Divastin-E 20/10 Tablet 20 mg + 10 mg Tablet

Divastin-E 20/10 Tablet 20 mg + 10 mg tablet by Drug International Ltd., Gopalpur contains Atorvastatin + Ezetimibe. It is used in Bangladesh as an add-on to diet and lifestyle measures to lower high LDL cholesterol and other harmful blood lipids when a statin plus ezetimibe combination is appropriate.

Atorvastatin + Ezetimibe works in two complementary ways: atorvastatin reduces cholesterol production in the liver, while ezetimibe reduces cholesterol absorption from the intestine. A key caution is to seek medical advice promptly for unexplained muscle pain, weakness, dark urine, or symptoms of liver problems.

• Treatment of primary hypercholesterolaemia, including heterozygous familial hypercholesterolaemia, as an adjunct to diet when combination therapy is appropriate.
• Treatment of mixed dyslipidaemia to reduce elevated LDL cholesterol and other atherogenic lipids when directed by a doctor.
• Adjunct treatment for homozygous familial hypercholesterolaemia, usually along with other lipid-lowering treatments where needed.

For adults, Atorvastatin + Ezetimibe is generally taken once daily, with or without food. The exact strength and treatment target depend on baseline cholesterol level, cardiovascular risk, other medicines, liver function, and response to therapy. Continue a cholesterol-lowering diet, exercise, and other lifestyle advice. Do not start, stop, or change the dose without the prescribing doctor’s advice.

• Common or relatively common effects may include headache, stomach discomfort, diarrhoea, constipation, nausea, joint pain, muscle aches, and tiredness.
• Blood tests may show increased liver enzymes.
• Serious but uncommon effects include myopathy, rhabdomyolysis with dark urine or kidney injury, severe liver injury, allergic reactions, and severe unexplained muscle weakness or pain.
• Report persistent muscle symptoms, yellowing of the skin or eyes, severe abdominal pain, or unusual bleeding or bruising to a doctor promptly.

Use caution in people with a history of liver disease, heavy alcohol use, kidney disease, untreated hypothyroidism, previous statin-related muscle problems, older age, or when taking medicines that increase statin exposure. Liver function tests and lipid levels may be checked as advised by the doctor. Use under the guidance of a registered doctor or pharmacist, and seek advice before combining it with other cholesterol medicines or antibiotics/antifungals.

• Strong CYP3A4 inhibitors such as clarithromycin, erythromycin, itraconazole, ketoconazole, posaconazole, voriconazole, some HIV/HCV antivirals, and nefazodone can increase atorvastatin levels and muscle toxicity risk.
• Cyclosporine, gemfibrozil, other fibrates, high-dose niacin, colchicine, and systemic fusidic acid may increase the risk of muscle injury.
• Warfarin and other coumarin anticoagulants may require closer INR monitoring when therapy is started or changed.
• Bile acid sequestrants such as cholestyramine can reduce ezetimibe absorption; dosing times may need separation as advised by a doctor.
• Large amounts of grapefruit juice can increase atorvastatin exposure and should generally be avoided.

• Known hypersensitivity to atorvastatin, ezetimibe, or any component of the tablet.
• Active liver disease or unexplained persistent elevation of liver transaminases.
• Pregnancy, planned pregnancy, or breastfeeding, unless a specialist determines an exceptional need and provides specific guidance.

Atorvastatin + Ezetimibe is not recommended during pregnancy and should usually be stopped if pregnancy occurs, because cholesterol-lowering with statins is generally not needed during pregnancy and may pose risk. It is also not recommended during breastfeeding, as statins may pass into breast milk and could affect the infant. Women who are pregnant, planning pregnancy, or breastfeeding should consult a doctor for safer alternatives.

Store tablets at room temperature, away from excess heat, moisture, and direct sunlight. Keep in the original packaging and out of reach of children. Do not use after the expiry date or if the tablet or packaging appears damaged.