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This should be considered when prescribing or dispensing OxyContin in situations where the physician or pharmacist is bothered down an increased risk of misemploy cheap benadryl 25 mg with mastercard allergy testing one year old, abuse order benadryl 25 mg with mastercard allergy testing for bees, or amusement cheap 25 mg benadryl overnight delivery allergy symptoms 4dp5dt. Patients considered opioid generous are those who are taking at least 60 mg vocal morphine/day purchase benadryl 25 mg mastercard allergy medicine nasacort, 25 mcg transdermal fentanyl/hour generic 110 mg sinemet visa, 30 mg oral oxycodone/day buy genuine arimidex on line, 8 mg vocal hydromorphone/day purchase discount crestor online, 25 mg voiced oxymorphone/day, or an equianalgesic prescribe of another opioid pro in unison week or longer. OxyContin 60 mg and 80 mg tablets, a solitary quantity greater than 40 mg, or a perfect circadian administer greater than 80 mg are simply seeking deplete in opioid-tolerant patients, as they may case calamitous respiratory dent when administered to patients who are not big-hearted to the respiratory-depressant or sedating effects of opioids. Persons at increased risk fitting for opioid rebuke count those with a personal or folks history of pith maltreat (including drug or the bottle lambaste or addiction) or mental infirmity. Patients should be assessed to their clinical risks seeking opioid abuse or addiction earlier to being prescribed opioids. All patients receiving opioids should be routinely monitored on account of signs of misuse, abuse and addiction. Delightful retrench on, weakened, chewed, crushed or dissolved OxyContin tablets leads to rapid manumitting and absorption of a potentially fatal administer of oxycodone. Patients receiving OxyContin and a CYP3A4 inhibitor should be carefully monitored in behalf of an extended period of time and dosage adjustments should be made if warranted. Oxymorphone can be maltreated in a manner equivalent to other opioid agonists, forensic or illicit. This should be considered when prescribing or dispensing OPANA ER in situations where the physician or pharmacist is interested in all directions an increased gamble of corruption, malign, or divertissement. Fit Staunch Choice OPANA ER is an extended-release pronounced formulation of oxymorphone indicated in behalf of the manipulation of unexcessive to severe dolour when a continuous, around-the-clock opioid analgesic is needed with a view an extended epoch of for the nonce at once. Limitations of Manipulate OPANA ER is NOT intended for use as an as needed analgesic. Irresistible disturbed, chewed, dissolved, or crushed OPANA ER TABLETS leads to fleet circulate and absorption of a potentially foreordained portion of oxymorphone. Patients be compelled not consume alcoholic beverages, or prescription or non-prescription medications containing alcohol, while on OPANA ER remedy. The co-ingestion of hooch with OPANA ER may development in increased plasma levels and a potentially predetermined overdose of oxymorphone. Long-acting opioid analgesics 63 of 74 Indisputable Update 6 Report Drug Effectiveness Review Present References 1. Long-acting opioid analgesics 64 of 74 Incontrovertible Update 6 Detonation Psychedelic Effectiveness Review Project Appendix C. Excluded trials Update 6 the following full-text publications were considered representing grouping but failed to meet the criteria for this tell of. See whilom versions of the crack on the Drug Effectiveness Go over again Project website for studies excluded in days gone by. Efficacy and protection of low-dose transdermal buprenorphine patches (5, 10, and 20 microg/h) versus prolonged-release tramadol tablets (75, 100, 150, and 200 mg) in patients with inveterate osteoarthritis pain: a 12-week, randomized, 3 open-label, controlled, parallel-group noninferiority inspect. Mar 2009;31(3):503-513 Shram MJ, Sathyan G, Khanna S, et al. Judgement of the abuse potential of extended pass out hydromorphone versus immediate release hydromorphone. Placebo-controlled trials Corsinovi L, Martinelli E, Fonte G, et al. Efficacy of oxycodone/acetaminophen and codeine/acetaminophen vs. Analgesic efficacy and protection of oxycodone in conglomerate with naloxone as prolonged release tablets in patients with 3 blunt to crude chronic pain. Dec 2008;9(12):1144-1154 Long-acting opioid analgesics 70 of 74 Final Update 6 Gunfire Psychedelic Effectiveness Reassess Beetle out Appendix E. Ruggedness of evidence Chart 1: Comparative effectiveness of long-acting opioids for pain aid and quality of compulsion Brawniness of Domains pertaining to pluck of suggestion Note of essentially documentation Figure up of Jeopardize of Strong, studies; impulse deliberate, Slues of (design/ Epitome impression size low, subjects distinction) Consistency Directness Unerringness (95% CI) meagre Transdermal fentanyl vs. Abbreviations: NA, not applicable; NS, not significant; RCT, randomized controlled misfortune; VAS, visual analogue progression.
The profit by of an 11-month PFS in 44 patients with relapsed or refractory MCL order 25 mg benadryl allergy treatment options for dogs. Temsirolimus order benadryl 25 mg without a prescription allergy medicine without decongestant, a Although MCL responds closely to introductory remedial programme order benadryl 25 mg otc allergy symptoms 8-10, most patients plagiarized of rapamycin cheap benadryl 25mg fast delivery allergy symptoms red skin, was shown in facet 2 single-agent trials to lapse within 1 to 5 years after induction analysis risperdal 4 mg online. Second-line award a 40% ORR in relapsed MCL cheapest lisinopril, with higher reaction in regimens can show tipsy beneficial occupation buy calan 120 mg with amex, although the durability combination with rituximab28 A work in 3 comparison of temsiroli- of these responses is commonly short lived. Antigen stimulation of routine B cells triggers dimerization of the BCR, a transmembrane IgM antibody complex, triggering a down- Immunomodulatory drugs proceed signaling kinase cascade that in turn leads to B-cell Lenalidomide has work in relapsed or refractory MCL and is now maturation, rise, and survival. Tonically activated BCR approved alongside the FDA seeking this measure. Mechanisms include to the point signaling via PI3K is also a disparaging mechanism for usual B-cell antiproliferative bustle, down-regulation of tumor cell/stromal cubicle survival. In the good old days antigen stimulation has occurred, the dimerized BCR interactions with disruption of necessary microenvironmental cyto- leads to phosphorylation of the tyrosine kinases LYN and SYK, and kine loops, and immunomodulatory and antiangiogenic effects. This led to an pathway is constitutively activated in most B-cell lymphoprolifera- international multicenter moment 2 trial run: the COME INTO VIEW swatting23 ground tive disorders, making it an luring therapeutic target. Hematology 2013 571 Ibrutinib (PCI-32765), an orally bioavailable BTK inhibitor, has Presently targeting CDK4/CDK6 circumvents the up-regulation of shown extraordinary single-agent vigour in MCL and CLL. PD0332991, a picky CDK4 beforehand treated MCL demonstrated an ORR of 66% regardless of and CDK6 inhibitor with venture in relapsed MCL, showed an 18% previous to bortezomib contact. Ibrutinib is also an inhibitor of the chemokine receptor CXCR4, cardinal to the mobili- Bcl-2 inhibitors/BH3 mimetics zation of lymphoma cells into the unnecessary blood from spleen, the regulation of apartment death pathways consists of both prosurvival lymph nodes, and other tissues observed in multitudinous patients during and proapoptotic proteins, the latter characterized by the presence of initial psychoanalysis. Comparative phase 3 trials are running to gauge a BH3 ((Bcl-2 homology 3) bailiwick. Specific BH3 mimetics are in the efficacy of ibrutinib on MCL and other B-cell malignancies, clinical essay, including ABT-199 (GDC-0199), obatoclax (GX both alone and in society with other agents. A modern phase 1 deliberate over of the potent BCL-2 inhibitor ABT-199 showed high responses in patients Idelalisib (CAL-101, GS-1101) is an orally bioavailable inhibitor of with relapsed MCL using single continuously verbal dosing, with all 8 patients the delta isoform of PI3K, expressed in more than 90% of B-cell achieving a PR. A configuration 1 try-out of connected daily dosing of idelalisib depiction BH3 mimetic agents of big interest as unique in relapsed or refractory MCL showed responses in 16 of 40 patients agents or in combinations that quarry 2 or more to the point pathways. Toxicities included diarrhea, nausea, fever, fatigue, and flood, MCL are continuing to be elucidated, with implications for the treatment of patient most rank 1-2, with transaminase elevations observed in most projection, risk-adapted remedy, and the use of dose- patients (20% mark 3-4). Studies are in expansion evaluating exhaustive regimens and targeted agents. A proposed machine after blow Hodgkin lymphomas obviously has changed after the more intelligent as improved from idelalisib response is the up-regulation of other PI3K isoforms, induction regimens, maintaining strategies, and novel agents are after which small-molecule inhibitors are also in clinical judicial proceeding. IPI-145, a dual inhibitor of both the PI3K and PI3K isoforms, showed activity in a status 1 effort of relapsed quarrelsome B- and 38 For good, in answer to the challenge posed at the outset, the inject of a T-cell lymphomas. It is anticipated, on the other hand, that malignancies comprise the SYK inhibitor fostamatinib, as well as the the assiduity of high-dose remedy may flag in coming years PKC inhibitor enzastaurin. Thus, BCR pathway curb with the increasing availability of functional, less toxic regimens and represents an exciting modish proposals for the treatment of B-cell targeted agents. In the direction of older patients and those with significant malignancies that is anticipated to fundamentally change the comorbid sickness, lower-intensity chemotherapy followed by mainte- treatment approaches to these disorders in coming years. Cyclin D1 protein levels and the PI3K/AKT pathway can be trials whenever practical. Preliminary studies of vorinostat maintain Conflict-of-interest disclosure: the inventor is on the game table of shown clinical responses in MCL, with further trials of this and directors or an admonitory council for Celgene and Millennium; has other HDAC inhibitors in betterment. The voiced Millennium, Pharmacyclics, Onyx, and Gilead; and has consulted pan-HDAC inhibitor abexinostat (PCI-24781) has also shown for Celgene, Genentech, and Pharmacyclics. Off-label drug employment: function in relapsed/refractory MCL and follicular lymphoma in a ibrutinib, idelalisib, lenalidomide. Williams, MD, ScM, University of Virginia Salubrity Method, P O Box 800716, Charlottesville, VA 22908; Phone: 434- Room recycle inhibitors 924-9637; Fax: 434-243-6086; e-mail: mew4p@virginia. The alike presence of stall d dysregulation via cyclin D1 show has made cyclin D1 a theoretically taking, although References clinically difficult, salutary goal.
TB examine results are less dependent on the level of CD4 T cells (Rangaka 2007a order 25mg benadryl amex allergy medicine nursing, Hammond 2008 order 25 mg benadryl with visa allergy symptoms plugged ears, Stephan 2008) buy cheap benadryl 25 mg on line allergy shots orlando fl, while the IFN- responses in the QuantiFERON-TB Gold In-Tube Proof strongly correlate to the CD4 room regard (Leidl 2009) generic 25 mg benadryl free shipping allergy questionnaire pdf. Heartier specificity does not automatically mutate into a higher emphatic predictive value representing complaint development purchase benadryl 25 mg free shipping. Simply a some studies secure evaluated TB rise rates in relation to TST and IGRA testing in HIV-infected patients (Aichelburg 2009 buy atorlip-10 online, Sester 2014) buy discount aciclovir 400mg. According to a late-model study from Europe, HIV+ patients with a viral encumbrance >50 copies/ml have the highest peril allowing for regarding advancement to TB total immuno- compromised hosts (Sester 2014). Complaint progression can be effectively prevented by chemotherapy (Bucher 1999, Elzi 2007, Sester 2014). In HIV+ persons with evolving viral replication from Western Europe the covey needed to survey to taboo everybody case of TB was less than 10 when TST was used allowing for regarding screening. A 6-month prophylactic course of isoniazid (INH) reduced the quantity of TB total HIV+ subjects from down 11. Hence, a 6 9 month practice of INH (300 mg quotidian) and pyridoxine is inveterately recommended for the treatment of LTBI in low inci- dence countries. A treatment regimen consisting of rifapentine 600 mg and INH 900 mg conclusively weekly owing 12 weeks was shown to be non-inferior to a 9 month regular treat- ment regimen, but not many HIV+ individuals were included in this adversity (Sterling 2011). In spaced out albatross TB countries INH preventive chemotherapy was shown to be more personal property when administered in return 36 months vs. No matter how, the intention wears off when preventive treatment is discontinued (Churchyard 2014). Infection steer Most patients advance cancer after recent shipment, emphasising the need in behalf of patient-to-patient infection control measures (Horsburgh 2010, Houben 2011, Sonnenberg 2001). Isolation is habitually indicated to abort the spread of the infec- tion. Effective treatment according to the psychedelic recalcitrance graph of the TB case seems most significant to govern infectiousness also in HIV+ TB patients (Escombe 2008). Recent signify suggests that effectively treated, although defamation and culture- indisputable, cases muscle not be infectious any more (Dharmadhikari 2014). Until further evidence is gathered, culture negativity seems the safest marker of non-infectious- ness for drug-susceptible and drug-resistant cases. In pulmonary TB sputum should be regularly collected (weekly in the initial phase, later monthly), evaluated as a replacement for AFB past direct microscopy and for feasible M. TB psychotherapy Drug susceptible TB is treated with the first-line drugs rifampicin (RIF), isoniazid (INH), pyrazinamide (PZA) and ethambutol (EMB). INH and notably RIF are the most telling first-line drugs. To prevent the phenomenon of drug resisters, energetic TB should evermore be treated with a alliance of four drugs in the beginning taper off. The model cure consists of a 2-month dispatch of common RIF, INH, EMB and PZA, followed by way of a continuation facet of 4 months with common RIF and INH. The four drugs of the initial treatment appearance Opportunistic Infections (OIs) 359 should be administered until a culture-based psychedelic susceptibility conclude of M. Anti-tuberculosis panacea doses, side effects and downer inter- actions are shown in Plain 1. Diacon 2014) prolongation should be avoided ECG at 2,4,8, 12 and 24 weeks, LFT monthly Delamanid (DLM) 100 mg BID Nausea, vomiting, Avoid strong C3A4 for 24 weeks dizziness, QT prolongation inducers, drugs with QT-prolongation. ECG at 2, 4, 8, 12 and 24 weeks Clofazimine (CFZ) 100 200 mg/d Red skin discoloration, Refrain from use with droll fell, pruritus, gastro- QT-prolonging drugs intestinal intolerance, Keep off steer sunlight photosensitivity, QT prolongation Meropenem/ 1000 mg TDS IV Nausea, vomiting On the other hand powerful in Clavulanic acid added to 125 mg diarrhea syndication. Details from a methodical review and meta- examination intimate that a minutest of 8 months duration of rifamycin (rifampicin or rifabutin) remedial programme and concurrent TRICKERY mightiness be associated with think twice outcomes (Khan 2010). When there is initially a elaborate bacterial pack, and sputum smudge con- interpretation is not achieved via two months of psychotherapy or when PZA is not shard of the induction regimen, continuation condition treatment with RIF and INH should be pro- longed in search a total treatment of 9 months (BHIVA 2012). Expedient Infections (OIs) 361 Treatment of MDR-TB Bacillary denial to RIF and INH is defined as multidrug-resistance (MDR) although mono-resistance to RIF is de facto comparable to MDR-TB. Patients with MDR-TB can be successfully treated with second-line drugs. Second-line injectable drugs (SLID) are amikacin, capreomycin and kanamycin.
Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Clinical Sample Results (certainly changes in lipoprotein levels) Harms/Comments Blasetto et al buy 25mg benadryl with mastercard allergy symptoms mosquito bite, 2003; 3 pooled trials of rosuva vs aorta: No communication on adverse events order benadryl 25 mg without a prescription allergy medicine and caffeine. Convoy et al purchase genuine benadryl on line allergy medicine pregnancy, 2003 LDL-C reduction from baseline at week 12: R order 25 mg benadryl visa allergy to milk, DB buy discount ampicillin 250mg online, MC rosuva 5mg: 41 order ketoconazole cream in india. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Clinical Essay Funding Creator Blasetto et al discount provigil 100 mg fast delivery, 2003; Supported via Lead et al, 2003 AstraZeneca R, DB, MC 5 trials prospectively designed to concession for pooling 2153 patients randomized (n=394 rosuva 5 mg, 392 rosuva 10 mg, 396 aorta 10 mg, 240 rosuva 5mg, 226 rosuva 10 mg, 250 simva 20 mg, 255 prava 20 mg) 12 weeks Statins Point 131 of 395 Finishing News Update 5 Painkiller Effectiveness Review Stand out Evidence Board 1. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Involvement Criteria/ Unswerving Clinical Trial Citizens Exclusion criteria Intervention Bots A, et al, 2005 Age-old 18 years with genre IIa or type IIb Familial hypercholesterolemia or exemplar III hyperlipoproteinemia, 12- week treatment with rosuvastatin 10 mg, (Dutch FINDING) hypercholesterolemia and a 10-year unimportant dyslipidemia (except diabetic dyslipidemia seeking patients with atorvastatin 10 mg, cardiovascular risk of >20% or a controlled diabetes), frenzied diabetes or hypertension, operative liver simvastatin 20 mg or pravastatin 40 mg. RCT (3:1:1:1), DB, MC, history of CHD or other established ailment or hepatic dysfunction, capricious CVD (including inconsistent AC, atherosclerotic contagion, fasting LDL-C angina), report of hypersensitivity to other statins, unexplained serum 1215 patients of >3. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Clinical Trying out Results (course changes in lipoprotein levels) Harms/Comments Bots A, et al, 2005 LDL-c change at 12 weeks: Rosuva vs. Statins Messenger 133 of 395 Final Clock in Update 5 Antidepressant Effectiveness Review Obligation Token Stay 1. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Clinical Proof Funding Documentation Bots A, et al, 2005 AstraZeneca (Dutch IDEA) RCT (3:1:1:1), DB, MC, AC, 1215 patients randomized (n=621 rosuva10, 189 atorva10, 194 simva20, 211 prava40 ) 16 weeks Statins Period 134 of 395 Final Write up Update 5 Numb Effectiveness Review Describe Support Flatland 1. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Numbering Criteria/ Sedulous Clinical Adversity Natives Exclusion criteria Intervention Brown et al, 2002 Men and women ≥18 years with Effectual hepatic disease or dysfunction, operative arterial disorder within 3 6-week dietary contretemps with NCEP Trace 1 R, DB, MC, not ITT LDL-c ≥160 and <250 mg/dl, and months, <10-year narration of malignancy (unless basal or squamous aliment, then: triglyceride levels ≤400 mg/dL cubicle crust carcinoma), wild hypertension, experiences of rosuva 5 mg or 477 patients randomized ketoacidosis within 5 years, of control hypothyroidism, serum rosuva 10 mg or (n= 239 rosuva, 118 Mean baseline LDL-c creatine kinase (CK) concentration>3 times the later limit of reasonable parva 20 mg or parva vs. Women of childbearing quiescent not using NCEP (ATP 2) targets or maximum dispense of a sure stamp of contraception or who were in a family way or lactating rosuva 80 mg, parva 40 mg or simva 80 were also excluded. Clearfield M, et al 2006 Men and women, 18 years or more, Narrative of statin-induced myopathy or a momentous hypersensitivity to 6 week dietary govern in then 6 weeks of RCT (PULSAR) hypercholesterolemia and either a statins; patients considered to be inconsistent after a myocardial infarction rosuva vs.. Statins Announce 135 of 395 Conclusive Cover Update 5 Drug Effectiveness Judge Stick out Evidence Pr‚cis 1. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Clinical Trial Results (definitely changes in lipoprotein levels) Harms/Comments Brown et al, 2002 Efficacy scrutiny for the purpose 472 patients. Withdrawals due to treatment-related adverse events:7 rosuva 5 mg, 7 rosuva R, DB, MC, not ITT LDL-c reduction at 12 weeks: 10 mg, 6 parva, 7 simva. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Clinical Trying out Funding Begetter Brown et al, 2002 3 authors employed close R, DB, MC, not ITT AstraZeneca 477 patients randomized (n= 239 rosuva, 118 parva vs. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Classification Criteria/ Long-suffering Clinical Tentative Populace Rejection criteria Intervention Davidson et al, 2002 Men and women period 18 and older Active arterial sickness within 3 months of venture entry, familial 6-week dietary dispute with NCEP Intensify 1 R, DB, MC, PC. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Clinical Trying out Results (assuredly changes in lipoprotein levels) Harms/Comments Davidson et al, 2002 LDL-c reduction from baseline at week 12: Withdrawals needed to adverse events: 4 (3. No humourless rosuva 5 mg: 17% adverse episode was considered by the investigators to be joint to retreat narcotic. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Clinical Trial Funding Outset Davidson et al, 2002 Supported by a award R, DB, MC, PC. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Grouping Criteria/ Patient Clinical Dry run Residents Rejection criteria Intervention Faergeman O, et al ≥ 18 years with hypercholesterolemia Old hat of statin-induced myopathy or a serious hypersensitivity counteraction 6-week dietary lead-in period, randomized to 2008 (COVERING) and a curriculum vitae of CHD, LDL-C ≥160 to to statins, clinical instability after a cardiovascular outcome, homozygous constantly treatment with rosuvastatin 10 mg or < 400 mg/dL, clinical data of familial hypercholesterolemia, untrammelled hypothyroidism, severe atorvastatin RCT (1;1), OL, MC, AC. Doses were increased shoals > 20% of childbearing latent but not using contraception, unexplained CK incrementally (10 20 1,036 patients were ≥3x ULN and SCr >2. Course baseline LDL-c: through(SD) mg/dL Rosuva 10 mg: 191. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Clinical Whack Results (no way changes in lipoprotein levels) Harms/Comments Faergeman O, et al NCEP ATP III LDL-C target of < 100 mg/dl at 24 weeks Rosuva vs. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Clinical Checking Funding Outset Faergeman O, et al AstraZeneca. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Classification Criteria/ Long-suffering Clinical Dry run Natives Refusal criteria Intervention Fonseca et al, Patients age 18 and older with Familial hypercholesterolemia, fasting TG levels >400 mg/dL, Statin-naГЇve patients completed a 6-week 2005 primary hypercholesterolemia, with aspartate aminotransferase or alanine aminotransferase >1. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Clinical Try-out Results (mode changes in lipoprotein levels) Harms/Comments Fonseca et al, % LDL-c reduction from baseline at 12 weeks (statin-naГЇve patients): Treatment-emergent adverse events: 2005 rosuva 10 (n=358): вЂ40. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Clinical Hearing Funding Inception Fonseca et al, Supported past 2005 AstraZeneca R, Open, MC 1124 patients randomized (rosuva 561, atorva 563) 12 week treatment age Statins Servant 146 of 395 End Backfire Update 5 Drug Effectiveness Review Conjure up Evidence Table 1. Trials comparing LDL-c lowering/HDL-c raising abilities of 2 or more statins Inclusion Criteria/ Persistent Clinical Trial Folk Rejection criteria Intervention Herregods M, et al Patients (> or = 18 years) with direct Curriculum vitae of critical adverse regardless with another HMG-CoA reductase 4 weeks of victuals then randomized to rosuva 10 2008 (Discovery-Belux) hypercholesterolemia, with a low- inhibitor, occupied liver disorder, unsuitable cardiovascular malady, unfeeling mg/day or aorta 10 mg/day in support of 12 weeks. Patients not at target with rosuva 10 mg randomized Baseline LDL-c were further titrated to rosuva 20 mg. Triglyceride levels <400 familial hypercholesterolemia or familial dysbetalipoproteinemia; consume of 10, 20, 40, or 80 mg; pravastatin 10, 20, or 40 2431 patients mg/dL.