Torasemide: instructions for use. "Torasemid sandoz": price, description, reviews

"Torasemide" is a modern powerful diuretic that is excellent for long-term therapy of diseases associated with the appearance of edema. Due to the smaller number of clinically important side effects, the breadth of its therapeutic use is greater. It is safer than other loop diuretics and has more indications. In the treatment of various diseases, its dosage is modified. Also, it is applicable in the case of a deficiency in renal function, even at a low rate of filtration by the glomerulus of nephrons.

Effects of Torasemide

"Torasemide" as a representative of a group of loop (salt) diuretics acts in the luminal part of the epithelium of the nephron tubules at the site of the ascending loop of Henle. Having a retarding effect on the joint transport of potassium, chlorine and sodium ions, it significantly lowers the electrochemical potential on the surface of the epithelium of the nephron. The result of blockade of ion transport is a violation of the reverse absorption of sodium from the primary urine, which increases diuresis.

Virtually all loop diuretics cause electrolyte disturbances due to the strong effect on the reabsorption of potassium, sodium, magnesium and chlorine ions. "Torasemide" to a lesser extent affects the release of potassium and magnesium, because of what is much less likely to cause arrhythmias, anorexia, constipation, muscle weakness. Also, the drug to a small extent blocks the formation of thromboxane A2, expanding the vessels. It also blocks the receptors of myocardial aldosterone, inhibiting the processes of fibrosis of the heart muscle.

Indications

The instructions for use with the "Torasemide" preparation contain information on the diseases for which it is used. Torasemide is shown for:

• Pathogenetic treatment of arterial hypertension, resistant to therapy with combinations of ACE inhibitors (ARBs) with thiazide diuretics;
• Treatment of chronic heart failure, coupled with an overload of blood circulation circles;
• Symptomatic treatment of chronic kidney failure, including at a low filtration rate (less than 20 ml / min);
• Symptomatic treatment of hepatic (associated with hypoalbuminemia) edema as an alternative to Furosemide.

With arterial hypertension, "Torasemide", analogs and its generics are used only when thiazide diuretics are ineffective. And with renal insufficiency, the drug can be prescribed for a long time because of the small number of clinically important and dangerous side effects. Such a "Torasemide" is much less than that of "Furosemide".

Instructions for use

Based on the clinical recommendations for the preparation "Torasemide", the instructions for use contain the characteristics of the dosages of the drug required for the correction and treatment of the target disease. And the drug itself is produced in tablets with the following substance content: 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg, 100 mg, 200 mg.

The drug is taken on a tablet in the morning, regardless of food. For these dosages of the drug "Torasemide" the price is different: it is lower at the lowest dose and the highest at the maximum. According to the averaged data, 30 tablets of the drug at 5 mg cost about 400 rubles. In this case, the doses are distributed as follows according to the indications:

• In the treatment of hypertension is taken 2.5 - 10 mg / day;
• With chronic heart failure taken at 10-20 mg / day;
• With chronic renal failure - 50 and more mg;
• With insufficient liver requires an individual dose.

Side effects of Torasemide

The instructions for use with the "Torasemide" preparation contain information on multiple side effects. In a therapeutic dose, that is up to 200 mg per day, there is an increased risk of thromboembolic complications, ischemia of the heart, brain. Increased risk of transient ischemic attack and myocardial infarction, pulmonary embolism, arrhythmia. Also, there is a possibility of the appearance of allergic rashes or urticaria with a predisposition of the patient.

"Torasemide" sometimes causes nausea or vomiting, rarely mediates dyspepsia, diarrhea. Single cases of development of pancreatitis against the background of the application of "Torasemide" are described. Hepatic transaminases also increase, which indicates the hepatic toxicity of the drug in high doses. Sometimes patients are concerned about ringing in the ears, visual disturbances.

When taking in a toxic dose, an overdose develops with a small number of symptoms. Overdosage is accompanied by loss of fluid in the urine: diuresis is prolonged and frequent, hypotension, vascular collapse, fainting, and stroke on a background of cerebral ischemia are possible.

Contraindications and limitations of use

The drug "Torasemide", analogs and its generics can not be used in the presence of absolute contraindications. These are allergic reactions to the drug or binders. "Torasemide" is prohibited for use in renal failure with anuria, with hepatic insufficiency in the state of hepatic coma, with tachyarrhythmias. Contraindicated in lactation and pregnancy, as well as under the age of 18, hypersensitivity to sulfonamides.

Side effects of "Torasemide"

In the treatment of hypertension, Torasemide tablets can have a negative effect on the course of gout. Since the active substance enters the proximal tubules of the nephron by active transport, there is a competitive inhibition of uric acid excretion. Against the background of the use of "Torasemide", the probability of hyperuricemia and exacerbation of the gout current is great.

The medicinal preparation "Torasemide" is characterized by a specific effect on the tubular epithelium of the proximal portion of the Henle loop. Due to a strong diuretic effect and electrolyte imbalance, this causes the likelihood of clinically important pharmacological interactions. They are dangerous, insignificant and desirable. Among the dangerous and significant are:

• The use of high doses (from 50 mg / day) "Torasemide" when combined with platinum drugs increases the toxicity of the latter;
• Large doses of "Torasemide" (from 50 mg / day) increase the nephrotoxic and ototoxic effect of aminoglycoside antibiotics;
• In cephalosporin antibiotics, when combined with "Torasemide" at a dose of 50 mg / day, the property of nephrotoxicity appears;
• Salicylates along with "Torasemide" (from 50 mg / day) are characterized by neurotoxicity.
• "Torasemide" on the background of relative hypokalemia increases the susceptibility of the myocardium to cardiac glycosides, increasing their inotropic and antiarrhythmic effect, increasing the risk of intoxication;
• The risk of hypokalemia increases with the combined use of "Torasemide" with corticosteroids or salt laxatives;
• "Torasemide" enhances the effect of "Theophylline" and curare-like muscle relaxants.

Desired effects of joint application

Of the desired effects requiring control, there remains a reduction in blood pressure in the background of therapy with ACE inhibitors. "Torasemide" by removing the fluid reduces the hydrostatic pressure of blood, mediating the drop in blood pressure. This aspect is important in the treatment of hypertension and requires dose adjustment of the ACE inhibitor. Moreover, in the treatment of hypertensive drugs resistant to therapy, the combination of ACE inhibitors and Torasemide allows achieving normalization of BP in 90% of patients.

In the treatment of chronic heart failure, the effect of reducing the vasoconstrictive activity of catecholamines is clinically important. The heart against the background of diuretic therapy "Torasemide" weakly responds to stimulating signals of adrenaline and noradrenaline. However, the same effect reduces the effectiveness of epinephrine and norepinephrine during resuscitation.

Negative effects of interaction

There are effects of inhibiting the effectiveness of drugs when combined with certain substances. In particular:

• Preparations of the group of bile acid sequestrants reduce the capture of "Torasemide" from the intestine, weakening the effect of the latter;
• Non-narcotic analgesics (NSAIDs) reduce the effectiveness of Torasemide;
• "Probenecid" due to the intensification of uricosuric processes inhibits the isolation of "Torasemide" in the lumen of the tubules, reducing its effectiveness.

Comparative characteristics of "Torasemide"

In the preparation "Torasemide" analogs can be class, kinetic and generic. Among the class analogues are represented: "Furosemide", "Bumetanid", "Etakrinaic acid". In comparison with "Furosemide", "Torasemide" is characterized by a slow onset of action and a longer lasting effect with a correlated increase in diuresis. Having a diuretic effect of almost the same strength as Furosemide, Torasemide has fewer side effects associated with rapid electrolyte imbalance.

"Bumetanide" is characterized by an even stronger diuretic property, which is associated with a large number of side effects. Ectric acid has a lower rate of onset of the diuretic effect and remains a rarely used drug. In the pharmacokinetics of the preparation "Torasemide", experts' reviews highlight another important point. The drug has no "ricochet" property: after strengthening diuresis due to the elimination of sodium, there is no compensatory delay in the body.

Pharmacokinetic analogues of "Torasemide"

The "Torasemide" preparation contains information on its use in arterial hypertension. Along with this drug, thiazide and potassium-sparing diuretics are also used to treat hypertension. And thiazide because of the slowly advancing and prolonged diuretic effect are the drugs of choice.

In connection with these pharmacokinetic characteristics of analogues, for the preparation "Torasemide" the application can be the following: treatment of hypertension resistant to therapy with standard combinations of ACE inhibitors (or angiotensin receptor blockers) with thiazides. Also, "Torasemide" is used in the treatment of chronic kidney failure with reduced filtration capacity.

Generics "Torasemide"

In the preparation "Torasemide" instructions for use, analogs, indications and contraindications entirely characterize its main effect - increased diuresis. And this action has the original drug and its generics. The latter contain the same amount of "Torasemide", but are produced under other trade names.

The most famous are: Britomar, Diver, Torasemid Sandoz, Trifas, Torsid, Trigrim. During numerous tests of pharmacological drugs in Russia, no significant differences between them were noted. Each of the above drugs fully replaces another one.

The economic aspects of Torasemide treatment

When treating arterial hypertension, when thiazide diuretics are ineffective in combination with ACE inhibitors (or with ARBs), treatment with "Torasemide" can be prescribed: the instructions for use justify a single dose during the day. The monthly cost of treatment is about 400 rubles at a price of 60 tablets of the drug about 760-800 rubles. For comparison: the monthly price of Furosemide treatment rarely exceeds 20 rubles. But for the constant treatment of hypertension the latter is of little use.

In chronic heart failure with edema on both circles of circulation, the cost of a month's treatment of Furosemide is about 20-30 rubles. The drug "Torasemide" price is 10-15 times more. At the same time, the latter has a mild effect, that is, it does not significantly increase the urination in the first hours of admission. In Furosemide, the characteristics are reversed: it significantly increases the amount of urine in the first two hours with a gradual weakening of diuresis.

As a result, it is reasonable to apply "Torasemide" to able-bodied patients with hypertension or with chronic kidney or circulatory failure, the instruction (the price is indicated above) for the use of which does not contain information on significant diuresis intensification at the first time of admission. However, in patients of retirement age, in connection with the lack of the need to come to work, the speed of diuresis is almost unimportant. This does not create difficulties, and therefore allows us to accept a cheap class analogue - Furosemide.