients with CAD
- Pencard reduces inflammatory markers (hs-CRP & Secretory phospholipase A2)
- Pencard lowers significantly level of Ox-LDL-C, the effect that is not observed by dose titration of statin
- Pencard provides higher safety profile than maximizing atorvastatin dose
- Pencard could be taken at any time of the day
- Pencard Achieves reduction -54% LDL-C, -39% TC, -44% APO-B, -30% TG and it improves +9% HDL-C

What is the meaning of Hyperlipidemia, Ischemia, Angina, Myocardial Infarction, Stroke, Heart Failure, Bad Cholesterol & Good Cholesterol?

- Hyperlipidemia: Elevated levels of lipids and/or lipoproteins in the blood, it could be Primary (Genetic) or Secondary (Disease or Drug Related or Dietary)

- Ischemia: Inadequate blood supply to an organ or part of the body

- Angina (Chest pain): Narrowing (Stenosis) of one or more coronary artery due to formation of plaques

- Myocardial Infarction MI (Heart Attack): Death of part of myocardial tissue due to total occlusion of a coronary artery

- Stroke: Blockage of blood flow to part of Brain by a plaque formation, blood clot or bleeding

- Heart Failure: Malfunction of the pumping action of the heart muscle due to ischemia or infarction

- LDL Low density lipoprotein / Bad Cholesterol: is considered the “bad” cholesterol because it contributes to plaque, a thick, hard deposit that can clog arteries and make them less flexible, this condition is known as atherosclerosis

- HDL High density lipoprotein / Good Cholesterol: is considered “good” cholesterol because it helps remove LDL cholesterol from the arteries. Experts believe HDL acts as a scavenger, carrying LDL cholesterol away from the arteries and back to the liver, where it is broken down and passed from the body

What are the risk factors of developing Hyperlipidemia and Atherosclerosis?

- Genetic factors - Family history of a premature CHD (definite MI or sudden death before 55 years in father or other male first-degree relative or before 65 years in mother or other female first-degree relative)
- Obesity, sedentary Life and lack of exercise
- Smoking
- Diabetes mellitus
- Hypertension (≥140/90 mm hg or on antihypertensive drugs
- Sex and Age: man ≥45 years & Woman ≥55 years
- Male / female gender
- Diet high in saturated fat, found in animal products, and Trans fats
- Alcohol
- Disease e.g. kidney disease, and hypothyroidism
- Drugs e.g. estrogen, corticosteroids, oral contraceptives, protease inhibitors, thiazide diuretics, and beta-blockers
- Low HDL-C (< 40 mg/dl)
- High LDL-C

What are the major Statin Drug Interactions?

- Bile Acid Sequestrants (Resin) decrease the absorption of Ezetimibe
- Fibrates (Gemfibrozil, Bezafibrate, and Fenofibrate) enhance risk of myopathy
- Niacin
- Cyt P450 Inhibitors e.g. Erythromycin, Azithromycin & Clarithromycin, enhance myopathic effect
- Amiodarone, decrease the metabolism of HMG-CoA Reductase Inhibitors
- Spironolactone, statin enhance the adverse effect of Spironolactone
- Digoxin & Diltiazem, may increase the serum concentration
- Antacids, decrease the serum concentration of statin
- Grapefruit Juice, increase the serum concentration
- Phenytoin, decrease the serum concentration
- HIV protease inhibitors & Hepatitis C protease inhibitor
- Oral contraceptives

What is the meaning of lifestyle change to reduce the risk of hyperlipidemia?

- Diet, Eat less high-fat food, especially food high in saturated fats
- Replace saturated fats with polyunsaturated and monounsaturated fats and fish oils whenever possible
- Choose foods high in complex carbohydrates (starch and fiber)
- Weight reduction
- Smoking cessation
- Increase physical activity & Regular exercise
- Stop Alcohol intake