Tukon Special Precautions

Atorvastatin: Liver Dysfunction: HMG-CoA reductase inhibitors have been associated with biochemical abnormalities of liver function. Therefore, liver function tests should be performed prior to and at 12 weeks following initiation of therapy or elevation in dose, and semiannually thereafter.
Atorvastatin should be used with caution in patients who consume substantial quantities of alcohol and/or have a history of liver disease.
Rare cases of rhabdomyolysis with acute renal failure secondary to myoglobinuria have been reported with other drugs in this class. A history of renal impairment may be a risk factor for the development of rhabdomyolysis. Therefore, Atorvastatin therapy should be temporarily withheld or discontinued in any patient with an acute, serious condition suggestive of a myopathy or having a risk factor predisposing to the development of renal failure secondary to rhabdomyolysis (e.g., severe acute infection, hypotension, major surgery, trauma, severe metabolic, endocrine and electrolyte disorders, and uncontrolled seizures).
Caution should be exercised when used in patients with recent stroke or TIA as higher incidence of hemorrhagic stroke was seen.
Caution should be exercised if an HMG-CoA reductase inhibitor is administered concomitantly with drugs that may decrease the levels or activity of endogenous steroid hormones, such as ketoconazole, spironolactone and cimetidine.
Amlodipine: In patients with severe obstructive coronary artery disease there is possibility of increased frequency; duration and/or severity of angina or acute myocardial infarction on starting calcium channel blocker therapy or at the time of dosage increase.
Acute hypotension have rarely been reported, hence caution should be exercised particularly in patients with severe aortic stenosis.
Amlodipine is extensively metabolized in the liver; hence caution should be exercised when administering to patients with severe hepatic impairment.