Diuver pills 5mg, 20pcs

Composition

1 tablet contains the Active ingredient-torasemide 5 mg

Auxiliary substances:

lactose monohydrate,

corn starch,

sodium glycolate starch,

colloidal anhydrous silicon,

magnesium stearate.

Pharmacological action

Pharmacodynamics

Reduces or completely inhibits the reabsorption of sodium ions and reduces the osmotic pressure of intracellular fluid and water reabsorption. Blocks aldosterone receptors in the myocardium, reduces fibrosis and improves diastolic function of the myocardium.

Pharmacokinetics

Suction

After oral use, torasemide is rapidly and almost completely absorbed from the gastrointestinal tract. Cmax of torasemide in plasma is reached 1-2 hours after oral use after a meal. Bioavailability is about 80% with minor individual variations.

Distribution

Binding to plasma proteins is more than 99%. The apparent Vd is 16 liters.

Metabolism and elimination

It is metabolized in the liver with the participation of cytochrome P450 isoenzymes. As a result of successive oxidation, hydroxylation, or ring hydroxylation reactions,3 metabolites (M1, M3, and M5) are formed, binding to plasma proteins is 86%,95%, and 97%, respectively. T1 / 2 of torasemide and its metabolites in healthy volunteers is 3-4 hours. Total clearance is 40 ml / min, 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%).

Pharmacokinetics in special clinical cases

In renal insufficiency, the T1/2 of torasemide does not change, the T1 / 2 of the M3 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, the T1 / 2 of torasemide and the M5 metabolite is 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 sensitivity of the myocardium to cardiac glycosides in hypokalemia and hypomagnesemia;
• when taken simultaneously with mineral and glucocorticoids, laxatives, potassium excretion may increase;
• increases the effect of antihypertensive agents;
• torasemide, especially in high doses, may enhance the nephro-and ototoxic effects of aminoglycoside antibiotics. the toxicity of cisplatin drugs, nephrotoxic effects of cephalosporins and cardio – and neurotoxic effects of lithium products;
• the torasemid may enhance the action of muscle relaxants currentarray and theophylline;
• the application of high doses of salicylates their toxic effects may be intensified;
• the torasemid can reduce the effectiveness of hypoglycemic (anti-diabetic) agents;
• sequential or simultaneous reception of torasemid with angiotensin-converting enzyme (ACE) may lead to a temporal drop in blood pressure. This can be avoided by reducing the initial dose of an ACE inhibitor or by reducing the dose of torasemide (or temporarily discontinuing it);
• nonsteroidal anti-inflammatory drugs and probenicide may reduce the diuretic and hypotensive effects of torasemide.
• colestyramine may reduce the absorption of torasemide from the gastrointestinal tract (according to a preclinical study in animals)

How to take, course of use and dosage

Diuver is taken orally, once a day, after meals. The therapeutic dose is 5 mg per day. If necessary, the dose is increased to 20 mg per day, and in some cases to 40 mg.

Elderly patients do not require special dose selection.

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

Tablets

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

Description

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

Indications

Liver Damage, Heart Failure, Hypertension