Torasemide-SZ, tablets 5 mg 30 pcs

Heart failure, Hypertension (high blood pressure), Oedema

• Oedematous syndrome of various genesis, including chronic heart failure, liver, lung and kidney disease
• arterial hypertension.
  

Active ingredient

How to take, the dosage

The drug is taken orally once a day, at any convenient (but at the same time) time, regardless of meals. The tablets should be swallowed without chewing and with plenty of water.

Oedema syndrome in chronic heart failure

The recommended starting dose is 10-20 mg once daily. If necessary, the dose may be doubled until the desired effect is achieved.

Oedematous syndrome in renal disease

The recommended starting dose is 20 mg once daily. If necessary, the dose may be doubled until the desired effect is achieved.

Oedematous syndrome in liver disease

The recommended starting dose is 5-10 mg once daily. If necessary, the dose may be doubled until the desired effect is achieved.

It is not recommended to exceed the maximum single dose, which is 40 mg (no experience with use).

The drug is used over a long period or until the edema disappears.

Arterial hypertension

The starting dose is 2.5 mg (1/2 tablet of 5 mg) once daily. If there is no therapeutic effect within 4 weeks, the dose is increased to 5 mg once daily. If there is no adequate BP reduction when administered in a dose of 5 mg once daily for 4-6 weeks, the dose is increased to 10 mg once daily. If use of 10 mg/day does not produce the desired effect, an antihypertensive agent from another group should be added to the treatment.

In elderly patients, no dose adjustment is required.

Interaction

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

Effectiveness of diazoxide and theophylline increases, decreases effectiveness of hypoglycemic agents, allopurinol.

Presor amines and thorasemide mutually reduce the effectiveness of each other.

Drugs that block tubular secretion increase the serum concentration of thoracemide.

The simultaneous use of GCS, amphotericin B increases the risk of hypokalemia; with cardiac glycosides – the risk of glycoside intoxication due to hypokalemia (for high- and low-polar) and prolongation of T1/2 (for low-polar) increases.

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

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

It increases the antihypertensive effect of hypotensive drugs, neuromuscular blockade of depolarizing myorelaxants (suxamethonium) and weakens the effect of nondepolarizing myorelaxants (tubocurarine).

The simultaneous use of salicylates in high doses with torasemide therapy increases the risk of their toxicity (due to competitive renal excretion).

The sequential or simultaneous use of thorasemide with ACE inhibitors or angiotensin II receptor antagonists may lead to a significant decrease in BP. This can be avoided by reducing the dose of thorasemide or temporarily cancelling it.

The concomitant use of probenecid or methotrexate may decrease the efficacy of thorasemide (same secretion pathway). On the other hand, thorasemide may lead to decreased renal elimination of these drugs.

The simultaneous use of cyclosporine and thorasemide increases the risk of gouty arthritis due to the fact that cyclosporine may cause impaired urate excretion by the kidneys and thorasemide may cause hyperuricemia.

It has been reported that patients at high risk of nephropathy taking oral thoracemide were more likely to have impaired renal function when given radiopaque agents than patients at high risk of nephropathy who underwent IV hydration before radiopaque agent administration.

The bioavailability and, consequently, the effectiveness of thoracemide may be reduced when co-therapy with colestyramine.

Special Instructions

Use strictly as directed by the physician. 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, in order to avoid development of hyponatremia, metabolic alkalosis and hypokalemia, a diet with sufficient content of table salt and use of potassium preparations are recommended. Increased risk of water-electrolyte balance disorders is noted in patients with renal insufficiency.

In the course of treatment it is necessary to monitor periodically the concentration of plasma electrolytes (including sodium, calcium, potassium, magnesium), acid-base balance, residual nitrogen, creatinine, uric acid and if necessary to provide the 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 worsen in patients with severe progressive renal disease, it is recommended to suspend treatment.

The dosage regimen of patients with ascites against the background of liver cirrhosis should be chosen under hospital conditions (disorders of water-electrolyte balance may lead to 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 unconscious patients with prostatic hyperplasia, ureteral narrowing, diuresis control is necessary due to the possibility of acute urinary retention.

Impact on driving and operating machinery

Patients must refrain from driving and engaging in other potentially dangerous activities requiring increased concentration and rapid psychomotor reactions during treatment (risk of dizziness and somnolence).

Contraindications

Side effects

Senses: incidence unknown – visual impairment, hearing impairment, tinnitus and hearing loss (usually reversible) usually in patients with renal failure or hypoproteinemia (nephrotic syndrome).

Cardiovascular disorders: infrequent – extrasystole, arrhythmia, tachycardia; frequency unknown – excessive BP decrease, orthostatic hypotension, collapse, deep vein thrombosis, thromboembolism, decrease in BOD.

Nervous system disorders:often – headache, dizziness, somnolence; infrequently – cramps of the muscles of the lower extremities; frequency unknown – confusion, fainting, paresthesias in the extremities (feeling of numbness, “creeping shivers” and tingling).

In the respiratory system: infrequent – nasal bleeding.

From the digestive system: frequent – diarrhea; infrequent – abdominal pain, flatulence, polydipsia; frequency unknown – dry mouth, nausea, vomiting, loss of appetite, pancreatitis, dyspeptic disorders, intrahepatic cholestasis.

Urinary system disorders:often – increased frequency of urination, polyuria, nycturia; infrequent – frequent urge to urinate; frequency unknown – oliguria, urinary retention (in patients with urinary tract obstruction), interstitial nephritis, hematuria.

Concerning the reproductive system: incidence unknown – decreased potency.

Skin and subcutaneous tissue disorders: frequency unknown – skin itching, rash, urticaria, erythema polymorphic, exfoliative dermatitis, purpura, vasculitis, photosensitization.

Muscular system disorders: frequency unknown – muscle weakness.

Metabolism: incidence unknown – hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, hypochloremia, metabolic alkalosis, hypovolemia, dehydration (more often in elderly patients).

Laboratory parameters: infrequent – hypercholesterolemia, hypertriglyceridemia; infrequent unknown – hyperuricemia, slightly increased plasma ALP activity, increased plasma creatinine and urea concentrations, increased plasma activity of some liver enzymes (e.g., GGT), thrombocytopenia, leukopenia, agranulocytosis, hyperglycemia, decreased glucose tolerance (possible manifestation of latent diabetes).

Others: frequency unknown – aplastic or hemolytic anemia.

Overdose

Symptoms:Elevated diuresis accompanied by a decrease of the CIC and disturbed water-electrolyte balance of the blood, followed by an excessive decrease in BP, drowsiness and confusion, collapse. Gastrointestinal disorders may be observed.

Treatment:There is no specific antidote. Provocation of vomiting, gastric lavage, activated charcoal.

Symptomatic therapy, dose reduction or drug withdrawal and simultaneous replacement of the blood circulation and parameters of water-electrolyte balance and acid-base status under control of serum concentrations of electrolytes, hematocrit. Hemodialysis is ineffective.

Similarities