Composition Diuver:
1 tablet of 5 mg contains:
active substance:
Torsemide 5.00 mg; excipients: lactose monohydrate 58.44 mg, corn starch 14.56 mg, sodium carboxymethyl starch 0.80 mg, anhydrous colloidal silicon dioxide 0.60 mg, magnesium stearate 0.60 mg.
Pharmacodynamics Diuver:
Torasemide is a “loop” diuretic. The maximum diuretic effect develops 2-3 hours after taking the drug inside.
The main mechanism of action of the drug Torsemide is due to the reversible binding of torasemide with a sodium / chlorine / potassium ion transporter located in the apical membrane of the thick segment of the ascending Henle loop, resulting in a decrease or inhibition of sodium ion reabsorption and the osmotic pressure of intracellular fluid and water reabsorption. Blocks aldosterone myocardial receptors reduces fibrosis and improves diastolic myocardial function.
Torasemide/Diuver to a lesser extent than furosemide causes hypokalemia, while it is more active and its effect is longer. The use of torasemide is the most reasonable choice for long-term therapy.
Pharmacokinetics Diuver:
After oral administration, torasemide is rapidly and almost completely absorbed in the gastrointestinal tract.
The maximum concentration of torasemide in the blood plasma is observed 1-2 hours after ingestion after a meal. Bioavailability is 80-90% with minor individual variations.
The diuretic effect lasts up to 18 hours, which facilitates the tolerance of therapy due to the lack of very frequent urination in the first hours after taking the drug inside, limiting the activity of patients. Communication with plasma proteins more than 99%.
The apparent distribution volume is 16 liters. It is metabolized in the liver using isoenzymes of the cytochrome P450 system. As a result of successive oxidation, hydroxylation, or ring hydroxylation reactions, three metabolites are formed (Ml, MOH, and M5), which bind to plasma proteins by 86%, 95%, and 97%, respectively.
The half-life (T1 / 2) of torasemide and its metabolites is 3-4 hours and does not change in chronic renal failure.
The total clearance of torasemide is 40 ml / min, renal clearance - 10 ml / min. On average, about 83% of the dose taken is excreted by the kidneys: unchanged (24%) and in the form of predominantly inactive metabolites (Ml - 12%, MH - 3%, M5 - 41%). In renal failure, T 1/2 does not change, T 1/2 of the metabolites of MOH and M5 increases. Torasemide and its metabolites are slightly excreted by hemodialysis and hemofiltration.
With liver failure, the concentration of torasemide in the blood plasma increases due to a decrease in the metabolism of the drug in the liver. In patients with heart or liver failure, T 1/2 of torasemide and M5 metabolite is slightly increased, the cumulation of the drug is unlikely. Torsemide
Side effects Diuver:
From the side of water-electrolyte and acid-base balance: hyponatremia, hypochloremia, hypokalemia, hypomagnesemia, hypocalcemia, metabolic alkalosis. Symptoms that indicate the development of electrolyte and acid-base disturbances may include headache, confusion, cramps, tetany, muscle weakness, cardiac arrhythmias, and dyspeptic disorder; hypovolemia and dehydration (more often in elderly patients), which can lead to hemoconcentration with a tendency to thrombosis.
From the cardiovascular system: an excessive decrease in blood pressure, orthostatic hypotension, collapse, tachycardia, arrhythmias, a decrease in the volume of circulating blood.
From the side of metabolism: hypercholesterolemia, hypertriglyceridemia; transient increase in the concentration of creatinine and urea in the blood; an increase in the concentration of uric acid in the blood, which can cause or increase the manifestations of gout; decreased glucose tolerance (possible manifestation of latent diabetes mellitus). Torsemide
From the urinary system: oliguria, acute urinary retention (for example, with prostatic hyperplasia, narrowing of the urethra, hydronephrosis); interstitial nephritis, hematuria, decreased potency.
From the digestive tract: nausea, vomiting, diarrhea, intrahepatic cholestasis, increased activity of "liver" enzymes, acute pancreatitis.
From the central nervous system, hearing organ: hearing impairment, usually reversible, and / or tinnitus, especially in patients with renal failure or hypoproteinemia (nephrotic syndrome), paresthesia.
On the part of the skin: skin itching, urticaria, other types of rashes or bullous skin lesions, polymorphic erythema, exfoliative dermatitis, purpura, fever, vasculitis, eosinophilia, photosensitivity; severe anaphylactic or anaphylactoid reactions up to shock, which until now have been described only after intravenous administration.
From the peripheral blood: thrombocytopenia; leukopenia; agranulocytosis, aplastic or hemolytic anemia. Torsemide
Special conditions Diuver:
Apply Diuver strictly as directed by your doctor. Patients with hypersensitivity to sulfonamides and sulfonylurea derivatives may have cross-sensitivity to Diuver.
For patients receiving high doses of Diuver for a long period, in order to avoid the development of hyponatremia, metabolic alkalosis and hypokalemia, a diet with sufficient sodium chloride and the use of potassium preparations are recommended.
An increased risk of water-electrolyte imbalance is observed in patients with renal failure. During the course Diuver of treatment, it is necessary to periodically monitor the concentration of blood plasma electrolytes (including sodium, calcium, potassium, magnesium), the acid-base state, residual nitrogen, creatinine, uric acid and, if necessary, carry out appropriate corrective therapy (with a greater frequency in patients with frequent vomiting and parenteral fluids).
With the appearance or intensification of azotemia and oliguria in patients with severe progressive kidney disease, it is recommended to suspend treatment. Dose regimen selection for patients with ascites on the background of cirrhosis should be carried out under stationary conditions (disturbances in the water-electrolyte balance can lead to the development of hepatic coma). This category of patients shows regular monitoring of plasma electrolytes.
In patients with diabetes mellitus or with reduced glucose tolerance, periodic monitoring of the concentration of glucose in the blood and urine is required. In patients in an unconscious state, with prostatic hyperplasia, narrowing of the ureters, diuresis control is necessary due to the possibility of acute urinary retention. During the treatment period, patients should refrain from driving vehicles and engaging in other potentially dangerous activities that require an increased concentration of attention and speed of psychomotor reactions.
Indications Diuver:
edematous syndrome of various origins
including in chronic heart failure
diseases of the liver
lungs and kidneys
arterial hypertension.
Contraindications Diuver:
Hypersensitivity to torasemide or to any of the components of the drug Diuver; in patients with an allergy to sulfonamides (sulfonamide antimicrobials or sulfonylurea preparations); renal failure with anuria; hepatic coma and precoma; severe hypokalemia; severe hyponatremia; hypovolemia (with or without arterial hypotension) or dehydration; pronounced violations of the outflow of urine of any etiology (including unilateral damage to the urinary tract); glycosidic intoxication; acute glomerulonephritis; decompensated aortic and mitral stenosis, hypertrophic obstructive cardiomyopathy; increased central venous pressure (over 10 mm Hg); hyperuricemia age up to 18 years; lactation period; lactose intolerance, lactase deficiency or glucose-galactose malabsorption.
Carefully Arterial hypotension, stenosing atherosclerosis of the cerebral arteries, hypoproteinemia, a predisposition to hyperuricemia, impaired urine outflow (benign prostatic hyperplasia, narrowing of the urethra or hydronephrosis), a history of ventricular arrhythmia, acute myocardial infarction, diarrhea, cardiac enlargement, increase diabetes mellitus (decreased glucose tolerance), hepatorenal syndrome, gout, anemia, pregnancy. Pregnancy and lactation: Torasemide does not have a teratogenic effect and fetotoxicity, penetrates the placental barrier, causing impaired water-electrolyte metabolism and thrombocytopenia in the fetus.
The drug Diuver during pregnancy can be used only if the benefit to the mother outweighs the potential risk to the fetus only under the supervision of a doctor and only in minimal doses. It is not known whether torasemide/Diuver passes into breast milk. If it is necessary to use the drug Diuver during lactation, it is necessary to stop breastfeeding.
Drug Interactions Diuver:
It increases the concentration and risk of developing the nephro- and ototoxic effects of cephalosporins, aminoglycosides, chloramphenicol, ethacrynic acid, cisplatin, amphotericin B (due to competitive renal excretion). Increases the effectiveness of diazoxide and theophylline, reduces hypoglycemic agents, allopurinol.
Pressor amines and torasemide mutually reduce effectiveness. Medicines that block channel secretion increase the concentration of torasemide in the blood serum.
With the simultaneous use of glucocorticosteroids, amphotericin B, the risk of developing hypokalemia increases, with cardiac glycosides - the risk of developing glycoside intoxication due to hypokalemia (for high and low polar) and an increase in the half-life (for low polar) increases.
Reduces renal clearance of lithium preparations and increases the likelihood of developing intoxication.
Nonsteroidal anti-inflammatory drugs, sucralfate reduce the diuretic Diuver effect due to inhibition of prostaglandin synthesis, impaired renin activity in blood plasma and excretion of aldosterone.
It enhances the hypotensive effect of antihypertensive drugs, neuromuscular blockade of depolarizing muscle relaxants (suxamethonium) and weakens the effect of non-depolarizing muscle relaxants (tubocurarine).
The simultaneous administration of large doses of salicylates during treatment with torasemide increases the risk of toxicity (due to competitive renal excretion). The consecutive or simultaneous use of torasemide with angiotensin converting enzyme inhibitors (ACE) or angiotensin II receptor antagonists can lead to a significant decrease in blood pressure.
This can be avoided by lowering the dose of torasemide or by temporarily canceling it. The simultaneous use of probenecid or methotrexate can reduce the effectiveness of torasemide (the same secretion path). Torasemide, on the other hand, can lead to decreased renal elimination of these drugs Diuver.
With the simultaneous use of cyclosporine and torasemide, the risk of developing gouty arthritis increases due to the fact that cyclosporine can cause a violation of the excretion of urate by the kidneys, and torasemide - hyperuricemia.
It was reported that in patients with a high risk of developing nephropathy, taking torasemide by mouth, with the introduction of X-ray contrast agents, impaired renal function was observed more often than in patients with a high risk of developing nephropathy who were given intravenous hydration before the administration of X-ray contrast agents.
Dosage Diuver:
Inside, once a day, after breakfast, washed down with a small amount of water. Edematous syndrome of various origins, including in chronic heart failure, diseases of the liver, lungs and kidneys The usual therapeutic dose Diuver is 5 mg orally once a day.
If necessary, the dose should be gradually increased to 20-40 mg once a day, in some cases - up to 200 mg per day. The drug is prescribed for a long period or until the edema disappears. Arterial hypertension The initial dose Diuver is 2.5 mg (1/2 tablet of 5 mg) once a day. If necessary, the dose can be increased to 5 mg once a day.
Elderly patients do not need dose adjustment.
Overdose Diuver:
Symptoms: excessively increased diuresis, accompanied by a decrease in the volume of circulating blood and a violation of the electrolyte balance of the blood, followed by a pronounced decrease in blood pressure, drowsiness and confusion, collapse.
Gastrointestinal upsets may occur. Treatment: there is no specific antidote. Provocation of vomiting, gastric lavage, activated charcoal.
Symptomatic treatment, dose Diuver reduction or drug withdrawal and at the same time replenishment of BCC and indicators of water-electrolyte balance and acid-base state under the control of serum concentrations of electrolytes, hematocrit, symptomatic treatment.
Hemodialysis is ineffective.
