Trigrim, tablets 2.5mg 30 pcs

Pharmaceutical group: diuretic.

Pharmic action:The main mechanism of action of Trigrim is due to the reversible binding of torasemide to the Na+/2Cl-/K+ transporter located in the apical membrane of the thick segment of the ascending Genle loop, resulting in reduced or complete inhibition of sodium ion reabsorption, thereby reducing intracellular fluid osmotic pressure and water reabsorption.

With this due to anti-aldosterone action torasemide causes hypokalemia to a lesser extent than furosemide, with greater activity and duration of action.
Pharmacokinetics: After oral administration torasemide is quickly and almost completely absorbed in the gastrointestinal tract. Maximum concentration of torasemide in plasma is noted 1-2 hours after administration. Bioavailability is about 80-91% or more in edema.

The binding to plasma proteins is 99 %. The volume of distribution is 16 liters. It is metabolized in the liver in the cytochrome P450 system with the formation of 3 metabolites M1, M3 and M5. The elimination half-life of torasemide and its metabolites in healthy volunteers is 3-4 hours. Total clearance of thorasemide is 40 ml/min and renal clearance is about 10 ml/min. On average 80-83% of taken dose is excreted through renal tubules: unchanged (24-25%) and as metabolites (M1 – 11-12%, M3 – 3%, M5 – 41-44%). In renal insufficiency the half-life of thoracemide does not change.

Indications

Hypertension (high blood pressure), Edema, Liver damage, Heart failure- Edema caused by heart failure, liver, kidney and lung diseases.

– Primary arterial hypertension (used as monotherapy or in combination with other hypotensive drugs).

Active ingredient

Torasemide

Composition

1 tablet:

– Torasemide 2.5 mg, 5 mg or 10 mg.

Auxiliary substances:

Lactose,

Corn starch,

Colloidal silicon dioxide,

Magnesium stearate.

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How to take, the dosage

The drug is administered in adults, orally, regardless of meals.

In case of edema

The drug is prescribed in a dose of 5 mg once daily. If necessary, the dose may be gradually increased to 20 mg once daily. In individual cases it is recommended to use up to 40 mg/day.

In oedema associated with congestive heart failure

Prescribed in a dose of 5-20 mg once daily. If necessary, the daily dose may be gradually increased, doubling to a maximum of 200 mg.

In cases of edema associated with chronic renal failure

The starting dose is 20 mg/day. If necessary, this dose may be gradually increased, doubling it, until optimal diuretic action is achieved. The maximum daily dose is 200 mg.

In case of edema associated with cirrhosis

The drug is indicated in a dose of 5-10 mg once daily. If necessary, this dose may be gradually increased, doubling it, until an appropriate diuretic effect is achieved. There have been no appropriately controlled studies in patients with liver disease using doses greater than 40 mg/day.

In primary arterial hypertension

The dose is 2.5 mg once daily. If necessary, the dose may 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 BP. Maximum effect is achieved after about 12 weeks of continuous treatment.

Patients of advanced age do not require dose adjustment.

Interaction

Trigrim® increases myocardial sensitivity to cardiac glycosides in potassium or magnesium deficiency. When concomitant administration with mineral and glucocorticoids, laxatives may increase potassium excretion.

Trigrim® increases the effect of hypotensive drugs.

In high doses Trigrim® may increase the toxic effects of aminoglycosides, antibiotics, cisplatin; nephrotoxic effect of cephalosporins, and cardio- and neurotoxic effects of lithium.

Torasemide may increase the effects of curare-like myorelaxants and theophylline. When using salicylates in high doses, their toxic effects may increase, and the effect of antidiabetic agents, on the contrary, weakened. Consecutive or concomitant administration of thoracemide with ACE inhibitors may lead to a transient drop in BP. This can be avoided by reducing the starting dose of ACE, or by reducing the dose of thorasemide (or temporarily withdrawing it).

Torasemide reduces the effect of vasoconstrictors (epinephrine and norepinephrine). NSAIDs and probenecid may decrease the diuretic and hypotensive effect of torasemide. Colestiramine can reduce absorption of thoracemide from the gastrointestinal tract (in experimental studies in animals).

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Special Instructions

In long-term treatment it is recommended to monitor electrolyte balance, glucose, uric acid, creatinine and blood lipids. In case of hypokalemia, hyponatremia, hypovolemia or urinary disorders before prescribing Trigrim all these conditions should be eliminated.

In the presence of diabetes mellitus, carbohydrate metabolism should be controlled. In case of thrombocytopenia or inhibition of bone marrow function, as well as in case of skin rashes, the drug should be discontinued.

Pediatric use

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

Influence on driving and operating machinery

In the initial phase of use, it is not recommended to drive vehicles and operate machinery because of the possibility of dizziness.

Contraindications

– Anuria.

– Hepatic coma and precoma.

– Chronic renal failure with increasing azotemia.

– Arrhythmia.

– Arterial hypotension.

– Pregnancy.

– Lactation period (no data on use during lactation).

– Age under 18 years (effectiveness and safety not established).

– Hypersensitivity to thorasemide and sulfonamides.

With caution should use the drug in patients with:

– Diabetes mellitus.

– Gout.

– Disorders of the water-electrolyte balance.

– Disorders of liver function.

– Liver cirrhosis.

– Predisposition to hyperuricemia.

Side effects

Hematopoietic system:in some cases – decrease in the number of red and white blood cells and platelets.

From the metabolic system: in some cases – hypovolemia, disorders of electrolyte balance, hypokalemia, increased serum levels of uric acid, glucose and lipids.

Cardiovascular system disorders: in isolated cases – circulatory disorders and thromboembolism (due to dehydration), decreased BP.

Digestive system disorders: Symptoms of gastrointestinal dysfunction, loss of appetite, dry mouth; in some cases – increased activity of liver enzymes (including GGT), pancreatitis.

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

CNS and peripheral nervous system disorders:headache, dizziness, weakness, drowsiness, confusion, convulsions, paresthesias in the extremities.

Sensory organs: visual disturbances, tinnitus, deafness.

Allergic reactions: skin itching, rashes and photosensitization.

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Overdose

Symptoms: There is no typical picture of poisoning; in overdose there is increased diuresis accompanied by hypovolemia, electrolyte imbalance, followed by a drop in BP, somnolence, confusion, collapse, gastrointestinal disorders are possible.

treatment: conducting symptomatic therapy – dose reduction or drug withdrawal with simultaneous replenishment of fluid and electrolyte loss. A specific antidote is unknown.

Pregnancy use

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

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Similarities

Diuver, Trigrim, Torasemide-SZ, Lotonel, Torasemide