Nilfisk - 180-10 Premium Pressure washer

Product Information

With it robust design & powerful output the Premium 180 is ideal for cleaning large areas, providing professional cleaning results. Offering a high level of comfort, mobility & control this ergonomic pressure washer can handle a wide range of cleaning tasks including patios, paths, driveways, garden furniture, walls, fences & cars, as well as larger tasks such as swimming pools, mowers, horse trailers, caravans & boats. There is limited experience with bempedoic acid in patients with severe renal impairment (defined as eGFR < 30 mL/min/1.73 m 2), and patients with ESRD on dialysis have not been studied with bempedoic acid (see section 5.2). Additional monitoring for adverse reactions may be warranted in these patients when Nustendi is administered. atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin (used to lower cholesterol and known as statins). Multiples of 15: 15, 30, 45, 60, 75, 90, 105, 120, 135, 150, 165, 180, 195, 210, 225, 240, 255, 270, 285, 300 Hepatic transaminase (AST and/or ALT) elevations of ≥ 3× ULN were reported in 2.4% of patients treated with Nustendi compared with no patients on placebo. In four controlled clinical trials of bempedoic acid, the incidence of elevations (≥ 3× ULN) in hepatic transaminase levels (AST and/or ALT) was 0.7% for patients treated with bempedoic acid and 0.3% for placebo. In controlled clinical combination trials of ezetimibe initiated concurrently with a statin, the incidence of consecutive elevations (≥ 3× ULN) in hepatic transaminase levels was 1.3% for patients treated with ezetimibe administered with statins and 0.4% for patients treated with statins alone. The elevations in transaminases with bempedoic acid or ezetimibe were not associated with other evidence of liver dysfunction (see section 4.4).

The bioavailability of Nustendi tablets was similar relative to that from the individual tablets, coadministered. C max values for bempedoic acid and its active metabolite (ESP15228) were similar between formulations, but ezetimibe and ezetimibe glucuronide C max values were approximately 13% and 22% lower, respectively, for Nustendi relative to the individual tablets, coadministered. Given a similar overall extent of ezetimibe and ezetimibe glucuronide exposure (as measured by AUC), a 22% lower C max is unlikely to be clinically significant. Nustendi increases serum creatinine and BUN. A mean increase of 0.02 mg/dL (1.8 micromole/L) in serum creatinine and a mean increase of 2.7 mg/dL (1.0 mmol/L) in BUN compared to baseline was observed with Nustendi at week 12. The elevations in serum creatinine and BUN usually occurred within the first 4 weeks of treatment, remained stable, and returned to baseline following discontinuation of therapy. No clinically significant pharmacokinetic interaction was seen when ezetimibe was coadministered with bempedoic acid. Total ezetimibe (ezetimibe and its glucuronide form) and ezetimibe glucuronide AUC and C max increased approximately 1.6- and 1.8-fold, respectively, when a single dose of ezetimibe was taken with steady-state bempedoic acid. This increase is likely due to inhibition of OATP1B1 by bempedoic acid, which results in decreased hepatic uptake and subsequently decreased elimination of ezetimibe-glucuronide. Increases in the AUC and C max for ezetimibe were less than 20%.Although the percentage formula can be written in different forms, it is essentially an algebraic equation involving three values. Patients receiving Nustendi as adjunctive therapy to a statin should be monitored for adverse reactions that are associated with the use of high doses of statins. All patients receiving Nustendi in addition to a statin should be advised of the potential increased risk of myopathy and told to report promptly any unexplained muscle pain, tenderness, or weakness. If such symptoms occur while a patient is receiving treatment with Nustendi and a statin, a lower maximum dose of the same statin or an alternative statin, or discontinuation of Nustendi and initiation of an alternative lipid-lowering therapy should be considered under close monitoring of lipid levels and adverse reactions. If myopathy is confirmed by a creatine phosphokinase (CPK) level > 10× upper limit of normal (ULN), Nustendi and any statin that the patient is taking concomitantly should be immediately discontinued. In a multiple-dose study with ezetimibe given 10 mg once daily for 10 days, plasma concentrations for total ezetimibe were about 2-fold higher in older (≥ 65 years) healthy subjects compared to younger subjects. LDL-C reduction and safety profile are comparable between elderly and young subjects treated with ezetimibe. The primary route of elimination for bempedoic acid is through metabolism to the acyl glucuronide. Bempedoic acid is also reversibly converted to an active metabolite (ESP15228) based on aldo-keto reductase activity observed in vitro from human liver. Mean plasma AUC metabolite/parent drug ratio for ESP15228 following repeat-dose administration was 18% and remained constant over time. Both bempedoic acid and ESP15228 are converted to inactive glucuronide conjugates in vitro by UGT2B7. Bempedoic acid, ESP15228 and their respective conjugated forms were detected in plasma with bempedoic acid accounting for the majority (46%) of the AUC 0-48h and its glucuronide being the next most prevalent (30%). ESP15228 and its glucuronide represented 10% and 11% of the plasma AUC 0-48h, respectively.

Percentages are computed by multiplying the value of a ratio by 100. For example, if 25 out of 50 students in a classroom are male, . The value of the ratio is therefore 0.5, and multiplying this by 100 yields: Administration of bempedoic acid and ezetimibe alone and in combination with other lipid modifying medicinal products decreases LDL-C, non-high density lipoprotein cholesterol (non-HDL-C), apolipoprotein B (apo B), and total cholesterol (TC) in patients with hypercholesterolaemia or mixed dyslipidaemia.

Multiples of 8: 8, 16, 24, 32, 40, 48, 56, 64, 72, 80, 88, 96, 104, 112, 120, 128, 136, 144, 152, 160 In coadministration studies with ezetimibe and statins the toxic effects observed were essentially those typically associated with statins. Some of the toxic effects were more pronounced than observed during treatment with statins alone. This is attributed to pharmacokinetic and pharmacodynamic interactions in coadministration therapy. Myopathies occurred in rats only after exposure to doses that were several times higher than the human therapeutic dose (approximately 20 times the AUC level for statins and 500 to 2,000 times the AUC level for the active metabolites). Of the 3,621 patients treated with bempedoic acid in the placebo-controlled studies, 2,098 (58%) were > 65 years old. No overall differences in safety or efficacy were observed between these patients and younger patients. If cholelithiasis is suspected in a patient receiving Nustendi and fenofibrate, gallbladder studies are indicated and alternative lipid-lowering therapy should be considered (see section 4.4).