Torasemide-SZ pills 5mg 60pcs

Composition

Tablets

Active ingredient:

 torasemide 5 mg;

Auxiliary substances:

lactose monohydrate (lactopress) (milk sugar) – 89.3 mg;

pregelatinized starch (starch 1500) – 24.5 mg;

colloidal silicon dioxide (aerosil) — 0,6 mg;

magnesium stearate-0,6 mg

Pharmacological action

Torasemide-SZ is a loop diuretic.

The main mechanism of action is due to the reversible binding of torasemide to the sodium / chlorine / potassium 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 and reduces the osmotic pressure of intracellular fluid and water reabsorption.

Torasemide is less likely to cause hypokalemia than furosemide, but it is more active and has a longer duration of action.

The diuretic effect develops approximately within an hour after ingestion, reaching a maximum in 3-6 hours, and lasts from 8 to 10 hours.

Reduces systolic and diastolic blood pressure in the “lying” and “standing” positions.

Indications

Arterial hypertension, edematous syndrome of various origins, including chronic heart failure, liver, lung and kidney diseases.

Contraindications

• Hypersensitivity;
• are allergic to sulfonamides (sulfa antimicrobial agent or a sulfonylurea);
• renal failure with anuria;
• hepatic coma and precoma;
• refractory hypokalemia/refractory hyponatremia;
• hypovolemia (hypotension with or without it) or dehydration;
• pronounced violations of the outflow of urine of any etiology (including unilateral lesion of the urinary tract);
• glycoside intoxication;
• acute glomerulonephritis;
• decompensated aortic and mitral stenosis, hypertrophic obstructive cardiomyopathy;
• increase in Central venous pressure (over 10 mm Hg. St. )
• hyperuricemia;
• concurrent use of aminoglycosides and cephalosporins;
• lactose intolerance, lactase deficiency or glucose-galactose malabsorci;
• pregnancy;
• breastfeeding;
• the age of 18.

With caution:  hypotension, stenosing atherosclerosis of cerebral arteries, hypoproteinemia, predisposition to hyperuricemia, disturbance of the outflow of urine (benign prostatic hyperplasia, narrowing of the urethra or hydronephrosis), ventricular arrhythmia history, acute myocardial infarction (increased risk of developing cardiogenic shock), diarrhea, pancreatitis, diabetes mellitus (reduced tolerance to glucose), hepatorenal syndrome, gout, anemia; the simultaneous use of cardiac glycosides, corticosteroids and ACTH.

Side effects

Nervous system disorders: often — headache, dizziness, drowsiness; infrequently – muscle cramps of the lower extremities; frequency unknown-confusion, fainting, paresthesia in the extremities (numbness, crawling goosebumps and tingling).

From the side of the senses: frequency unknown-visual impairment, hearing impairment, tinnitus, and hearing loss (usually reversible) usually in patients with renal insufficiency or hypoproteinemia (nephrotic syndrome).

From the CCC side: infrequently-extrasystole, arrhythmia, tachycardia; frequency unknown-excessive decrease in AP, orthostatic hypotension, collapse, deep vein thrombosis, thromboembolism, BCC decrease.

Respiratory system disorders: infrequently-nosebleeds.

From the digestive system: often — diarrhea; infrequently-abdominal pain, flatulence, polydipsia; frequency unknown-dry mouth, nausea, vomiting, loss of appetite, pancreatitis, dyspeptic disorders, intrahepatic cholestasis.

Skin and subcutaneous tissue disorders: frequency unknown – pruritus, rash, urticaria, erythema multiforme, exfoliative dermatitis, purpura, vasculitis, photosensitization.

From the musculoskeletal system: frequency unknown-muscle weakness.

From the urinary system: often-increased frequency of urination, polyuria, nocturia; infrequently-frequent urge to urinate; frequency unknown-oliguria, urinary retention (in patients with urinary tract obstruction), interstitial nephritis, hematuria.

From the side of the reproductive system: frequency unknown-decreased potency.

From the side of metabolism: the frequency is unknown-hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, hypochloremia, metabolic alkalosis, hypovolemia, dehydration (more often in elderly patients).

From the side of laboratory parameters: rarely, hypercholesterolemia, hypertriglyceridemia; frequency unknown — hyperuricemia, a small increase in the activity of alkaline phosphatase in blood plasma, increasing the concentration of creatinine and urea in blood plasma, increasing the activity of some liver enzymes in the blood plasma (e. g. GGT), thrombocytopenia, leukopenia, agranulocytosis, hyperglycemia, reduced tolerance to glucose (a possible manifestation of latent diabetes mellitus flowing).

Other services: the frequency is unknown-aplastic or hemolytic anemia.

Interaction

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

Increases the effectiveness of diazoxide and theophylline, reduces-hypoglycemic agents, allopurinol.

Pressor amines and torasemide mutually reduce the effectiveness.

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

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).

Reduces the renal clearance of lithium preparations and increases the likelihood of intoxication.

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

Increases 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 doses of salicylates during torasemide therapy increases the risk of toxicity (due to competitive renal elimination).

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.

Concomitant use of probenecid or methotrexate may reduce the effectiveness of torasemide (same secretion pathway). On the other hand, torasemide may reduce the renal elimination of these drugs.

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 at high risk of developing nephropathy, taking torasemide orally, with the introduction of radiopaque agents, renal function disorders were observed more often than in patients at high risk of developing nephropathy, who underwent intravenous hydration before the introduction of radiopaque agents.

The bioavailability and, as a consequence, the effectiveness of torasemide may be reduced with co-therapy with colestyramine.

How to take, course of use and dosage

Inside,1 time a day, without chewing, with a sufficient amount of water, at any convenient constant time, regardless of food intake.

Edematous syndrome in CHF. The usual initial dose is 10-20 mg once a day. If necessary, the dose can be doubled until the desired effect is obtained.

Edematous syndrome in kidney diseases. The usual starting dose is 20 mg once a day. If necessary, the dose can be doubled until the desired effect is obtained.

Edematous syndrome in liver diseases. The usual starting dose is 5-10 mg once a day. If necessary, the dose can be doubled until the desired effect is obtained. The maximum single dose is 40 mg, it is not recommended to exceed it (there is no experience of using it). The drug is used for a long period or until the edema disappears.

Arterial hypertension.  The initial dose is 2.5 mg (1/2 table of 5 mg) once a day. In the absence of a therapeutic effect for 4 weeks, the dose is increased to 5 mg 1 time a day. If there is no adequate reduction in blood pressure when taking a dose of 5 mg 1 time a day for 4-6 weeks, the dose is increased to 10 mg 1 time a day. If the use of the drug at a dose of 10 mg / day does not give the desired effect, a hypotensive drug of another group is added to the treatment regimen.

Elderly patients do not need to adjust the dose.

Overdose

Symptoms:  increased diuresis, accompanied by a decrease in BCC and a violation of the water-electrolyte balance of the blood, followed by a pronounced decrease in blood pressure, drowsiness and confusion, collapse. Gastrointestinal disorders may occur.

Treatment: symptomatic. Induction of vomiting, gastric lavage, use of activated carbon; dose reduction or discontinuation of the drug and simultaneously replenishment of BCC and indicators of water-electrolyte balance and acid-base state under the control of serum electrolyte concentrations, hematocrit. There is no specific antidote. Hemodialysis is ineffective.

Special instructions

Use strictly as directed by your doctor.

Patients with hypersensitivity to sulfonamides and sulfonylurea derivatives may have cross-sensitivity to Torasemide-SZ.

Patients receiving high doses of Torasemide-SZ for a long period of time, in order to avoid the development of hyponatremia, metabolic alkalosis and hypokalemia, a diet with sufficient table salt and the use of potassium preparations is recommended.

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

If azotemia and oliguria appear or increase in patients with severe progressive kidney disease, it is recommended to suspend treatment.

Selection of the dose regimen for patients with ascites on the background of cirrhosis of the liver should be carried out in a hospital setting (violations of the water-electrolyte balance can lead to the development of hepatic coma). Regular monitoring of blood plasma electrolytes is indicated for this category of patients.

In patients with diabetes mellitus or with reduced glucose tolerance, periodic monitoring of blood and urine glucose concentrations is required.

In patients in an unconscious state, with prostatic hyperplasia, narrowing of the ureters, monitoring of diuresis is necessary due to the possibility of acute urinary retention.

Influence on the ability to drive motor vehicles and manage mechanisms. During treatment, patients should refrain from driving vehicles and engaging in other potentially dangerous activities that require increased concentration of attention and speed of psychomotor reactions (risk of dizziness and drowsiness).

Storage conditions

 In a dark place, 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

Hypertension, Heart Failure