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Once the compound entered pre-clinical development, process chemistry developed a cost-effective and scalable synthesis. [107] In atorvastatin's case, a key element of the overall synthesis was ensuring stereochemical purity in the final drug substance, and hence establishing the first stereocenter became a key aspect of the overall design.
Within the year of 2014, the cost of prescriptions had increased by at least 11.4% and 58% within the last eight years. The average cost for a month supply of brand-name drugs can run up to a couple of hundred US dollars, whereas in Canada and Great Britain the same medication could cost up to $40 US dollars.
These rates, which are much higher than those seen in randomized clinical trials [74] have been the topic of extensive debate and discussion. [34] [86] Muscle pain and other symptoms often cause patients to stop taking a statin. [87] This is known as statin intolerance.
Persons consuming more than 10 grams/day of calcium carbonate (4 grams of elemental calcium) are at risk of developing milk-alkali syndrome, [19] but the condition has been reported in at least one person consuming only 2.5 grams/day of calcium carbonate (1 gram of elemental calcium), an amount usually considered moderate and safe. [20]
Ezetimibe/atorvastatin (trade names Liptruzet, Atozet) is a cholesterol lowering combination drug. In the United States, it was approved in May 2013, by the Food and Drug Administration for the treatment of elevated low-density lipoprotein (LDL) in patients with primary or mixed hyperlipidemia as adjunctive therapy to diet. [ 1 ]
Journalist Todd Hixon reported on a study that U.S. spending on physicians per person is about five times higher than peer countries, $1,600 versus $310, as much as 37% of the gap with other countries. This was driven by a greater use of specialist doctors, who charge 3-6 times more in the U.S. than in peer countries. [52]
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