Treatment of oedematous swelling and transfusion in patients with intravenous therapy, e.g. patients with pulmonary edema due to acute myocardial failure.
Composition:
1 ampoule contains 20 mg of torasemide in the form of sodium salt.
Action:
A medicine with saluretic effect consisting in blocking the reabsorption of sodium and chloride ions in the ascending arm of the Henle's loop. The diuretic action of the drug occurs quickly, reaching a maximum within 2-3 h after administration, the effect persists for 12 hours. Torasemid reduces swelling. In the case of heart failure, torasemide causes a reduction in symptoms and improvement of myocardial function by reducing the initial and follow-up load. It reduces blood pressure by reducing peripheral resistance - after oral administration, it develops slowly within the first week of treatment, the maximum effect is achieved no later than around 12 weeks Presumably, the effect of the drug reduces the increased vascular wall contractility in response to endogenous pressurizing compounds blood, e.g. catecholamines. After oral administration, torasemide is absorbed quickly and almost completely, reaching a maximum concentration in the blood within 1-2 h. The bioavailability is 80-90%, the "first pass" effect is achieved in a maximum of 10-20%. The food does not affect the total absorption of the drug. It binds to plasma proteins in more than 99%. It is converted to three metabolites. T0,5 torasemide and its metabolites is 3-4 h. Approximately 80% of the administered dose is excreted in the urine in the form of torasemide and its metabolites. Torasemide and its metabolites are only slightly removed by hemodialysis and hemofiltration.
Contraindications:
The drug is contraindicated in cases of: hypersensitivity to torasemide or drugs with a similar chemical structure, reduced blood pressure, renal failure with anuria, severe hepatic impairment with impaired consciousness (pre-coma and hepatic coma), decreased circulating blood volume (hypovolaemia), lowering sodium and potassium in the blood, disorders of bladder emptying, e.g. caused by prostatic hyperplasia, breastfeeding period. Due to insufficiently documented results of clinical trials, torasemide should not be used in the case of: gout, myocardial arousal and conductive disorders, eg sinoatrial block, atrio-ventricular block IIst. or total block), acid-base disturbances, simultaneous use of lithium salts, aminoglycoside antibiotics and cephalosporins, pathological changes in blood counts, e.g. thrombocytopenia or anemia in patients without concomitant renal impairment, renal dysfunction caused by neurotoxic compounds. Do not use in children under 12 years of age.
Precautions:
If you are taking torasemide, the electrolytes (especially potassium levels), Glucose, uric acid, creatinine, cholesterol and triglycerides (especially in patients with high blood lipids) and peripheral blood counts should be regularly monitored. Due to the fact that, in individual cases, an increase in blood Glucose can not be excluded, it is recommended to control the metabolism of carbohydrates in patients with symptomatic diabetes or impaired carbohydrate tolerance. In addition, blood counts (erythrocytes, leukocytes, platelets) should be monitored regularly. Particularly cautiously used in patients with hepatic insufficiency, due to the possibility of increasing the concentration of torasemide in the blood.
Pregnancy and lactation:
The drug can be used during pregnancy only when it is absolutely necessary after careful analysis of all benefits and risks. The drug should not be used during breast-feeding.
Side effects:
Disturbances in fluid and electrolyte balance, especially hypovolemia, hypopotamiaemia and / or hyponatraemia with dose-related and duration of treatment.In patients with impaired urination, increased urine production may lead to urination and bladder expansion. Rare: metabolic alkalosis, increased urea and creatinine in the blood, decreased erythrocytes, leukocytes and platelets, cutaneous hypersensitivity reactions (pruritus, rash, photosensitivity), dry mouth, paraesthesia and visual disturbances. Occasionally, gastrointestinal disorders may occur (including loss of appetite, stomach pain, nausea, diarrhea, constipation). In individual cases, it was observed: headache and dizziness, fatigue, weakness, muscle spasms (mainly at the beginning of treatment), pancreatitis, increased uric acid, glucose and blood lipids, increased activity of some liver enzymes (GGT), increased lipid levels ( triglycerides, cholesterol) and allergic reactions, tinnitus, hearing loss. In cases of high loss of fluids and electrolytes caused by increased diuresis, hypotension, disorientation, thrombosis, cerebral ischaemia, myocardial ischemia, angina pectoris, myocardial infarction and fainting may occur. When administered intravenously, acute and even potentially fatal hypersensitivity reactions (anaphylactic shock) requiring adequate and immediate medical attention and severe allergic reactions may occur in individual cases.
Dosage:
Intravenously in a slow injection.Edema and / or diffusion: initially 10 mg once a day; in the case of insufficient efficacy, the dose may be increased to 20 mg per day; in the case of a further lack of desired therapeutic effect, a dose of 40 mg per day may be administered for a short time (not longer than 3 days).Acute pulmonary edema: initially 20 mg, depending on the effectiveness the dose can be repeated at intervals of 30 min (the maximum daily dose is 100 mg). It must not be used injections and infusions with other medicines. Intravenous therapy can be given for a maximum of 1 week, in the case of long-term use, it is recommended to introduce oral administration as soon as possible.
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