Diuver pills 5mg №60

Indications

- edematous syndrome of various genesis, including in chronic heart failure, liver, kidney and lung diseases;

- arterial hypertension.

Dosage and administration

The drug is taken orally 1 time / day after breakfast, with a small amount of water.

Edematous syndrome of various genesis, incl. in chronic heart failure, liver, lung and kidney diseases

The therapeutic dose is 5 mg 1 time / day. If necessary, the dose should be gradually increased to 20-40 mg 1 time / day, in some cases - up to 200 mg / day. The drug is prescribed for a long period or until the edema disappears.

Arterial hypertension

The initial dose is 2.5 mg (1/2 tab. 5 mg) 1 time / day. If necessary, the dose can be increased to 5 mg 1 time / day.

Elderly patients dose adjustment is not required.

Adverse effects

From the side of water-electrolyte and acid-base balance: hyponatremia, hypochloremia, hypokalemia, hypomagnesemia, hypocalcemia, metabolic alkalosis. Symptoms that indicate the development of electrolyte and acid-base disorders can be headache, confusion, convulsions, tetany, muscle weakness, heart rhythm disturbances, and dyspepsia disorders; hypovolemia and dehydration (more often in elderly patients), which can lead to hemoconcentration with a tendency to develop thrombosis.

Since the cardiovascular system: excessive decrease in blood pressure, orthostatic hypotension, collapse, tachycardia, arrhythmias, reduced BCC.

Metabolism: hypercholesterolemia, hypertriglyceridemia; a transient increase in the concentration of creatinine and urea in the blood; increasing the concentration of uric acid in the blood, which can cause or increase the manifestations of gout; decrease in glucose tolerance (possible manifestation of latent flowing diabetes mellitus).

From the urinary system: Oliguria, acute urinary retention (for example, prostatic hyperplasia, narrowing of the urethra, hydronephrosis); interstitial nephritis, hematuria, reduced potency.

From the digestive system: nausea, vomiting, diarrhea, intrahepatic cholestasis, increased liver enzymes, acute pancreatitis.

From the side of the central nervous system and organ of hearing: hearing loss, usually reversible, and / or tinnitus, especially in patients with renal insufficiency or hypoproteinemia (nephrotic syndrome), paresthesia.

From the skin: pruritus, urticaria, other types of rash or bullous skin lesions, erythema multiforme, exfoliative dermatitis, purpura, fever, vasculitis, eosinophilia, photosensitization; severe anaphylactic or anaphylactoid reactions up to shock, which have hitherto been described only after intravenous administration.

Peripheral Blood: thrombocytopenia, leukopenia, agranulocytosis, aplastic or hemolytic anemia.

Contraindications

- hypersensitivity to Torsemide;

- renal failure with anuria;

- hepatic coma and precoma;

- severe hypokalemia;

- severe hyponatremia;

- hypovolemia (with or without arterial hypotension) or dehydration;

- pronounced violations of the outflow of urine of any etiology (including unilateral damage to the urinary tract);

- glycoside intoxication;

- acute glomerulonephritis;

- decompensated aortic and mitral stenosis;

- hypertrophic obstructive cardiomyopathy;

- increase in central venous pressure (more than 10 mm Hg);

- hyperuricemia;

- age up to 18 years;

- lactation period;

- lactose intolerance, lactase deficiency, glucose-galactose malabsorption;

- hypersensitivity to the drug;

- Allergy to sulfonamides (sulfanilamide antimicrobial agents or sulfonylureas).

WITH caution should be prescribed for arterial hypotension, stenosing atherosclerosis of cerebral arteries, hypoproteinemia, predisposition to hyperuricemia, violation of urine outflow (benign prostatic hyperplasia, narrowing of the urethra or hydronephrosis), ventricular arrhythmia in anamstrose diarrhea, pancreatitis, diabetes mellitus (decreased glucose tolerance), hepatorenal syndrome, gout, anemia, pregnancy.

Use during pregnancy and lactation

In pregnancy, Diuver can be used only when the potential benefit to the mother outweighs the possible risk to the fetus, only under the supervision of a physician, and only in minimal doses.

Torsemide does not have a teratogenic effect and fetotoxicity, penetrates the placental barrier, causing impaired water-electrolyte metabolism and thrombocytopenia in the fetus.

It is not known whether Torsemide is excreted in breast milk. If necessary, the use of the drug Diuver during lactation should stop breastfeeding.

Application for violations of the liver

The drug is contraindicated in hepatic coma and prekomatoznom state.

Application for violations of kidney function

The drug is contraindicated in renal failure with increasing azotemia.

Use in children

Contraindication: age up to 18 years (efficacy and safety have not been established).

Use in elderly patients

Elderly patients no special dose selection is required.

Special notes

Apply strictly on doctor's prescription.

The diuretic effect lasts up to 18 hours, it facilitates tolerability of therapy due to the lack of very frequent urination in the first hours after taking the drug inside, which limits the activity of patients.

Patients with hypersensitivity to sulfonamides and sulfonylurea derivatives may have a cross-sensitivity to Diuver.

Patients receiving high doses of the drug Diuver for a long period, in order to avoid the development of hyponatremia, metabolic alkalosis and hypokalemia, it is recommended a diet with an adequate content of salt and the use of potassium preparations.

An increased risk of developing disorders of water and electrolyte balance is observed in patients with renal insufficiency. During the course of treatment, it is necessary to periodically monitor the concentration of electrolytes in the blood plasma (including sodium, Calcium, potassium, magnesium), acid-base state, residual nitrogen, creatinine, uric acid, and, if necessary, carry out appropriate corrective therapy (with a higher frequency in patients with frequent vomiting and on the background of parenterally administered fluids).

When the onset or increase of azotemia and oliguria in patients with severe progressive kidney disease, it is recommended to suspend treatment.

The selection of a dosing regimen in patients with ascites on the background of cirrhosis should be carried out in a hospital setting (disruption of water and electrolyte balance may lead to the development of hepatic coma). This category of patients shows regular monitoring of plasma electrolytes.

Patients with diabetes mellitus or with reduced glucose tolerance require periodic monitoring of the concentration of glucose in the blood and urine.

In unconscious patients with hyperplasia of the prostate gland, narrowing of the ureters, control of diuresis is necessary due to the possibility of acute urinary retention.

Influence on ability to drive motor transport and control mechanisms

During the period of treatment, patients should refrain from driving and engaging in other potentially hazardous activities that require increased concentration and psychomotor reactions.

Overdosage

Symptoms: excessively increased diuresis, accompanied by a decrease in the bcc and impaired electrolyte balance in the blood, followed by a pronounced decrease in blood pressure, drowsiness, confusion, collapse; possible gastrointestinal disorders.

Treatment: there is no specific antidote. It should induce vomiting, gastric lavage, appoint activated charcoal. Dose reduction or withdrawal of the drug and at the same time replenishment of the BCC and indicators of water and electrolyte balance and acid-base balance under the control of serum electrolyte concentrations, hematocrit, symptomatic treatment. Hemodialysis is ineffective.

Drug interaction

Torsemide increases the concentration and risk of nephro and ototoxic effects of cephalosporins, aminoglycosides, chloramphenicol, ethacrynic acid, Cisplatin, amphotericin B (due to competitive renal excretion).

Torsemide increases the effectiveness of diazoxide and theophylline, reduces the effectiveness of hypoglycemic agents, Allopurinol .

Pressor amines and Torsemide mutually reduce effectiveness.

Drugs that block tubular secretion, increase the concentration of Torsemide in serum.

With the simultaneous use of GCS, amphotericin B increases the risk of hypokalemia, with cardiac glycosides - increases the risk of glycoside intoxication due to hypokalemia (for high and low polar) and T_1/2 (for low polar).

Torsemide reduces renal clearance of lithium preparations and increases the likelihood of intoxication.

NSAIDs, sucralfat reduce the diuretic effect due to inhibition of prostaglandin synthesis, impaired plasma renin activity and aldosterone elimination.

Torsemide enhances the hypotensive effect of antihypertensive agents, neuromuscular blockade of depolarizing muscle relaxants (suksametoniy) and weakens the effect of non-depolarizing muscle relaxants (tubocurarine).

At the same time taking high doses of salicylates during therapy with Torsemide, the risk of their toxicity increases (due to competitive elimination by the kidneys).

Consistent or simultaneous use of Torsemide with ACE inhibitors or angiotensin II receptor antagonists can lead to a strong decrease in blood pressure. This can be avoided by lowering the dose of Torsemide or temporarily canceling it.

When applied simultaneously with probenecid or Methotrexate, it is possible to reduce the effectiveness of Torsemide (the same secretion route). On the other hand, Torsemide may lead to a decrease in the renal elimination of these drugs.

With the simultaneous use of cyclosporine and Torsemide increases the risk of developing gouty arthritis due to the fact that cyclosporine can cause a violation of the excretion of urate by the kidneys, and Torsemide - hyperuricemia.

It was reported that patients with a high risk of nephropathy, receiving Torsemide orally, with the introduction of X-ray contrast agents, renal dysfunction was observed more often than in patients with a high risk of developing nephropathy who underwent iv hydration before X-ray contrast agents.

Terms and conditions of storage

The drug should be kept out of the reach of children and at a temperature not higher than 30 ° C.