The usage and dosage of Nilemdo should be adjusted according to the individual situation of the patient, and special attention should be paid to dosage adjustment and monitoring when using it for special populations. The following provides a detailed explanation from three aspects: standard usage, dosage adjustment, and management of special populations, to provide guidance for rational drug use in clinical practice.

1. Usage and dosage

(1) Standard dose

The recommended starting dose is 180mg orally, once daily, with or without food, but with a fixed administration time to maintain stable blood drug concentration.

(2) Administration method

The whole tablet should not be chewed or broken open. If missed, it should be taken as soon as possible on the same day, but double the dose should not be taken on the same day.

2. Medication for special populations

(1) Liver dysfunction

Child Pugh A patients need to reduce their dosage to 90mg once daily; Child Pugh B/C patients are contraindicated due to significantly increased drug exposure.

(2) Renal insufficiency

Mild to moderate renal dysfunction (eGFR ≥ 30mL/min) does not require dose adjustment; Severe damage (eGFR<30mL/min) should be used with caution and adverse reactions monitored.

(3) Elderly patients

Patients over 65 years old do not need to adjust the starting dose, but due to the possibility of liver and kidney dysfunction, liver function and creatine kinase monitoring need to be strengthened.

(4) Pregnancy and lactation

Prohibited during pregnancy, women of childbearing age need to confirm their pregnancy status before taking medication; Breastfeeding should be suspended until 3 days after the last administration.

3. Drug monitoring requirements

(1) Liver function monitoring

ALT/AST should be tested before treatment and 3 months after medication. If it continues to exceed 3 times the upper limit of normal values, medication should be discontinued for evaluation.

(2) Blood lipid monitoring

After 4-8 weeks of treatment, LDL-C levels need to be rechecked to evaluate the efficacy and consider whether to adjust the combination therapy based on the results.