Trigrim, pills 5mg, 30pcs

Composition

Auxiliary substances:

lactose,

corn starch,

colloidal silicon dioxide,

magnesium stearate.

Pharmacological action

A diuretic drug. The main mechanism of action is due to the reversible binding of torasemide to the Na+/2Cl-/K+ countertransporter located in the apical membrane of the thick segment of the ascending Henle loop, which reduces or completely inhibits the reabsorption of sodium ions, which leads to a decrease in the osmotic pressure of intracellular fluid and water reabsorption.

At the same time, due to the antialdosterone effect, torasemide causes hypokalemia to a lesser extent than furosemide, with greater activity and duration of action.

Pharmacokinetics

Suction

After oral use, torasemide is rapidly and almost completely absorbed from the gastrointestinal tract. _cmax of torasemide in plasma is noted 1-2 hours after use. Bioavailability is about 80-91% or more for edema.

Food intake does not affect the absorption of the drug.

Distribution

Binding to plasma proteins is 99%. V_d – 16 l.

Metabolism

It is metabolized in the liver with the participation of cytochrome P450 isoenzymes with the formation of 3 metabolites M1, M3 and M5.

The elimination

of T_1/2 torasemide and its metabolites in healthy volunteers is 3-4 hours. The total clearance of torasemide is 40 ml / min and the renal clearance is about 10 ml/min. On average,80-83% of the dose taken is excreted by the kidneys by tubular secretion in unchanged form (24-25%) and in the form of metabolites (M1-11-12%, M3-3%, M5-41-44%).

Pharmacokinetics in special clinical cases

In renal failure, T_1/2 of torasemide does not change.

Indications

• Edema caused by heart failure, liver, kidney, and lung diseases.
• Primary arterial hypertension (used as monotherapy or in combination with other antihypertensive drugs).

Use during pregnancy and lactation

The drug Trigrim is contraindicated during pregnancy, lactation, and under the age of 18 years (efficacy and safety have not been established).

Contraindications

• Anuria.
• Hepatic coma and precomatous state.
• Chronic renal failure with increasing azotemia.
• Arrhythmia.
• Arterial hypotension.
• Pregnancy.
• Lactation period (no data on use during lactation).
• Age up to 18 years (efficacy and safety have not been established).
• Hypersensitivity to torasemide and sulfonamides.

The drug should be used with caution in patients with:

• Diabetes mellitus.
• Gout.
• Violations of the water-electrolyte balance.
• Impaired liver function.
• Cirrhosis of the liver.
• Predisposition to hyperuricemia.

Side effects

From the hematopoietic system: in some cases – a decrease in the number of red blood cells and white blood cells, as well as platelets.

From the side of metabolism: in some cases – hypovolemia, electrolyte imbalance, hypokalemia, increased serum uric acid, glucose and lipids.

From the cardiovascular system: in some cases-circulatory disorders and thromboembolism (due to dehydration), a decrease in blood pressure.

From the digestive system: symptoms of impaired gastrointestinal function, loss of appetite, dry mouth; in some cases – increased activity of liver enzymes (including GGT), pancreatitis.

From the urinary system: acute urinary retention, increased levels of urea and creatinine in plasma.

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

Sensory disorders: visual disturbances, tinnitus, deafness.

Allergic reactions: skin pruritus, rashes and photosensitization.

Interaction

Trigrim ® increases the sensitivity of the myocardium to cardiac glycosides in cases of potassium or magnesium deficiency.

When taken simultaneously with mineral – and glucocorticoids, laxatives, it is possible to increase the excretion of potassium.

Trigrim® enhances the effect of antihypertensive drugs.

In high doses, Trigrim® can enhance the toxic effect of aminoglycosides, antibiotics, cisplatin; the nephrotoxic effect of cephalosporins, as well as the cardio – and neurotoxic effect of lithium.

Torasemide may enhance the effects of curare-like muscle relaxants and theophylline.

When using salicylates in high doses, their toxic effect may increase, and the effect of antidiabetic agents, on the contrary, is weakened.

Sequential or simultaneous use of torasemide with ACE inhibitors can lead to a transient drop in blood pressure. This can be avoided by reducing the initial dose of ACE inhibitors, or by reducing the dose of torasemide (or temporarily stopping it).

Torasemide reduces the effect of vasoconstrictors (epinephrine and norepinephrine).

NSAIDs and probenecid may reduce the diuretic and hypotensive effects of torasemide.

Colestyramine is able to reduce the absorption of torasemide from the gastrointestinal tract (in experimental animal studies).

How to take, course of use and dosage

The drug is prescribed for adults, inside, regardless of food intake.

For edema

The drug is prescribed at a dose of 5 mg 1 time/day. If necessary, the dose can be gradually increased to 20 mg 1 time/day. In some cases, it is recommended to use up to 40 mg / day.

For edema associated with congestive heart failure

Assign a dose of 5-20 mg 1 time/day. If necessary, the daily dose can be gradually increased, doubling it, up to a maximum of 200 mg.

For edema associated with chronic renal failure

The initial dose is 20 mg / day. If necessary, this dose can be gradually increased, doubling it, until the optimal diuretic effect is achieved. The maximum daily dose is 200 mg.

For edema associated with cirrhosis of the liver

The drug is prescribed at a dose of 5-10 mg 1 time/day. If necessary, this dose can be gradually increased, doubling it, until the appropriate diuretic effect is achieved. No appropriately controlled studies have been conducted in patients with liver disease using doses greater than 40 mg/day.

In primary arterial hypertension

The dose is 2.5 mg 1 time/day. If necessary, the dose can be gradually increased to 5 mg / day. According to studies, a dose of more than 5 mg / day does not lead to a further decrease in blood pressure. The maximum effect is achieved after approximately 12 weeks of continuous treatment.

Elderly patients do not require dose adjustment.

Overdose

• Symptoms: there is no typical picture of poisoning; in case of overdose, increased diuresis is observed, accompanied by hypovolemia, electrolyte imbalance, followed by a drop in blood pressure, drowsiness, confusion, collapse, gastrointestinal disorders are possible.
• Treatment: conducting symptomatic therapy – reducing the dose or discontinuing the drug while simultaneously replenishing the loss of fluid and electrolytes. The specific antidote is unknown.

Special instructions

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

In case of hypokalemia, hyponatremia, hypovolemia or urination disorders, all these conditions are eliminated before Trigrim is prescribed.

In the presence of diabetes mellitus, it is necessary to control carbohydrate metabolism.

In case of thrombocytopenia or bone marrow suppression, as well as skin rashes, the drug should be discontinued.

Use in pediatrics

There are no data on the use of Trigrim in children.

Influence on the ability to drive motor vehicles and manage mechanisms

At the initial stage of admission, it is not recommended to drive vehicles and maintain mechanisms due to the possibility of dizziness.

Form of production

Trigrim tablets.

Storage conditions

Store in a dry place, protected from light, at a temperature not exceeding 25 °C

Shelf life

3 years

Active ingredient

Torasemide

Conditions of release from pharmacies

By prescription

Dosage form

Tablets

Purpose

For adults as directed by your doctor

Indications

Liver Damage, Hypertension, Heart failure