Essential hypertension. Treatment and prevention of recurrence of edema and / or effusion caused by heart failure.
active substance: torasemide;
1 tablet contains anhydrous torasemide in terms of 100% substance 10 mg;
excipients: lactose monohydrate, pregelatinized starch, colloidal anhydrous silicon dioxide, magnesium stearate.
Dosage form. Pills.
Basic physical and chemical properties: tablets with a flat surface, scored and chamfered, white or almost white.
The main mechanism of diuretic action is due to reverse binding to the Na + / 2Cl- / K + cotransporter in the apical part of Henle’s loop, as a result of which renal reabsorption of sodium and chlorine ions in the ascending part of Henle’s loop is reduced or completely suppressed, and the osmotic pressure of intracellular fluid and water reabsorption decrease. In the dose range of 5–100 mg, the increase in urine output is proportional to the logarithm of the dose. An increase in urine output also occurs when other diuretic drugs (for example, thiazides) no longer show a sufficient effect, for example, with limited renal function.
Eliminates edema, has an antihypertensive effect due to a decrease in peripheral vascular resistance by reducing the content of free calcium in the cells of the muscle layer of arteries and normalizing the disturbed electrolyte balance. As a result, the contractility and reaction of the vessels to the body’s own pressor substances, in particular catecholamines, decrease. Improves the working conditions of the heart by reducing pre- and afterload. After oral administration, the maximum diuretic effect lasts 1–3 hours, and the diuretic effect lasts for almost 12 hours. The hypotensive effect of torasemide develops gradually during the first week and reaches a maximum no later than 12 weeks.
Essential hypertension. Treatment and prevention of recurrence of edema and / or effusion due to heart failure.
Hypersensitivity to the active substance, to sulfonylurea preparations and to the auxiliary substances of the drug. Renal failure with anuria. Hepatic coma or precoma. Arterial hypotension. Hypovolemia. Hyponatremia. Hypokalemia. Significant violation of urination, for example, due to prostatic hypertrophy. Breastfeeding period.
Interaction with other medicinal products and other types of interactions.
Torasemide enhances the effect of other antihypertensive drugs, in particular, angiotensin-converting enzyme inhibitors, which can lead to an excessive decrease in blood pressure when used simultaneously. With the simultaneous use of torasemide with digitalis drugs, a potassium deficiency caused by the use of a diuretic can lead to an increase or increase in the side effects of both drugs. Torasemide may reduce the effectiveness of antidiabetic drugs. Probenecidal nonsteroidal anti-inflammatory drugs (eg, indomethacin, acetylsalicylic acid) can inhibit the diuretic and antihypertensive effects of torasemide. When treated with salicylates in high doses, torasemide can increase their toxic effect on the central nervous system. Torasemide, especially in high doses, can enhance the ototoxic and nephrotoxic effects of ethacrynic acid and aminoglycoside antibiotics, such as kanamycin, gentamicin, tobramycin and cytostatic agents – active derivatives of platinum, as well as the nephrotoxic effect of cephalosporins. Torasemide can enhance the effect of theophylline, as well as the effect of curariform drugs. Laxatives as well as mineral and glucocorticoids can increase the potassium loss associated with torasemide. With the simultaneous use of torasemide and lithium preparations, an increase in the concentration of lithium in the blood plasma is possible, which can cause an increase in the effect and increase in the side effects of lithium. Torasemide may reduce the vasoconstrictor effect of catecholamines such as epinephrine and norepinephrine. With simultaneous use with cholestyramine, the absorption of torasemide and, accordingly, its expected effectiveness may decrease.
Method of administration and dosage
Take orally 1 time a day in the morning after meals, without chewing, with a small amount of liquid. The dose and duration of the course of treatment should be set individually, taking into account the indications, effectiveness and tolerability of therapy.
With essential hypertension. The usual dose is 2.5 mg of Torsid. If, after 12 weeks of therapy with the drug at a dose of 2.5 mg per day, the normalization of blood pressure is not achieved, the dose can be increased to 5 mg. A further increase in the dose is impractical, since this will not lead to a further decrease in blood pressure.
With edema or effusion: the initial dose is 5 mg of Torsid per day. Usually this dose is considered maintenance. If the daily dose of 5 mg is insufficient, then use 10 mg of torasemide per day. The dose can be increased depending on the severity of the disease, up to 20 mg of the drug per day.
With liver failure. Treatment of such patients should be carried out with caution, since an increase in the concentration of torasemide in the blood plasma is possible.
Elderly patients. No special dose selection is required. There are no adequate studies comparing the treatment of elderly patients with young patients.
Torasemide should not be used in children due to the lack of sufficient clinical experience.
The typical symptoms are unknown. Overdose can cause severe diuresis, including the risk of excessive loss of water and electrolytes, drowsiness, amentive syndrome (a form of impaired consciousness), symptomatic hypotension, cardiovascular failure, and disorders of the digestive system.
Overdose treatment. The specific antidote is unknown. Symptoms of intoxication disappear, as a rule, when the dosage is reduced and the drug is discontinued and with appropriate replacement of fluid and electrolytes (it is necessary to monitor the level of electrolytes in the blood). Torasemide is not cleared from the blood by hemodialysis. Treatment for hypovolemia is fluid volume replacement. Treatment in case of hypokalemia: administration of potassium supplements. Treatment of cardiovascular failure: supine position of the patient and, if necessary, prescribe symptomatic therapy.
Anaphylactic shock (emergency measures). At the first appearance of skin reactions (such as, for example, urticaria or redness of the skin), an agitated state of the patient, headache, sweating, nausea, cyanosis, vein catheterization should be performed; give the patient a horizontal position, provide free air flow, prescribe oxygen. If necessary, use the introduction of epinephrine, solutions that replace the volume of fluid, glucocorticoid hormones.
- Metabolism / electrolytes. Often: increased metabolic alkalosis. Muscle spasms (especially at the beginning of treatment), indigestibility of food, flatulence, urge to urinate, skin rashes. An increase in the concentration of uric acid and glucose in the blood, as well as cholesterol and triglycerides. Hypokalemia with concomitant potassium-free diet, vomiting, diarrhea, after excessive use of laxatives, as well as in patients with chronic liver dysfunction. Depending on the dosage and duration of treatment, disturbances in water and electrolyte balance are possible, for example, hypovolemia, hypokalemia and / or hyponatremia. With significant losses of fluid and electrolytes as a result of increased urination, hypotension, headache, fatigue, drowsiness may occur, especially at the beginning of treatment and in elderly patients.
- On the part of the cardiovascular system. Very rare: due to possible blood thickening, thromboembolic complications, confusion, arterial hypotension, as well as circulatory and cardiac disorders, including ischemia of the heart and brain, can occur, which can lead, for example, to arrhythmias, angina pectoris, acute myocardial infarction , syncope.
- From the digestive system. Often: disorders of the digestive system (especially at the beginning of treatment), including lack of appetite, stomach pain, nausea, vomiting, diarrhea, constipation. Very rare: pancreatitis.
- From the kidneys and urinary tract. Sometimes: increased concentration of creatinine and blood urea. In patients with urinary disorders (such as prostatic hypertrophy), increased urine production can lead to urinary retention and excessive distension of the bladder.
- From the liver. Often: an increase in the concentration of certain liver enzymes (gamma-glutamyl transpeptidase) in the blood.
- From the immune system. Very rare: allergic reactions such as pruritus, exanthema, photosensitivity, severe skin reactions.
- On the part of the blood and hematopoietic system. Very rare: a decrease in the number of platelets, erythrocytes and / or leukocytes as a result of hemoconcentration.
- General manifestations and reactions at the injection site. Often: headache, dizziness, increased fatigue, general weakness (especially at the beginning of treatment). Sometimes: dry mouth, discomfort in the limbs (paresthesia). Very rare: visual impairment, tinnitus, hearing loss, hearing loss.
Do not use the drug after the expiration date indicated on the package.
Store in its original packaging at a temperature not exceeding 25 ° C.
Keep out of the reach of children.