Lawtonel
Lotonel: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Lotonel
ATX code: C03CA04
Active ingredient: torasemide (torasemide)
Manufacturer: VERTEX, JSC (Russia)
Description and photo update: 2018-27-11
Prices in pharmacies: from 221 rubles.
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Lotonel is a diuretic drug.
Release form and composition
Lotonel is available in the form of tablets: white or almost white, flat-cylindrical, round, with a dividing line and a chamfer (in blisters: 10 pcs., In a cardboard box 2, 3 or 6 packages; 15 pcs., In a cardboard box 2 or 4 packages; 20 pcs., In a cardboard box 1 or 3 packages; 30 pcs., In a cardboard box 1 or 2 packages; in polyethylene cans: 20 or 60 pcs., In a cardboard box 1 can; each the pack also contains instructions for the use of Lotonel).
1 tablet contains:
- active substance: torasemide - 5 mg or 10 mg;
- auxiliary components: corn starch, lactose monohydrate, colloidal silicon dioxide, sodium carboxymethyl starch (sodium starch glycolate, type A), magnesium stearate.
Pharmacological properties
Pharmacodynamics
Lotonel is a "loop" diuretic, the active substance of which is torasemide. Its main mechanism of action is due to the ability of torasemide to reversibly bind to the counterporter of sodium, chlorine and potassium ions located in the apical membrane of the thick segment of the ascending loop of Henle. This leads to a decrease or complete inhibition of the reabsorption of sodium ions, a decrease in the osmotic pressure of the intracellular fluid and reabsorption of water. As a result of blocking myocardial aldosterone receptors, fibrosis decreases and diastolic myocardial function improves.
The antialdosterone effect of torasemide, showing high activity and a longer lasting effect, makes it possible to cause the development of hypokalemia to a lesser extent, compared with furosemide.
The diuretic effect appears in about 1 hour, and reaches its maximum 2-3 hours after ingestion. The action of Lotonel lasts for 18 hours, which makes it possible not to limit the activity of patients by the need for very frequent urination after taking the drug and to facilitate the tolerance of therapy.
Lotonel causes a decrease in systolic and diastolic blood pressure (BP) while lying and standing. Its appointment is considered the most reasonable choice when long-term treatment is required.
Pharmacokinetics
After oral administration, there is a rapid and almost complete absorption of torasemide in the gastrointestinal tract. Simultaneous food intake does not significantly affect the absorption of the drug. The maximum concentration (C max) of torasemide in the blood plasma is reached after 1–2 hours. Bioavailability of Lotonel is 80–90%.
Plasma protein binding - more than 99%.
The volume of distribution (V d) - 12-16 liters, including those with mild and moderate renal failure or chronic heart failure. V d with cirrhosis of the liver doubles.
Torasemide is metabolized in the liver under the influence of isoenzymes of the cytochrome P 450 system. As a result of successive oxidation and ring hydroxylation reactions, 3 metabolites are formed - M1, M3 and M5, the activity of which for binding to blood plasma proteins corresponds to 86%, 95% and 97%.
The half-life (T 1/2) is 3-4 hours. Total clearance is 40 ml / min, renal clearance is 10 ml / min.
Excretion to a large extent (about 83% of the dose taken) occurs through the kidneys, 24% - unchanged, the rest - in the form of inactive metabolites.
In renal failure, T 1/2 of metabolites M3 and M5 increases, T 1/2 of the active substance does not change. With hemodialysis and hemofiltration, there is a slight excretion of torasemide and its metabolites.
In liver failure, the level of concentration of the drug in the blood plasma increases.
In cardiac or hepatic failure, T 1/2 of torasemide and the M5 metabolite increases slightly, cumulation is unlikely.
In elderly patients, the pharmacokinetic profile, total clearance and T 1/2 do not change. There was a decrease in the renal clearance of Lotonel due to age-related impairment of renal function.
Indications for use
- arterial hypertension;
- edematous syndrome of various origins, including those caused by chronic heart failure, diseases of the kidneys, liver, lungs.
Contraindications
- hepatic coma, precoma;
- allergy to sulfonamide antimicrobial agents and sulfonylureas;
- refractory hyponatremia;
- refractory hypokalemia;
- glycosidic intoxication;
- decompensated aortic and mitral stenosis;
- sinoatrial and atrioventricular block II – III degree;
- hypertrophic obstructive cardiomyopathy;
- arrhythmia;
- an increase of more than 10 mm Hg in the central venous pressure;
- acute glomerulonephritis;
- violations of the outflow of urine of any etiology in a pronounced form, including against the background of unilateral lesions of the urinary tract;
- chronic renal failure with increasing azotemia;
- renal failure with anuria;
- hyperuricemia;
- dehydration, hypovolemia with or without arterial hypotension;
- concomitant therapy with aminoglycosides and cephalosporins;
- syndrome of glucose-galactose malabsorption, lactase deficiency, lactose intolerance;
- age up to 18 years;
- period of pregnancy;
- breast-feeding;
- hypersensitivity to the components of the drug.
With caution, it is necessary to prescribe Lotonel tablets for arterial hypotension, stenosing atherosclerosis of the cerebral arteries, a history of ventricular arrhythmias, acute myocardial infarction, hypoproteinemia, anemia, diarrhea, pancreatitis, hyponatremia, hypokalemia, hepatic dysfunction, hepatic circulatory syndrome, liver cirrhosis, predisposition to hyperuricemia, renal failure, impaired outflow of urine (caused by benign prostatic hyperplasia, narrowing of the urethra or hydronephrosis), concomitant use of corticosteroids, cardiac glycosides and adrenocorticotropic hormone (ACTH).
Lotonel, instructions for use: method and dosage
Lotonel tablets are taken orally, swallowed whole and washed down with water, regardless of the meal.
Reception should be made once a day, always at the same time of day, convenient for the patient.
Recommended daily dosage for arterial hypertension: initial dose - 2.5 mg or 1/2 tablet of 5 mg. In the absence of a sufficient therapeutic effect, the dose after 28 days of taking Lotonel should be increased to 5 mg. If the first dose increase did not lead to an adequate decrease in blood pressure after 28–42 days of therapy, it is increased to 10 mg. In the absence of the required effect from taking 10 mg of torasemide per day, the treatment regimen must be supplemented with the appointment of an antihypertensive agent of another group.
Recommended daily dosage for edematous syndrome:
- edematous syndrome caused by chronic heart failure: the initial dose is 10–20 mg, in the future, to achieve the desired therapeutic effect, it can be increased to 40 mg;
- edematous syndrome due to kidney disease: the initial dose is 20 mg, in the absence of sufficient clinical action, it can be doubled to obtain the desired effect;
- edematous syndrome in liver pathologies: the initial dose is 5-10 mg, if necessary, it can be doubled in order to achieve the desired effect.
The maximum single dose is 40 mg (it is not recommended to exceed it, since there is no experience of using higher doses).
Lawtonel is used until the edema disappears or for a long period.
Elderly patients are shown to use the usual doses of the drug.
Side effects
- from the nervous system: often - drowsiness, dizziness, headache; infrequently - muscle cramps of the lower extremities; the frequency has not been established - confusion, fainting, paresthesia in the extremities (tingling sensation, "creeping" or numbness);
- from the digestive system: often - diarrhea; infrequently - flatulence, abdominal pain, polydipsia; frequency not established - dry mouth, loss of appetite, nausea, vomiting, dyspeptic disorders, pancreatitis, intrahepatic cholestasis;
- from the urinary system: often - polyuria, nocturia, increased frequency of urination; infrequently - an increased urge to urinate; frequency not established - urinary retention in obstruction of the urinary tract, oliguria, hematuria, interstitial nephritis;
- on the part of the cardiovascular system: infrequently - arrhythmia, tachycardia, extrasystole; the frequency has not been established - excessive lowering of blood pressure, orthostatic hypotension, thromboembolism, deep vein thrombosis, decreased circulating blood volume, collapse;
- from the respiratory system: infrequently - epistaxis;
- on the part of the senses: frequency not established - tinnitus, hearing impairment, hearing loss [usually transient; more often with renal failure or hypoproteinemia (nephrotic syndrome)], visual impairment;
- dermatological reactions: frequency not established - pruritus, rash, photosensitivity, urticaria, exfoliative dermatitis, erythema polymorphism, purpura, vasculitis;
- on the part of the musculoskeletal system: frequency not established - muscle weakness;
- from the side of metabolism: the frequency has not been established - hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, hypochloremia, hypovolemia, metabolic alkalosis, dehydration (more often in old age);
- on the part of the reproductive system: the frequency has not been established - a decrease in potency;
- laboratory parameters: infrequently - hypertriglyceridemia, hypercholesterolemia; the frequency is not established - hyperuricemia, an increase in the blood plasma activity of alkaline phosphatase (insignificant), some liver enzymes (including gamma-glutamyltransferase), the concentration of creatinine and urea, leukopenia, thrombocytopenia, agranulocytosis, decreased glucose tolerance (including manifestation diabetes mellitus), hyperglycemia;
- others: frequency not established - aplastic anemia, hemolytic anemia.
Overdose
Symptoms: increased diuresis, causing a violation of the water-electrolyte balance of the blood and a decrease in the volume of circulating blood, a marked decrease in blood pressure, drowsiness, confusion, collapse. Disorders of a gastrointestinal nature are possible.
Treatment: immediate gastric lavage, artificial vomiting, taking activated charcoal, prescribing symptomatic treatment, taking measures to replenish circulating blood volume, correcting water-electrolyte balance and acid-base state, canceling or lowering the dose of Lotonel. Careful monitoring of plasma electrolytes and hematocrit levels is required. There is no specific antidote.
The appointment of a hemodialysis session is ineffective, since this will not speed up the elimination of Lotonel.
special instructions
The use of Lotonel is indicated strictly as directed by a doctor.
If long-term use of Lotonel in high doses is necessary, patients should be prescribed potassium supplements and a diet should be recommended that contains a sufficient amount of table salt. This will reduce the risk of developing hypokalemia, hyponatremia, metabolic alkalosis.
The highest likelihood of developing hypokalemia with cirrhosis of the liver, increased diuresis, concomitant therapy with corticosteroids or ACTH, insufficient intake of electrolytes from food.
In renal failure, it is necessary to periodically conduct control studies for the content of electrolytes in the blood plasma (including sodium, calcium, potassium, magnesium), acid-base state, residual nitrogen concentration, uric acid and creatinine. In case of a violation of the water-electrolyte balance, appropriate therapy should be carried out.
If the results of laboratory tests indicate that the patient has hyper- or hyponatremia, hyper- or hypokalemia, hyper- or hypochloremia, acid-base balance disorders and an increased level of urea concentration in the blood plasma, it is necessary to temporarily stop taking Lotonel. After the restoration of laboratory parameters to normal values, treatment can be resumed with a lower dose of the drug.
The appearance or intensification of azotemia and oliguria in severe progressive kidney disease is the basis for discontinuation of therapy.
With ascites against the background of liver cirrhosis, dose selection is recommended in a hospital setting, this is associated with a high risk of developing hepatic coma in patients due to a violation of the water-electrolyte balance.
Patients with impaired glucose tolerance or diabetes mellitus require regular monitoring of blood and urine glucose levels.
Patients in an unconscious state, with narrowing of the ureters, benign prostatic hyperplasia, it is necessary to ensure careful control of urine output in order to prevent acute urinary retention.
In diseases of the cardiovascular system, especially in patients taking cardiac glycosides, the development of hypokalemia can cause arrhythmias.
Influence on the ability to drive vehicles and complex mechanisms
Due to the existing risk of dizziness or drowsiness during the treatment period, it is necessary to avoid performing potentially hazardous activities that require concentration of attention and high speed of psychomotor reactions, including driving.
Application during pregnancy and lactation
Lotonel, overcoming the placental barrier, causes a violation of water-electrolyte metabolism and thrombocytopenia in the fetus, therefore its use is contraindicated during gestation.
It is not recommended to take Lotonel while breastfeeding.
If it is necessary to prescribe torasemide during lactation, breastfeeding should be discontinued.
Pediatric use
The appointment of Lotonel is contraindicated in patients under the age of 18 years due to the lack of information on the safety and efficacy of torasemide in this category of patients.
With impaired renal function
The use of Lotonel is contraindicated for the treatment of patients with acute glomerulonephritis, a pronounced violation of the outflow of urine of any etiology (including unilateral lesion of the urinary tract), increasing azotemia against a background of chronic renal failure, renal failure with anuria.
With caution, it can be prescribed for renal failure, hepatorenal syndrome, impaired outflow of urine (caused by benign prostatic hyperplasia, narrowing of the urethra or hydronephrosis).
For violations of liver function
The appointment of Lotonel is contraindicated in hepatic coma and precoma.
It is recommended to take pills with caution to patients with impaired liver function, liver cirrhosis.
Use in the elderly
The use of the usual dosage regimen of Lotonel for the treatment of elderly patients is shown.
Drug interactions
With the simultaneous use of Lotonel:
- mineralocorticosteroids, glucocorticosteroids, amphotericin B: increase the risk of hypokalemia;
- cardiac glycosides: when interacting with torasemide, low-polar and high-polar cardiac glycosides can cause hypokalemia, low-polarity cardiac glycosides - they lengthen the half-life, resulting in an increased risk of glycosidic intoxication;
- antibiotics, salicylates, cisplatin, cephalosporin, aminoglycosides, chloramphenicol, ethacrynic acid, platinum preparations, amphotericin B: increase their concentration level and the risk of developing nephro- and ototoxic effects due to competitive renal excretion;
- angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists: contribute to a sharp decrease in blood pressure;
- sucralfate, non-steroidal anti-inflammatory drugs: cause inhibition of prostaglandin synthesis, impaired renin activity in blood plasma and elimination of aldosterone, which leads to a decrease in the diuretic effect of torasemide;
- antihypertensive drugs: enhance antihypertensive activity;
- suxamethonium (depolarizing muscle relaxants): enhances neuromuscular blockade;
- tubocurarine: under the influence of torasemide, non-depolarizing muscle relaxants weaken their effect;
- lithium preparations: there is a decrease in renal clearance of lithium preparations, which increases the risk of developing intoxication;
- diazoxide, theophylline: increase their activity;
- hypoglycemic agents, allopurinol: torasemide helps to reduce their therapeutic effect;
- pressor amines: there is a decrease in the clinical effect of each of the drugs;
- drugs that block tubular secretion: cause an increase in the concentration of torasemide in blood plasma;
- cyclosporine: due to the possible impairment of renal excretion of urate under the influence of cyclosporine and the development of hyperuricemia under the influence of torasemide, the risk of developing gouty arthritis increases;
- probenecid, methotrexate: the likelihood of a decrease in the effectiveness of torasemide and renal elimination of probenecid and methotrexate increases;
- cholestyramine: a decrease in the bioavailability of torasemide is possible;
- X-ray contrast agents: in patients with a high risk of developing nephropathy, intravenous hydration is recommended before the introduction of X-ray contrast agents, this will reduce the likelihood of impaired renal function.
Analogs
Analogues of Lotonela are: Britomar, Diuver, Trigrim, Torasemid, Torasemid Canon.
Terms and conditions of storage
Keep out of the reach of children.
Store at temperatures up to 25 ° C in a dark place.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Lotonel
Reviews of Lotonel are positive. They note the high efficacy of the drug in the treatment of edema syndrome and arterial hypertension. Among the indications of the good diuretic effect of Lotonel, there are patient reports that its appointment after surgery on the kidney allows potentiating the work of the second kidney.
Price for Lotonel in pharmacies
Price for Lotonel per pack containing 5 mg tablets, 30 pcs. can be from 269 rubles, 60 pcs. - from 314 rubles; at a dose of 10 mg: for 30 pcs. - from 309 rubles, 60 pcs. - from 555 rubles.
Lawtonel: prices in online pharmacies
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Drug name Price Pharmacy |
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Lotonel 5 mg tablets 30 pcs. 221 r Buy |
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Lotonel 5 mg tablets 60 pcs. 299 r Buy |
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Lotonel 10 mg tablets 30 pcs. 328 RUB Buy |
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Lotonel 10 mg tablets 60 pcs. RUB 513 Buy |
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
