Prevention of edema and treatment of edema and hypertrophy in heart failure. In addition, tabl. 5 mg: primary hypertension. Table. 200 mg are intended for use only in patients with severe renal impairment (creatinine clearance less than 20 ml / min and / or creatinine concentration greater than 6 mg / 100 ml) to maintain diuresis, in the event of swellings, leaks and high blood pressure. and dialysis patients, if the residual diuresis is more than 200 ml / day.
Composition:
1 tabl contains 5 mg, 10 mg or 200 mg of torasemide. The preparation contains lactose.
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. In addition, 200 mg are contraindicated in normal or only moderately impaired renal function (creatinine clearance above 30 ml / min and / or serum creatinine below 3.5 mg / 100 ml) due to the risk of excessive loss of water and electrolytes and should not be used in this dose in patients with creatinine clearance from 20 to 30 ml / min and / or serum creatinine from 3.5 to 6 mg / 100 ml.
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. The drug contains lactose - should not be used in patients with rare hereditary galactose intolerance, lactase deficiency (Lapp type) or malabsorption of glucose-galactose.
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, nausea, abdominal pain, 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.
Dosage:
Orally.Swelling and transmissions.Table. 5 mg, 10 mg. Treatment should start from 1 tablet. 5 mg daily. Typically, the starting dose can be used as a maintenance dose. In the event of unsatisfactory therapeutic effect and depending on the clinical picture, the dose may be increased up to a maximum of 20 mg per day.Acute pulmonary edema.Table. 5 mg, 10 mg. Treatment should start with 1 tablet. 10 mg torasemide per day. Then, depending on the clinical picture, the dose may be increased to a maximum of 20 mg of torasemide per day.Table. 200 mg. Treatment should start from 1/4 tabl. per day, equivalent to 50 mg torasemide, in the event of insufficient diuresis, the dose may be increased to a maximum of 1 tablet. daily, equivalent to 200 mg of torasemide.Primary hypertension (only 5 mg dose). Treatment should start from 1/2 tabl. 5 mg daily (2.5 mg torasemide). The antihypertensive effect starts in the first week of application, the maximum therapeutic effect is achieved after 12 weeks of treatment. If the pressure is not normalized after 12 weeks of treatment, the dose may be increased to 1 tablet. 5 mg daily. Do not increase the dose above 5 mg daily because this will not reduce your blood pressure further. The duration of treatment depends on the clinical condition of the patient. The tablets should be taken in the morning, swallowed whole with a small amount of liquid, taken with or without food. The tablets are divisible.