Diuver pills 10mg, 20pcs

Composition

1 tablet contains:

torasemide 10 mg.

Auxiliary substances:

lactose monohydrate,

corn starch,

sodium starch glycolate,

colloidal anhydrous silicon,

magnesium stearate.

Pharmacological action

Torasemide is a loop diuretic. The maximum diuretic effect develops 2-3 hours after ingestion of the drug. The main mechanism of action of the drug is due to the reversible binding of torasemide to the sodium / chlorine / potassium ion countertransporter located in the apical membrane of the thick segment of the ascending part of the Henle loop, as a result of which the reabsorption of sodium ions decreases or completely inhibits, and the osmotic pressure of intracellular fluid and water reabsorption decreases. Blocks the aldosterone receptors of the myocardium, reduces fibrosis and improves the diastolic function of the myocardium.

Torasemide causes hypokalemia to a lesser extent than furosemide, but it is more active and its effect is longer.

The use of torasemide is the most reasonable choice for long-term therapy.

Pharmacokinetics

After oral use, torasemide is rapidly and almost completely absorbed into the gastrointestinal tract. _cmaxof torasemide in blood plasma is noted 1-2 hours after oral use after meals. Bioavailability is 80-90% with minor individual variations.

The diuretic effect persists for up to 18 hours, which facilitates the tolerability of therapy due to the absence of very frequent urination in the first hours after oral use, which limits the activity of patients.

Binding to plasma proteins is more than 99%. The visible V_d is 16 liters.

It is metabolized in the liver by cytochrome P450 isoenzymes. As a result of successive oxidation, hydroxylation, or ring hydroxylation reactions, three metabolites (M1, M3, and M5) are formed, which bind to plasma proteins by 86,95, and 97%, respectively.

T_1/2 The duration of torasemide and its metabolites is 3-4 hours and does not change in CRF. The total clearance of torasemide is 40 ml / min, the renal clearance is 10 ml/min. On average, about 83% of the dose taken is excreted by the kidneys: unchanged (24%) and in the form of mainly inactive metabolites (M1 — 12%, M3 — 3%, M5 — 41%).

In renal insufficiency, T_1/2 does not change, T_1/2 of the MH and M5 metabolites increases. Torasemide and its metabolites are slightly eliminated by hemodialysis and hemofiltration.

In hepatic insufficiency, the concentration of torasemide in the blood plasma increases due to a decrease in the metabolism of the drug in the liver. In patients with cardiac or hepatic insufficiency T_1/2 torasemide and the M5 metabolite are slightly increased, and accumulation of the drug is unlikely.

Indications

Edema caused by heart failure, liver, kidney, and lung diseases.

Use during pregnancy and lactation

The drug Diuver is contraindicated during pregnancy (it can be used only if the potential benefit to the mother exceeds the possible risk to the fetus, only under the supervision of a doctor and only in minimal doses), during lactation, under the age of 18 years (efficacy and safety have not been established)

Contraindications

• hypersensitivity to torasemide and sulfonamides; anuria;
• hepatic coma and precomatous state;
• renal failure with increasing azotemia;
• arterial hypotension;
• arrhythmias;
• pregnancy;
• lactation (no data on use during lactation);
• age up to 18 years (efficacy and safety have not been established)

With caution: with a predisposition to hyperuricemia, gout, with latent and severe diabetes mellitus.

Side effects

From the blood: in some cases, changes in the blood picture may occur: a decrease in the number of red blood cells, leukopenia, thrombocytopenia.

From the cardiovascular system: in some cases, due to blood clots, circulatory disorders and thromboembolism occur, as well as a decrease in blood pressure.

From the digestive tract: various dysfunctions of the digestive tract, loss of appetite, dry mouth; rarely-pancreatitis.

From the side of the kidneys and urinary tract: in patients with urinary tract obstruction, it may cause urinary retention; sometimes-increased levels of urea and creatinine.

From the central nervous system: headache, dizziness, weakness, drowsiness, confusion, convulsions, and paresthesia of the extremities.

From the liver: there may be an increase in the activity of “liver” enzymes.

Changes in laboratory parameters: hypovolemia, impaired water and electrolyte balance, hypokalemia, increased serum uric acid levels, hyperglycemia and hyperlipidemia.

Allergic reactions: skin pruritus, rashes and photosensitization.

Sensory disorders: visual disturbances, tinnitus, deafness.

Interaction

Torasemide increases the concentration and risk of developing nephrotoxic and ototoxic effects of cephalosporins, aminoglycosides, chloramphenicol, ethacric acid, cisplatin, amphotericin B (due to competitive excretion by the kidneys).

Torasemide increases the effectiveness of diazoxide and theophylline, reduces the effectiveness of hypoglycemic agents, allopurinol.

Pressor amines and torasemide mutually reduce the effectiveness.

Drugs that block tubular secretion increase the concentration of torasemide in blood plasma.

With the simultaneous use of corticosteroids, 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 elongation of T1 / 2 (for low-polar).

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

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

Torasemide enhances the antihypertensive effect of antihypertensive agents, neuromuscular blockade of depolarizing muscle relaxants (suxamethonium) and weakens the effect of non-depolarizing muscle relaxants (tubocurarin).

Concomitant use of high-dose salicylates during torasemide therapy increases the risk of toxicity (due to competitive renal excretion).

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

When used concomitantly with probenecid or methotrexate, the effectiveness of torasemide may decrease (the same secretion pathway). On the other hand, torasemide can lead to a decrease in the excretion of these drugs by the kidneys.

Concomitant use of cyclosporine and torasemide increases the risk of gouty arthritis due to the fact that cyclosporine can cause impaired urate excretion by the kidneys, and torasemide-hyperuricemia.

It has been reported that patients with a high risk of developing nephropathy receiving oral torasemide, with the introduction of radiopaque agents, impaired renal function was observed more often than in patients with a high risk of developing nephropathy, who were given intravenous hydration before the introduction of radiopaque agents.

How to take, course of use and dosage

Tablets are taken 1 time a day after meals.

The average therapeutic dose is 5 mg per day. If necessary, it is possible to increase the dose to 20 mg per day, and in some cases-to 40 mg per day.

Elderly patients do not need a special dose adjustment.

Overdose

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

Treatment:  there is no specific antidote. You should induce vomiting, perform gastric lavage, prescribe activated charcoal. Reducing the dose or discontinuing the drug and simultaneously replenishing the BCC and indicators of water-electrolyte balance and acid-base balance under the control of serum electrolyte concentrations, hematocrit, symptomatic treatment. Hemodialysis is ineffective.

Special instructions

During long-term treatment with Diover, it is recommended to monitor the electrolyte balance, glucose, uric acid, creatinine and lipids in the blood.

Before prescribing a Diuver, the water-electrolyte balance should be corrected.

Use with caution if you have gout or a tendency to increase uric acid levels.

If you have type 1 or 2 diabetes, you need to monitor your blood glucose levels.

Influence on the ability to drive a car and dangerous mechanisms

During treatment with Diover, patients should refrain from driving a car and engaging in activities that require concentration of attention.

Form of production

Diuver tablets are white or almost white in color, round, biconvex, chamfered, with a risk on one side and engraved ” 915 ” or ” 916 ” on the other side.

Storage conditions

At a temperature not exceeding 30°C, out of the reach of children.

Shelf life

3 years

Active ingredient

Torasemide

Conditions of release from pharmacies

By prescription

Dosage form

Tablets

Purpose

For adults as prescribed by a doctor, for pregnant women as prescribed by a doctor

Indications

Hypertension, Heart Failure, Liver Damage