Torasemid
Torasemide: 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. Drug interactions
- 14. Analogs
- 15. Terms and conditions of storage
- 16. Terms of dispensing from pharmacies
- 17. Reviews
- 18. Price in pharmacies
Latin name: Torasemide
ATX code: C03CA04
Active ingredient: Torasemid (Torasemidum)
Producer: Berezovsky pharmaceutical plant (Russia)
Description and photo update: 2018-22-10
Prices in pharmacies: from 87 rubles.
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Torasemide is a drug with a diuretic effect.
Release form and composition
Dosage form of release of Torasemide - tablets: flat-cylindrical, round, almost white or white, with a line and a chamfer (in blisters of 10 pcs., In a cardboard box 2, 3 or 6 packages; in cans of 30 or 100 pcs., In cardboard box 1 can).
Composition:
- active substance: torasemide - 5 or 10 mg;
- auxiliary components (5/10 mg): microcrystalline cellulose - 44/88 mg; lactose monohydrate - 26.4 / 52.8 mg; magnesium stearate - 0.6 / 1.2 mg; sodium carboxymethyl starch - 2.4 / 4.8 mg; povidone - 1.6 / 3.2 mg.
Pharmacological properties
Pharmacodynamics
Torasemide is a loop diuretic. The main mechanism of its action is due to the reversible binding of the substance to the chlorine / sodium / potassium ion cotransporter, which is located in the apical membrane of the thick segment of the ascending part of Henle's loop. This leads to a decrease or complete inhibition of the reabsorption of sodium ions and a decrease in the osmotic pressure of the intracellular fluid.
The drug blocks aldosterone receptors in the myocardium, improves diastolic myocardial function and reduces fibrosis.
Compared with furosemide, torasemide leads to the occurrence of hypokalemia to a lesser extent, while it acts longer and is more active.
The maximum therapeutic effect is observed 2-3 hours after oral administration.
A long course is possible.
Pharmacokinetics
Absorption (fast and almost complete) occurs in the gastrointestinal tract. The maximum plasma concentration (C max) of the substance is reached 1-2 hours after oral administration of the drug after meals. Bioavailability - 80–90% (individual variation is possible).
The volume of distribution (Vd) is 16 liters, with cirrhosis of the liver, this indicator doubles.
Plasma protein binding is more than 99%.
Metabolism occurs in the liver with the participation of isoenzymes of the cytochrome P450 system. Forms 3 metabolites (M1, M3 and M5) as a result of sequential oxidation, hydroxylation or ring hydroxylation reactions. Their binding to plasma proteins is 86, 95 and 97%, respectively.
The half-life (T1 / 2) of the substance and its metabolites is 3-4 hours, against the background of chronic renal failure, this indicator remains unchanged.
Renal clearance is 10 ml / min, total clearance is 40 ml / min.
On average, about 83% of the dose taken is excreted by the kidneys, of which 24% is unchanged, the rest is in the form of predominantly inactive metabolites (M1 - 12%, M3 - 3%, M5 - 41%).
In a precomatose state and in hepatic coma, the use of the drug is contraindicated. The plasma concentration of torasemide in the blood in liver failure increases, which is associated with a decrease in the metabolism of the substance in the liver.
T1 / 2 of torasemide and the M5 metabolite in patients with hepatic or heart failure increases slightly, the accumulation of the drug is unlikely.
With liver cirrhosis, renal clearance, T1 / 2 and Vd increase, while the total clearance does not change.
In chronic heart failure in the stage of decompensation, the renal and hepatic clearance of the drug decreases. The total clearance of torasemide in such patients compared with healthy volunteers is 50% less, and the overall bioavailability and T1 / 2, respectively, are higher.
The renal clearance of torasemide in patients with renal insufficiency is markedly reduced, but this does not affect the total clearance. In this group of patients, the diuretic effect can be achieved by using the drug in higher doses. T1 / 2 of torasemide does not change, T1 / 2 of metabolites M3 and M5 increases. The substance and its metabolites are excreted slightly by hemofiltration and hemodialysis. In renal failure with increasing azotemia, the drug is contraindicated.
Indications for use
- arterial hypertension;
- edematous syndrome of various etiologies, including chronic heart failure, kidney, liver and lung disease.
Contraindications
Absolute:
- renal failure in combination with anuria;
- refractory hypokalemia / hyponatremia;
- precoma and hepatic coma;
- decompensated mitral / aortic stenosis;
- hypovolemia (with or without arterial hypotension) or dehydration;
- pronounced violations of the outflow of urine of any etiology (including unilateral lesion of the urinary tract);
- sinoatrial and atrioventricular block II – III degree;
- acute glomerulonephritis;
- hyperuricemia;
- glycosidic intoxication;
- increased central venous pressure (more than 10 mm Hg);
- hypertrophic obstructive cardiomyopathy;
- galactose intolerance, lactase deficiency, glucose-galactose malabsorption;
- combination therapy with aminoglycosides and cephalosporins;
- allergy to sulfonamides (sulfonylureas or sulfonamide antimicrobial agents);
- age up to 18 years;
- pregnancy and the period of breastfeeding;
- individual intolerance to the components of the drug.
Relative (diseases / conditions in the presence of which the appointment of Torasemide requires caution):
- a history of ventricular arrhythmias;
- diarrhea;
- pancreatitis;
- arterial hypotension;
- hypoproteinemia;
- stenosing atherosclerosis of the cerebral arteries;
- violations of the outflow of urine (hydronephrosis, benign prostatic hyperplasia or narrowing of the urethra);
- predisposition to the appearance of hyperuricemia;
- acute myocardial infarction (due to an increased risk of cardiogenic shock);
- impaired renal / hepatic function;
- diabetes mellitus (due to decreased glucose tolerance);
- hypokalemia / hyponatremia;
- hepatorenal syndrome;
- anemia;
- gout.
Instructions for the use of Torasemide: method and dosage
Torasemide is taken orally, preferably after meals, with a small amount of water.
The daily dose is taken in 1 dose.
Recommended dosage regimen:
- edematous syndrome of various etiologies: therapeutic dose - 5 mg, its gradual increase is possible - from 20 to 40 mg (maximum). There is no experience of using higher doses. Long-term therapy is indicated (or the drug is used until the edema disappears);
- arterial hypertension: initial dose - 2.5 mg, it is possible to increase it to 5-10 mg. If the clinical effect is insufficient, an antihypertensive drug of another group is added to the treatment regimen.
Side effects
Possible adverse reactions (> 10% - very often;> 1% and 0.1% and 0.01% and <0.1% - rarely; <0.01% - very rare; with an unknown frequency - in cases where according to the available data, it is impossible to determine the frequency of occurrence of violations):
- metabolism / nutrition: infrequently - hypertriglyceridemia, hypercholesterolemia; with an unspecified frequency - a decrease in glucose tolerance (possible manifestation of latent diabetes mellitus);
- lymphatic system / blood: with an unknown frequency - hemolytic / aplastic anemia, leukopenia, thrombocytopenia, agranulocytosis;
- organ of vision: with an unknown frequency - visual impairment;
- nervous system: often - drowsiness, headache, dizziness; infrequently - muscle cramps of the lower extremities; with an unknown frequency - paresthesia in the limbs, fainting, confusion;
- cardiovascular system: infrequently - tachycardia, extrasystole, facial flushing, increased heart rate; with an unknown frequency - orthostatic hypotension, excessive arterial hypotension, deep vein thrombosis, collapse, hypovolemia, thromboembolism;
- labyrinthine disorders / hearing organ: with an unknown frequency - hearing impairment, hearing loss and ringing in the ears (usually reversible), usually against the background of renal failure or hypoproteinemia;
- digestive system: often - diarrhea; infrequently - flatulence, abdominal pain, polydipsia; with an unknown frequency - nausea, dry mouth, vomiting, pancreatitis, loss of appetite, intrahepatic cholestasis, dyspeptic symptoms;
- respiratory system: infrequently - nosebleeds;
- genitals: with an unknown frequency - violation of potency;
- urinary tract / kidney: often - polyuria, increased frequency of urination, nocturia; infrequently - an increased urge to urinate; with an unknown frequency - oliguria, urinary retention (against the background of urinary tract obstruction), hematuria, interstitial nephritis, an increase in the concentration of creatinine and urea in the blood;
- subcutaneous tissue / skin: with an unknown frequency - photosensitivity, pruritus, urticaria, rash, exfoliative dermatitis, erythema polymorphism, vasculitis, purpura;
- laboratory parameters: infrequently - an increase in the number of platelets; with an unknown frequency - hyperuricemia, hyperglycemia, a decrease in the number of erythrocytes, platelets and leukocytes, a slight increase in the activity of alkaline phosphatase in the blood, an increase in the activity of some liver enzymes (in particular, gamma-glutamyl transferase);
- water-electrolyte / acid-base balance: with an unknown frequency - metabolic alkalosis, hyponatremia, hypokalemia, hypochloremia, hypocalcemia, hypomagnesemia (the main symptoms indicating the occurrence of acid-base / electrolyte disorders are confusion, headache, convulsions, muscle weakness, tetany, heart rhythm disturbances and dyspeptic disorders); dehydration and hypovolemia (most often in elderly patients), which can lead to hemoconcentration with a tendency to thrombosis;
- musculoskeletal system: with unknown frequency - muscle weakness;
- general disorders: infrequently - nervousness, asthenia, hyperactivity, thirst, increased fatigue, weakness.
Overdose
The main symptoms: excessively increased diuresis, proceeding with a decrease in the volume of circulating blood and a violation of the electrolyte balance of the blood, which can cause a pronounced decrease in blood pressure, drowsiness, confusion, collapse; possible disorders of the digestive system.
There is no specific antidote. Hemodialysis is ineffective. It is recommended to induce vomiting, gastric lavage, and take activated charcoal. Symptomatic treatment, dose reduction or withdrawal of Torasemide with simultaneous replenishment of circulating blood volume and control of water-electrolyte / acid-base balance indicators are shown.
special instructions
Torasemide should only be used as directed by a doctor.
The duration of the diuretic effect is up to 18 hours, which facilitates the tolerance of therapy due to the absence of too frequent urination, which limits the activity of patients in the first hours after taking the drug.
Against the background of increased sensitivity to sulfonamides and sulfonylurea derivatives, cross-sensitivity to Torasemide is possible. To avoid the development of hypokalemia / hyponatremia and metabolic alkalosis during a long course in high doses, it is recommended to take potassium supplements and follow a diet with a sufficient content of table salt.
The highest risk of hypokalemia is with cirrhosis of the liver, severe diuresis, insufficient intake of electrolytes from food, combination therapy with corticosteroids or adrenocorticotropic hormone.
In cases of the appearance or increase of oliguria and azotemia in patients with severe progressive kidney disease, it is recommended to suspend treatment.
An increased risk of imbalance in water and electrolyte balance was observed in patients with renal failure. During the course of treatment, it is necessary to periodically monitor the following indicators: plasma concentration of electrolytes in the blood (including sodium, potassium, calcium, magnesium), lipids, acid-base state, creatinine, residual nitrogen, uric acid. If necessary, appropriate corrective therapy should be carried out.
It is necessary to determine the regimen of drug use for ascites against the background of liver cirrhosis in stationary conditions, since disturbances in the water-electrolyte balance can cause the appearance of hepatic coma. For this category of patients, regular monitoring of blood plasma electrolytes is shown.
With diabetes mellitus and reduced glucose tolerance, it is necessary to periodically monitor the concentration of glucose in urine and blood.
With prostatic hyperplasia, narrowing of the ureters, as well as unconscious patients, diuresis control is required due to the possibility of acute urinary retention.
The use of Torasemide can cause exacerbation of gout.
In diseases of the cardiovascular system, especially while taking cardiac glycosides, hypokalemia caused by diuretics can lead to the development of arrhythmias.
Influence on the ability to drive vehicles and complex mechanisms
Driving while using Torasemide should be abandoned.
Application during pregnancy and lactation
According to the instructions, Torasemide is not prescribed during pregnancy and breastfeeding.
Pediatric use
The drug is not prescribed for patients under 18 years of age.
With impaired renal function
- renal failure with anuria - therapy is contraindicated;
- impaired renal function - Torasemide is prescribed with caution.
For violations of liver function
- hepatic coma and precoma - therapy is contraindicated;
- hepatic dysfunction - Torasemide is prescribed with caution.
Drug interactions
Possible interactions:
- diazoxide, theophylline: increasing their effectiveness;
- cephalosporins, aminoglycosides, chloramphenicol, ethacrynic acid, antibiotics, salicylates, platinum preparations, amphotericin B: an increase in their concentration and the likelihood of oto- and nephrotoxic effects (associated with competitive excretion by the kidneys);
- drugs that block tubular secretion: an increase in the serum concentration of torasemide in the blood;
- hypoglycemic agents, allopurinol: decrease in their effectiveness;
- lithium preparations: a decrease in their renal clearance and an increase in the likelihood of intoxication;
- cholestyramine: decreased bioavailability and effectiveness of torasemide;
- pressor amines: mutual decrease in efficiency;
- cardiac glycosides: increased risk of glycosidic intoxication associated with hypokalemia (for low- and high-polarity cardiac glycosides) and T1 / 2 lengthening (for low-polarity cardiac glycosides);
- probenecid, methotrexate: decrease in the effectiveness of torasemide, decrease in renal elimination of probenecid, methotrexate;
- mineral and glucocorticosteroids, amphotericin B: an increase in the likelihood of hypokalemia;
- angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists (simultaneous or sequential use): a pronounced decrease in blood pressure (the development of disorders can be avoided by reducing the dose of torasemide or its temporary cancellation);
- salicylates (in high doses): an increased risk of their toxicity;
- non-depolarizing muscle relaxants: weakening their action;
- X-ray contrast agents (in patients at high risk of nephropathy): an increase in the likelihood of developing impaired renal function (the risk of impairments can be reduced by prior intravenous hydration);
- cyclosporine: increased risk of gouty arthritis;
- nonsteroidal anti-inflammatory drugs, sucralfate: decreased diuretic effect;
- depolarizing muscle relaxants: increased neuromuscular blockade;
- antihypertensive drugs: enhancing their action.
Analogs
Torasemid analogs are Torasemid Canon, Trigrim, Torasemid-SZ, Lotonel, Diuver, Britomar.
Terms and conditions of storage
Store in a place protected from light at temperatures up to 25 ° C. Keep out of the reach of children.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews of Torasemid
Reviews of Torasemide are few, since the drug is not available in pharmacies. In general, the reviews are good about drugs with a similar effect, which include torasemide as an active substance. Usually, their quick effect and the possibility of a long course are noted.
The price of Torasemid in pharmacies
The price of Torasemide is unknown due to the lack of the drug in pharmacies. Analogs available:
- Torasemid Canon (5 or 10 mg): 90-505 or 110-620 rubles;
- Torasemid-SZ (5 or 10 mg): 80-380 or 110-470 rubles.
Torasemid: prices in online pharmacies
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Drug name Price Pharmacy |
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Torasemide 5 mg tablets 20 pcs. RUB 87 Buy |
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Torasemid Canon 5 mg tablets 20 pcs. RUB 88 Buy |
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Torasemide 5 mg tablets 20 pcs. RUB 90 Buy |
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Torasemide 10 mg tablets 20 pcs. RUB 97 Buy |
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Torasemide 5mg tablets 20 pcs. 106 RUB Buy |
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Torasemid Canon 10 mg tablets 20 pcs. 109 RUB Buy |
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Torasemide 5 mg tablets 20 pcs. 112 RUB Buy |
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Torasemide 5 mg tablets 30 pcs. 115 RUB Buy |
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Torasemide tablets 5mg 30 pcs. 119 RUB Buy |
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Torasemide tablets 10mg 20 pcs. 129 RUB Buy |
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Torasemid Canon 5mg tablets 20 pcs. 134 r Buy |
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Torasemide 5 mg tablets 60 pcs. 139 RUB Buy |
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Torasemide tablets 5mg 60 pcs. 143 r Buy |
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Torasemide tablets 10mg 30 pcs. 164 RUB Buy |
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Torasemide 5 mg tablets 60 pcs. 175 RUB Buy |
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Torasemide 10 mg tablets 60 pcs. 182 r Buy |
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Torasemid Canon 10mg tablets 20 pcs. 202 RUB Buy |
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Torasemide tablets 5mg 60 pcs. 244 RUB Buy |
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Torasemide 10 mg tablets 60 pcs. 244 RUB Buy |
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Torasemide tablets 10mg 60 pcs. 245 RUB Buy |
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Torasemid Canon 10 mg tablets 60 pcs. 278 r Buy |
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Torasemid Canon 5 mg tablets 60 pcs. 278 r Buy |
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Torasemide tablets 10mg 60 pcs. 295 RUB Buy |
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Torasemid Canon 5mg tablets 60 pcs. 329 r Buy |
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Torasemid Canon tablets 10mg 60 pcs. 425 RUB Buy |
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Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, 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!
