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Original torasemide. Dosage and method of administration

KNF (medicine included in the Kazakhstan National Formulary of Medicines)

ALO (Included in the List of free outpatient drug provision)

Manufacturer: Hetero Labs Limited

Anatomical-therapeutic-chemical classification: Torasemide

Registration number: No. RK-LS-5No. 122128

Registration date: 06.04.2016 - 06.04.2021

Limit price: 34.18 KZT

Instructions

Russian

Tradename

Toras emid

International nonproprietary name

Toras emid

Dosage form

Tablets 5 mg, 10 mg and 20 mg

Compound

One tablet contains

Description

For 5 mg dosage: Tablets are oval in shape, white or almost white, with a break line, engraved “56” on one side of the line and “H” on the other side.

For 10 mg dosage: Tablets are oval in shape, white or almost white, with a break line, engraved “57” on one side of the line and “H” on the other side.

For 20 mg dosage: Tablets are oval in shape, white or almost white, with a break line, engraved “59” on one side of the line and “H” on the other side.

Pharmacotherapeutic group

Diuretics. "Loop" diuretics. Sulfonamide diuretics. Torsemide.

ATX code C03CA04

Pharmacological properties

Pharmacokinetics

After oral administration, torasemide is rapidly and almost completely absorbed. The maximum concentration in plasma is reached an hour after administration. The area under the concentration-time curve increases proportionally with doses ranging from 2.5 mg to 200 mg. Concomitant use with food reduces C max for 30 minutes, but the overall bioavailability and diuretic activity does not change. More than 99% of torasemide is bound to plasma proteins. The volume of distribution of torsemide ranges from 12-15 liters for patients with mild to moderate renal failure or congestive heart failure. In patients with liver cirrhosis, the volume of distribution doubles. Torsemide is biotransformed by stepwise oxidation, hydroxylation and ring hydroxylation to form three metabolites: M1, M3 and M5. The half-life of torasemide and its metabolites in healthy individuals is 3 to 4 hours. The total clearance of torasemide is 40 ml/min, and the renal clearance is approximately 10 ml/min. Approximately 80% of the administered dose is excreted through the renal tubules unchanged: torasemide 24%, in the form of metabolites M1 - 12%, M3 - 3%, M5 - 41%. For renal failureThe half-life of torasemide does not change.

Pharmacodynamics

T orasemide acts on the inner surface of the thick segment of the ascending limb of the loop of Henle, where it inhibits the Na transport system+ /K + /2Cl - , as a result of which the renal reabsorption of sodium and chloride ions in the ascending part of the loop of Henle decreases, the osmotic pressure of the intracellular fluid and the reabsorption of water decreases. The action of Torsemide as an antihypertensive drug is due to its diuretic actions. Due to a decrease in extracellular and plasma fluid volume, blood pressure temporarily decreases, and systolic blood volume also decreases.

Indications for use

Edema syndrome of various origins, incl. for chronic heart failure, liver and kidney diseases

Arterial hypertension

Directions for use and doses

Orally, once a day, after breakfast, without chewing, with a small amount of water.

Elderly patients do not require special dosage selection.

Edema syndrome in chronic heart failure

The usual therapeutic dose is 10-20 mg orally once daily. If necessary, the dose should be gradually increased approximately 2 times until the desired effect is obtained.

Edema syndrome in kidney disease (cirrhosis of the liver)

The usual therapeutic dose is 20 mg orally once daily together with an aldosterone antagonist or other potassium-sparing diuretic. If necessary, the dose should be gradually doubled until the desired effect is obtained.

Edema syndrome in liver disease

The usual therapeutic dose is 5-10 mg orally once daily. 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 use).

Long-term use of any diuretic for liver disease has not been studied in adequate and well-controlled studies.

Arterial hypertension . The starting dose is 5 mg once daily. If there is no adequate reduction in blood pressure when taking the drug at a dose of 5 mg once a day for 4-6 weeks, the dose is increased to 10 mg once a day. If a dose of 10 mg does not give the required result, an antihypertensive drug of another group must be added to the treatment regimen.

Side effects

Fluid and electrolyte imbalances (hypovolemia, hypokalemia, hyponatremia)

Hypokalemia (especially with a low-potassium diet or with vomiting, diarrhea or laxative drug abuse, or liver failure)

Headache, dizziness, weakness, drowsiness, confusion

Arterial hypotension

Loss of appetite

Convulsions

Increased levels of uric acid, glucose and lipids in plasma

Metabolic alkalosis

Increased activity of certain liver enzymes, including γ-glutamyl transpeptidase (γ-GGTP)

Retention of urine outflow in patients with narrowing of the urinary tract,

Increased plasma urea and creatinine levels

Rarely< 1/10 000

Paresthesia of the limbs

Dry mouth

Thromboembolic complications, circulatory disorders associated with blood thickening

In isolated cases

- allergic reactions: skin itching, rash, angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis

Photosensitivity

Visual impairment, tinnitus and hearing loss

Erythropenia, leukopenia and thrombocytopenia

Pancreatitis

Dyspepsia, bleeding from the esophagus

According to clinical studies

Nausea, vomiting, rhinitis, increased cough, sore throat, asthenia, insomnia, nervousness, excessive urination, thirst, impotence, constipation, ECG changes, chest pain, atrial fibrillation, ventricular tachycardia, digitalis intoxication, diarrhea, gastrointestinal bleeding, including rectal bleeding, shunt thrombosis, syncope, arthritis, myalgia

Contraindications

Hypersensitivity to torasemide or auxiliary components of the drug and other sulfonylurea derivatives

Renal failure accompanied by anuria

Hepatic coma , precomatose state

Arterial hypotension, cardiac arrhythmias

Pregnancy and lactation period

Concomitant use of aminoglycosides or cephalosporins or renal failure after the use of other drugs that cause kidney damage

Children and adolescents under 18 years of age (safety and effectiveness of treatment in children have not been studied)

Hereditary galactose intolerance, lactase deficiency or glucose-galactose malabsorption

Drug interactions

When used simultaneously with cardiac glycosides, potassium and/or magnesium deficiency may increase the sensitivity of the myocardium to these drugs. Potentiation of the kaliuretic effect of mineral and glucocorticosteroids, as well as laxatives, may occur.

Torsemide, especially in high doses, can enhance the toxic effect of aminoglycosides, platinum drugs, the nephrotoxic effect of cephalosporins, as well as the cardio- and neurotoxic effects of lithium, curare-like muscle relaxants and theophylline. In patients taking high doses of salicylates, torasemide may increase their toxicity. Torsemide may reduce the effect of hypoglycemic drugs.

Torsemide enhances the effect of other antihypertensive drugs, in particular inhibitors ACE, which can cause excessivedecrease in blood pressure. This effect can be minimized by reducing the initial dose of the ACE inhibitor and/or reducing the dose or temporarily discontinuing Torsemide. The drug may reduce the sensitivity of arteries to pressor factors, such as adrenaline and norepinephrine. Nonsteroidal anti-inflammatory drugs (for example, indomethacin) and probenecid may weaken the diuretic and hypotensive effects of Torsemide. It is assumed that when combined with cholestyramine, there is a decrease in the absorption of orally administered torasemide.

special instructions

Liver disease with cirrhosis and ascites. Torsemide should be used with caution in patients with liver disease with cirrhosis and ascites, as sudden changes in fluid and electrolyte balance may precipitate hepatic coma. For such patients, diuresis with torasemide (or any other diuretic drug) is best started in the hospital. To prevent hypokalemia and metabolic alkalosis, an aldosterone antagonist or potassium-sparing drugs should be used simultaneously with torsemide.

Ototoxicity. Tinnitus and hearing loss (usually reversible) have been observed following rapid intravenous administration of other loop diuretics and have also been observed following oral torsemide. It is not clear whether these events are related to torsemide. Ototoxicity has also been observed in animal studies when very high plasma levels of torasemide are achieved.

Volume and electrolyte depletion

Patients receiving diuretics should be monitored for clinical signs of electrolyte imbalance, hypovolemia, or prerenal azotemia. Symptoms of these disorders may include one or more of the following: dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pain or cramps, muscle fatigue, hypotension, oliguria, tachycardia, nausea and vomiting. Excessive mechanical separation of bone or soft tissue can cause dehydration, decreased circulating blood volume, and possibly thrombosis and embolism, especially in elderly patients. In patients who develop fluid and electrolyte imbalances, hypovolemia, or prerenal azotemia, observed laboratory changes may include hyper- or hyponatremia, hyper- or hypochloremia, hyper- or hypokalemia, acid-base disturbances, and increased blood urea nitrogen. If these disturbances occur, torsemide should be discontinued until normal electrolyte values are restored; Torsemide may be resumed at a lower dose. In controlled studies conducted in the United States, torasemide was administered to patients with hypertension at doses of 5 mg or 10 mg per day. After 6 weeks at these doses, the mean decrease in serum potassium was approximately 0.1 mEq/L. The percentage of patients whose serum potassium level was below 3.5 mEq/L at any time during the studies was essentially the same in patients receiving torasemide (1.5%) and in patients receiving placebo (3%). In patients with 1-year follow-up, no further changes in mean serum potassium levels were observed. In patients with congestive heart failure, liver cirrhosis, or renal disease treated with torasemide at doses higher than those studied in the United States for the treatment of hypertension, hypokalemia was observed with a greater frequency in a dose-dependent manner. In patients with cardiovascular disease, especially those receiving digitalis glycoside, diuretic-induced hypokalemia may be a risk factor for the development of arrhythmias.

Before starting treatment, hypokalemia, hyponatremia and urinary disorders should be compensated. During long-term treatment with Torsemide, regular monitoring of the levels of electrolytes, glucose, uric acid, creatinine and blood lipids is recommended.

The drug should be used with caution in patients with cardiac arrhythmias, elderly patients with severe atherosclerosis, and during long-term therapy with cardiac glycosides.

For patients with prostatic hypertrophy and urinary disorders, the drug should be prescribed with caution, since intense urination can lead to urinary retention and bladder distension.

Application in pediatrics. There is no sufficient clinical data on the safety of torasemide in children.

Peculiaritiesthe effect of the drug on the ability to drive a vehicle or potentially dangerous mechanisms

The drug should not be used while driving a vehicle or other potentially dangerous mechanisms that require rapid psychomotor reactions and increased concentration.

Overdose

Symptoms: polyuria, hypovolemia and decreased electrolyte levels, which can lead to drowsiness and confusion, hypotension and cardiovascular collapse. Gastrointestinal disorders may occur.

Treatment: discontinuation of the drug while replenishing fluids and electrolytes. There is no specific antidote.

Release form and packaging

10 tablets are placed in a blister pack made of transparent polyvinyl chloride film and printed aluminum foil.

1,6 or 10 contour packages together with instructions for medical use in the state and Russian languages are placed in a cardboard pack.

Storage conditions

Store in a dry place, protected from light, at a temperature not exceeding 25 ºС.

Keep out of the reach of children!

Shelf life

2 years

Do not use after the expiration date

Conditions for dispensing from pharmacies

On prescription

Manufacturer

Hetero Labs Limited, India

Registration Certificate Holder

ABMG Expert LLP, Kazakhstan

Organization - drug packager

Hetero Labs Limited, India

Address of the organization that accepts claims from consumers regarding the quality of products (products) on the territory of the Republic of Kazakhstan

ABMG Expert LLP, Almaty, st. Gogol, 86 t.2508-445

Torsemide is a diuretic, a diuretic drug. It is used in the treatment of pathologies of the kidneys, liver, lungs, and edema. Also used in the treatment of cardiovascular diseases. The use of Torasemide is very common - as a means of weight loss.

Can one drug be used in such different areas of medicine? Is this remedy effective in treating diseases and losing weight? In order to answer these questions, it is necessary to become more familiar with the action of Torasemide.

Torsemide is included in the list of diuretic drugs. INN (International Nonproprietary Name) is similar - Torasemide. According to the Vidal drug reference book, the drug has the International name Rec.INN. A unique remedy used in cardiology, dietetics and for pathologies of the kidneys, liver, and lungs.

Compound

The drug is based on the substance of the same name, torasemide. The tablets are film-coated. Auxiliary components:

colloidal silicon dioxide;
mannitol;
magnesium stearate;
cellulose;
corn starch;
sodium croscarmellose.

Pharmacodynamics and pharmacokinetics,

It has a diuretic effect, the maximum therapeutic effect is observed 2-3 hours after oral administration. The basis of the mechanism of action of the drug is due to the reversible binding of the potassium/sodium/chloride ion contransporter and torsemide.

Due to this, the absorption of ions is partially reduced or completely inhibited, thereby reducing the osmotic pressure of the fluid inside the cells and the reabsorption of water. Secondary urine is formed, potassium/sodium/chlorine ions are not absorbed back, therefore, a large volume of liquid is not absorbed, which is then excreted from the body.

Torsemide has a beneficial effect on the functioning of the heart muscle. The drug helps block myocardial receptors and improve its diastolic function, reduce fibrosis, and activate the relaxation phase. Allows you to reduce the level of potassium concentration in the blood plasma and reduce high blood pressure.

After oral administration, it is quickly and almost completely absorbed into the gastrointestinal tract. The absorption of the active substances of Torasemide does not depend on food intake, so it is allowed to take tablets both during and after meals.

It is not recommended to take the medicine on an empty stomach before meals.

The diuretic effect lasts for 18 hours. This makes it easier to tolerate the effect of the drug, as well as reduce the frequency of urination, especially in the first hours after taking Torasemide.

Forms of release and prices, average for Russia

Available in the form of tablets containing 5 and 10 mg of the main active ingredient. Prices vary depending on the manufacturer and dosage. The drug is dispensed from pharmacies with a doctor's prescription. The approximate cost (on average for Russia) is presented in the table (Table 1).

Table 1 - Cost of Torasemide

Release form	Dosage, mg	Number of tablets per package, pcs.	Average price in Russia, rub.
Canon	5	20	185
Canon	10	20	230
Canon	5	60	450
NW	5	30	195
NW	10	30	210
NW	5	60	240
NW	10	60	325

Indications and contraindications

Indications for use:

edema, which manifests itself in chronic heart failure, renal and hepatic pathologies, and lung diseases;
arterial hypertension.

Torasemide has a fairly extensive list of contraindications:

There are also age restrictions - Torsemide is not recommended for use in patients under 18 years of age.

Prescribed with caution for the following disorders and diseases:

pancreatitis;
diarrhea;
diabetes;
anemia;
gout;
hypotension;
atherosclerosis;
benign prostatic hyperplasia;
acute form of myocardial infarction.

Instructions for use of Torasemide

Torsemide is suitable for constant, long-term use. This is its main difference from similar drugs, in particular from its main competitor, Furosemide.

Taking 5 and 10 mg tablets

The recommended starting dose is a 5 mg tablet, which should be taken in the morning with plenty of liquid. If the drug is well tolerated by the patient or if the therapeutic effect is insufficient, the dose can be increased to a 10 mg tablet, which should be taken once a day. Do not bite or chew the tablet. It is recommended to drink Torasemide at the same time every day.

For some pathologies, the doctor may prescribe a dose higher or lower than the optimal one:

It is important to note that increasing the starting dose is prohibited for elderly patients.

Rules for safe therapy

When prescribing Torasemide therapy, the patient must follow a number of rules and recommendations, as well as become familiar with the special conditions for taking the tablets:

The main instruction is to refrain from self-medication! Taking Torasemide is allowed only as prescribed by a doctor.

Possible adverse reactions

Possible adverse reactions:

If the drug is taken incorrectly, if the dosage is not observed, a side effect in the form of problems with urination is possible. Moreover, they can be expressed in different ways - either frequent or, conversely, difficult urination.

There are frequent cases of overdose of Torasemide. Symptoms:

forced diuresis;
confusion;
hypotension;
collapse;
disturbances in the gastrointestinal tract;
drowsiness;
general weakness.

Diuresis is especially dangerous; there is a high probability of losing a large amount of fluid. There is no specific antidote for an overdose of Torasemide. If symptoms of an increased dose of the drug occur in the body, you must immediately stop taking Torasemide and seek medical help.

The specialist will probably adjust the dosage or completely discontinue this drug, replacing it with another diuretic. It is also necessary to take measures related to the restoration of water and electrolyte balance.

Use for weight loss

Among nutritionists and those who want to get rid of excess weight, the effectiveness of using diuretics in losing weight is actively discussed. With the help of diuretics, you can stimulate the removal of excess water from the body, thereby relieving a person of extra pounds.

Negative effects and dosage

However, doctors are very disapproving of this method of losing weight. Of course, after removing the fluid, the weight will decrease. However, this effect is short-lived. As soon as you fill your stomach with a new portion of tea or juice, all the lost weight will return.

In addition, according to doctors, losing weight by taking diuretics is dangerous to health.

Moreover, many women, in pursuit of a slim figure, independently increase the dose of medications. Instead of the allowed one tablet per day, women losing weight take 3-4 pieces. Such weight loss is fraught with severe overdose.

What consequences can await a person who decides to lose weight with the help of diuretics:

Disruption of the normal functioning of the body. The body gets used to the active action of the diuretic and is not able to cope with its tasks on its own. The kidneys begin to work poorly, fluid is not removed from the body on time, and edema forms.
Long-term use of diuretics disrupts the water-electrolyte balance and leads to dehydration.
Against the background of dehydration, the body becomes dehydrated, a person develops tachycardia, hypotension, confusion, dizziness, loss of consciousness, and inadequate perception of reality.
The most dangerous consequence of losing weight with the help of diuretics is hypovolemic shock.

Despite the dangers of this method of losing weight, it is very popular among those who want to have a slim figure. Torasemide is recognized as the safest in this case. According to reviews, it has a milder effect and fewer adverse reactions.

Also, the body tolerates drug withdrawal more easily, unlike similar drugs, after stopping which swelling occurs. For the safest weight loss, it is recommended to take no more than one tablet per day.

It is important to remember that losing weight with diuretics is a questionable method that can lead to dangerous consequences. To lose weight, it is recommended to exercise and eat properly.

Reviews about losing weight with Torasemide

Is Torasemide effective if you need to get rid of extra pounds? It is recommended to read several real reviews from those who have tried the effects of the drug on themselves:

Elena, 25 years old, Ufa:“Before the wedding, I gained a couple of extra pounds. When I tried on the dress again, I realized that I couldn’t fit into it. I had to look for ways to quickly lose weight. I started reading advice on forums, where I saw a comment from a girl who wrote about Torasemid.

I bought pills and took one every morning for a week. At the same time, she controlled nutrition and fluid intake. In the end, we managed to achieve the desired weight. Of course, I understand that this method of weight loss is not correct. But in my emergency situation there was no choice.”

Evgeniya, 23 years old, Krasnodar:“Like any girl, I strive for an ideal appearance. I want to show off beautiful photos on social networks. I decided to improve my weight with the help of Torasemide. I started with one tablet a day, then began to take more and more.

It turned into a kind of mania, I could no longer stop. Of course, with regular urination, I began to lose a lot of fluid, and as a result, a long-awaited weight loss occurred. But gradually my health began to deteriorate.

My mother took me to the doctor, who diagnosed me as dehydrated. I heard from a specialist what could await me next. The dangerous consequences scared me, and I realized that using diuretic pills is not worth losing weight. At the moment I am restoring my health, then I will sign up for a fitness center. I will use sports to get myself in shape.”

Torasemide tablets should not be taken for other purposes. With the help of the drug, of course, you can lose a few kilograms, but the effect of such weight loss will be short-lived, and the consequences are irreversible and very dangerous.

Similar drugs

Doctors assure that Torasemide is one of the most effective diuretics, the effectiveness of which does not decrease even after long-term use. And yet there are a number of drugs with similar effects that deserve attention.

Structural

Among the generics of the drug are:

Means with similar effects

Among non-structural analogues we can highlight:

– is a natriuretic agent with the substance of the same name as an active ingredient. Indications for use:

– a diuretic with the active ingredient furosemide. Prescribed for edema of the brain, lungs, edema of various origins, hypertension, diuresis. Contraindicated in cases of water-salt imbalance, severe pathologies of the liver and kidneys, hepatic coma.

In a minimum dose, it can be prescribed to pregnant and lactating women. During Lasix therapy, it is recommended to gradually increase the dose, starting from 20 mg per day. The maximum daily dose should not exceed 80 mg. The price of the medicine is on average 55 rubles for 45 pieces (40 mg).

– refers to diuretic and antihypertensive drugs based on the substance of the same name – indapamide. It is used in the treatment of hypertension and fluid retention in the body against the background of chronic heart failure.

It is prohibited for use in cases of severe cerebrovascular accidents, kidney pathologies, liver diseases, diabetes mellitus, gout, pregnancy, breastfeeding, hypersensitivity to the composition of Indapamide. Prescribed as a tablet in the morning. After a month of intensive therapy, it is possible to increase the dose to 7.5 mg (3 tablets). Cost - about 25 rubles for 30 pieces (2.5 mg).
– a diuretic based on the substance spironolactone. Prescribed for essential hypertension, edema syndrome of various origins, hypokalemia.

Contraindicated for use in cases of hyperkalemia, severe liver failure, anuria, intolerance to the components of the composition, pregnancy, lactation. The dose of the medicine is prescribed by the doctor depending on the patient’s diagnosis. The optimal dosage is from 50 to 100 mg. Take the tablets strictly after meals, with plenty of water. Prices for the drug:
– a diuretic, the basis of the drug is the substance spironolactone. Used in the treatment of ascites, swelling, essential hypertension. Contraindicated in severe renal and hepatic pathologies, hyponatremia, hyperkalemia, pregnancy, breastfeeding, individual intolerance to substances included in the drug.

Therapy begins with a minimum dose of 25 mg per day. Increasing the dosage is permissible no earlier than after a week. The maximum permitted dose of Verospilactone is 100 mg. Approximate prices for medicine:
- 90 rubles for 20 pieces of 25 mg;
- 230 rubles for 30 pieces of 50 mg;
- 340 rubles for 30 pieces of 100 mg. Sold in pharmacies only with a doctor's prescription.

In this medical article you can familiarize yourself with the drug Torasemide. The instructions for use will explain in what cases the tablets can be taken, what the medicine helps with, what are the indications for use, contraindications and side effects. The annotation presents the forms of release of the drug and its composition.

In the article, doctors and consumers can only leave real reviews about Torasemide, from which one can find out whether the medicine has helped in treating hypertension and reducing blood pressure and getting rid of edema in adults and children, for which it is also prescribed. The instructions list Torasemide analogues, prices of the drug in pharmacies, as well as its use during pregnancy.

A drug with a diuretic effect is Torasemide. Instructions for use indicate that the tablets are loop diuretics.

Release form and composition

Torasemide Canon is available in the form of tablets for oral administration. The tablets are white, round, with a score on one side, packaged in blister packs of 10 pieces (1-10 blisters in a cardboard box), the box with the drug contains instructions with a detailed description.

Each tablet of the drug contains 5 mg or 10 mg of the active ingredient - Torasemide, as well as a number of additional auxiliary agents, including lactose.

pharmachologic effect

Torsemide is a loop diuretic. The main mechanism of its action is due to the reversible binding of the substance to the chlorine/sodium/potassium ion cotransporter, which is located in the apical membrane of the thick segment of the ascending limb of the loop of Henle.

This leads to a decrease or complete inhibition of the reabsorption of sodium ions and a decrease in the osmotic pressure of the intracellular fluid. The drug blocks aldosterone receptors in the myocardium, improves diastolic myocardial function and reduces fibrosis.

Compared to furosemide, torasemide causes hypokalemia to a lesser extent, but it acts longer and is more active. The maximum therapeutic effect is observed 2–3 hours after oral administration. It is possible to conduct a long course.

Indications for use

What does Torasemide help with?

For tablets with a mass content of torasemide 2.5 and 5 mg: – therapy of essential hypertension.
For tablets with a mass content of torasemide 5; 10 and 20 mg: – prevention or reduction of edema in patients suffering from heart failure.
For tablets with a mass content of torasemide 50; 100 and 200 mg: - prevention or reduction of edema, as well as increased blood pressure in severe renal failure (CRF) with CC less than 20 ml/min, provided there is a residual diuresis of more than 200 ml per day, including patients on hemodialysis.

Instructions for use

Torasemide is taken orally, 1 time per day, without chewing, with a sufficient amount of water. The tablets can be taken at any convenient time, regardless of meals.

Edema syndrome in chronic heart failure

The usual starting dose is 10-20 mg once daily. If necessary, the dose can be doubled until the desired effect is obtained.

Edema syndrome in kidney disease

The usual starting dose is 20 mg once daily. If necessary, the dose can be doubled until the required effect is obtained.

Edema syndrome in liver disease

The usual starting dose is 5-10 mg once daily. 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 with use). The drug is used for a long period or until swelling disappears.

Arterial hypertension

The initial dose is 2.5 mg (1/2 tablet of 5 mg) 1 time per day. If there is no therapeutic effect within 4 weeks, the dose is increased to 5 mg 1 time per day. If there is no adequate reduction in blood pressure when taken at a dose of 5 mg 1 time per day for 4-6 weeks, the dose is increased to 10 mg 1 time per day. If a dose of 10 mg does not give the required effect, an antihypertensive drug of another group must be added to the treatment regimen. Elderly patients do not require dose adjustment.

Contraindications

Absolute:

allergy to sulfonamides (sulfonylureas or sulfonamide antimicrobials);
acute glomerulonephritis;
refractory hypokalemia/hyponatremia;
age under 18 years;
pregnancy and breastfeeding;
renal failure in combination with anuria;
combination therapy with aminoglycosides and cephalosporins;
hypertrophic obstructive cardiomyopathy;
increased central venous pressure (more than 10 mm Hg);
precoma and hepatic coma;
galactose intolerance, lactase deficiency, glucose-galactose malabsorption;
hypovolemia (with or without arterial hypotension) or dehydration;
individual intolerance to the components of the drug;
glycoside intoxication;
decompensated mitral/aortic stenosis;
hyperuricemia;
pronounced disturbances in the outflow of urine of any etiology (including unilateral damage to the urinary tract);
sinoatrial and atrioventricular blockade of II–III degree.

Relative (diseases/conditions in which the use of Torasemide requires caution):

indications in the anamnesis of ventricular arrhythmia;
stenosing atherosclerosis of cerebral arteries;
renal/hepatic dysfunction;
arterial hypotension;
hepatorenal syndrome;
anemia;
pancreatitis;
hypoproteinemia;
gout;
acute myocardial infarction (due to an increased risk of cardiogenic shock);
diarrhea;
disturbances in the outflow of urine (hydronephrosis, benign prostatic hyperplasia or narrowing of the urethra);
predisposition to the appearance of hyperuricemia;
hypokalemia/hyponatremia;
diabetes mellitus (due to decreased glucose tolerance).

Side effects

from the urinary system - frequent urination, the predominance of nighttime daily diuresis over daytime, the appearance of red blood cells in the urine, as a result of which it turns red, oliguria, acute urinary retention, urinary tract obstruction;
from the senses - noise and ringing in the ears, blurred vision, decreased hearing acuity, up to complete deafness for a short period of time;
on the part of metabolic processes - a decrease in the level of potassium, sodium, magnesium, calcium in the blood, the development of metabolic alkalosis, hypovolemia;
decreased libido in women and erectile function in men;
from the heart and blood vessels - cardiac arrhythmia, extrasystole, rapid heartbeat, decreased blood pressure, development of orthostatic hypotension, venous thrombosis, decreased circulating blood volume;
muscle weakness and joint pain;
from the digestive system - pain in the epigastric region, nausea, increased thirst, dry mouth, sometimes vomiting, loss of appetite, the appearance of an unpleasant odor of acetone from the mouth, increased activity of liver transminases;
from the skin - itching, rash, multimorphic erythema, purpura, vasculitis, photosensitivity;
thrombocytopenia, aplastic and hemolytic anemia;
nosebleeds and shortness of breath;
from the nervous system - headaches and dizziness, apathy, lethargy, drowsiness, paresthesia, numbness of the limbs, confusion, and sometimes fainting.

If the described side effects occur, stop treatment with the drug and consult a doctor.

Children, pregnancy and breastfeeding

Torsemide does not have teratogenic effects and fetotoxicity, penetrates the placental barrier, causing disturbances in water-electrolyte metabolism and thrombocytopenia in the fetus. There have been no controlled studies on the use of torasemide in pregnant women; the drug is not recommended for use during pregnancy.

There is no data on the excretion of torasemide into breast milk, therefore, if it is necessary to use torasemide during lactation, breastfeeding should be stopped.

The use of the drug in children and adolescents under 18 years of age is contraindicated (safety and effectiveness have not been established).

special instructions

Torsemide should be used only as prescribed by a doctor. The duration of the diuretic effect is up to 18 hours, which helps to facilitate the tolerability of therapy due to the absence of too frequent urination, which limits the activity of patients in the first hours after taking the drug.

Against the background of hypersensitivity to sulfonamides and sulfonylurea derivatives, cross-sensitivity to Torsemide is possible. To avoid the development of hypokalemia/hyponatremia and metabolic alkalosis during a long course in high doses, it is recommended to take potassium supplements and follow a diet with sufficient sodium content.

The risk of hypokalemia is highest with liver cirrhosis, severe diuresis, insufficient dietary intake of electrolytes, and combination therapy with corticosteroids or adrenocorticotropic hormone. In cases of the appearance or intensification of oliguria and azotemia in patients with severe progressive kidney disease, it is recommended to suspend treatment.

The use of Torasemide may cause an exacerbation of gout. In diseases of the cardiovascular system, especially when taking cardiac glycosides, diuretic-induced hypokalemia can lead to the development of arrhythmias.

Drug interactions

Torsemide increases the effectiveness of curare-like muscle relaxants and Theophylline. Concomitant use of torasemide and cardiac glycosides may increase the sensitivity of the myocardium to these drugs due to the observed deficiency of magnesium or potassium.

Torsemide enhances the toxic effects of salicylates (in high doses) on the central nervous system. Concomitant use of Cholestyramine may reduce the absorption of torsemide, which leads to a weakening of its effect.

Torsemide enhances the effects of other antihypertensive drugs, including ACE inhibitors, which can cause severe hypotension. To prevent the development of hypotension, the dose of one or another drug should be adjusted.

Torsemide reduces the effectiveness of antidiabetic drugs and weakens the vasoconstrictor effect of Norepinephrine and Epinephrine.

High doses of torasemide can potentiate the ototoxic and nephrotoxic effects of aminoglycoside antibiotics (Kanamycin, tobramycin, Gentamicin), the nephrotoxic effect of cephalosporins and the toxic effect of platinum drugs.

When combined with laxatives, glucocorticoids and mineralocorticoids, the risk of developing potassium deficiency increases. NSAIDs and Probenecid weaken the hypotensive and diuretic effects of torasemide.

The combined use of lithium and torasemide may lead to an increase in lithium levels in the blood, which will increase its neurotoxicity and cardiotoxicity.

Analogues of the drug Torasemide

Analogues are determined by structure:

Thorasemid Canon.
Trigrim.
Britomar.
Diuver.
Torasemide Vertex.

The group of diuretics includes:

Trigrim.
Britomar.
Triampur compositum.
Hypothiazide.
Arifon retard.
Espiro.
Arindap.
Indapres.
Acripamide.
Brusniver.
Canephron H.
Mannitol.
Isobar.
Mannitol.
Retapres.
Indap.
Urological (diuretic) collection.
Hydrochlorothiazide.
Moduretic.
Fursemid.
Hydrochlorothiazide.
Indapamide Teva.
Cimalon.
Pamid.
Tenzar.
Brinaldix.
Arifon.
Verospilactone.
Spironolactone.
Aldactone.
Insp.
Indapamide.
Acetazolamide.
Clopamid.
Urakton.
Bufenox.
Phytolysin.
Diuver.
Lorvas.
Ionic.
Urea.
Indapsan.
Lespenefril.
Lespefril.
Uroflux.
Sandoz.
Lasix.

Vacation conditions and price

The average cost of Torasemide Canon (5 mg tablets No. 60) in Moscow is 375 rubles. Dispensed by prescription.

The drug Torasemide Canon is dispensed from pharmacies with a doctor's prescription. It is recommended to store the tablets out of the reach of children and in a cool place. The shelf life of the drug is 4 years from the date of production. After the expiration date, the drug cannot be taken orally.

Torasemide, like Furosemide, is a drug belonging to the category of loop diuretics.

The leading component of the drug is torasemide, due to which the following actions occur:

antihypertensive;
diuretic;
saluretic;
decongestant.

After taking the tablet, the therapeutic effect occurs within 2-3 hours. The main substance of the drug is well absorbed by the digestive tract.

The maximum plasma concentration of Torasemide occurs 1-2 hours after administration. This product is characterized by increased binding to plasma proteins (99%) and bioavailability (up to 90%).

In the body, Torasemide and Furosemide are metabolized to form pharmacologically inactive metabolites with little medicinal activity.

The drug and its analogues are excreted by the kidneys in pure form or as metabolites. The half-life is from 3 to 4 hours.

In case of kidney failure, the half-life of the drug remains unchanged. If liver function is impaired, the half-life does not change significantly.

The instructions state that the tablets do not accumulate in the body and are not excreted during hemofiltration and hemodialysis.

Instructions for use of the drug

Torsemide tablets contain 2.5 or 5 mg of the active ingredient. Indications for its use are essential hypertension.

The drug and its analogues (Furosemide), containing 5, 10, 20 mg of the active substance, are prescribed for the treatment of heart failure, in which edema often appears.

Tablets containing 50, 100 or 200 mg of the active ingredient are prescribed for the treatment of severe renal failure, which is accompanied by arterial hypertension and swelling.

Mode of application

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Torsemide and Furosemide are taken orally. The tablets can be divided, but it is not advisable to crush or chew them.

The instructions for use state that Torasemide, like Furosemide, must be taken in the morning with meals. The daily dose of the drug is usually a single dose. The duration of use and dosage are determined by the attending physician.

For essential hypertension, the dose is increased to 2.5 mg per day. If after 60 days the therapy has not brought the desired results, then the dosage is increased to 5 mg, but no more.

For swelling, the initial dose of Torasemide is 5 mg. But to enhance the effect, it can be increased to 20 mg.

In addition, the instructions for use state that the medicine for renal failure is prescribed at a dose of 20 mg per day. And in the absence of the necessary therapeutic effect, it slowly increases. But the dosage should not exceed 200 mg per day.

If long-term treatment is planned, then during this it is important to monitor the concentration of certain substances in the blood:

uric acid;
electrolytes;
creatinine;
glucose;
lipids.

Side effects, contraindications, overdose

During treatment with Torasemide, various adverse reactions may develop. Thus, from the cardiovascular system and hematopoiesis, cardiac and cerebral ischemia occurs, accompanied by angina pectoris, arrhythmia, and acute infarction of the heart muscle. Sometimes leukopenia, thrombosis, thrombocytopenia and anemia appear.

From the liver and digestive tract, adverse reactions occur such as increased activity of liver transaminases, anorexia, dryness of the oral mucosa, nausea, pancreatitis, vomiting, stool upset and gastralgia.

In addition, the instructions state that the urinary system and kidneys develop urinary retention, hypercreatininemia, and an increase in the concentration of urea in the blood.

Changes in laboratory data are also noted, such as:

hyperlipidemia;
water-electrolyte imbalance;
hyperglycemia;
metabolic alkalosis.

Allergic manifestations are also noted - Quincke's edema, rash and toothache, photosensitivity, urticaria. Moreover, tremors of the limbs, blurred vision, and hearing impairment (tinnitus) may occur.

Each drug has not only indications for use, but also contraindications. So, regarding Torasemide, it should not be taken if there is individual hypersensitivity to the components of the drug.

The product contains lactose, so it is not prescribed for glucose-galactose malabsorption, lactase deficiency and galactosemia.

In addition, Torasemide and its analogues (Furosemide) should not be taken with low blood pressure, precomatose state, hepatic coma and poor kidney function, in which anuria is observed.

In addition, it is better not to take the medicine if there is a water-electrolyte imbalance. Therefore, before prescribing Torasemide or Furosemide, it is necessary to adjust it.

Also, tablets should not be taken under 18 years of age, during lactation and gestation. And for patients over 65 years of age, the drug is prescribed under medical supervision.

In addition, careful use of Torasemide is recommended in the following cases:

prostatic hyperplasia;
arrhythmia;
liver dysfunction;
diabetes;
conditions affecting urination;
increased likelihood of developing gout and hyperuricemia.

It is worth noting that it is better for people driving various devices and vehicles to stop taking Torasemide.

Regarding overdose, in this case, forced diuresis, disruptions in the digestive system, drowsiness, confusion, hypovolemia, electrolyte imbalance and a decrease in blood pressure may develop, which can result in collapse.

There is no specific antidote. In case of overdose, gastric lavage and use of enetrosorbent are necessary, but only if no more than 2 hours have passed after taking Torasemide. At the same time, symptomatic treatment is carried out, the main task of which is to restore water and electrolyte balance.

Also, in case of overdose, it is necessary to adjust the dose or stop treatment with the drug altogether.

Interaction with other medications

The instructions for use state that Torasemide, like Furosemide, can increase the effect of cardiac glycosides on the heart muscle and enhance the therapeutic effect of Theophylline and muscle relaxants.

And if you combine the drug with laxatives and corticosteroid medications, the likelihood of hypokalemia increases.

The medicine potentiates the therapeutic effect of antihypertensive pills, in particular ACE inhibitors. Therefore, this combination should always be strictly controlled, which involves constantly measuring blood pressure levels and adjusting the dose of drugs used.

Torsemide reduces the vasoconstrictor effect of Norepinephrine and Epinephrine and reduces the effectiveness of hypoglycemic tablets.

Large doses of Torsemide can increase the adverse effects of platinum drugs and the nephrotoxic effect of aminoglycosides and cephalosporins. Moreover, the drug increases the likelihood of the ototoxic effect of aminoglycosides and the development of side effects affecting the central nervous system after taking a large dose of salicylates.

Probenecid and non-narcotic analgesics, if used together with Torasemide, reduce its therapeutic effect.

In addition, if you combine the drug with lithium drugs, their plasma concentration will increase. And with the simultaneous use of Torasemide with Kolestyramine, the absorption of the diuretic decreases.

Analogs

Composition: Diuver, Britomar, Torixal, Torsid, Trigrim, Trifas.

By indication and method of use: Furosemide, Frusemide.

Diuver is prescribed for essential hypertension. It is also appropriate for the treatment and prevention of edema or effusions due to heart failure.

Indications for use of Bitomar are:

essential hypertension;
edema that occurs against the background of liver, kidney and heart failure.

Torixal is also used to eliminate swelling caused by heart failure. It is used for EG as part of mono- or complex treatment.

Torsid is prescribed to eliminate effusions and swelling caused by heart failure, if the drug must be administered intravenously. For example, in acute heart failure or pulmonary edema.

Indications for the use of Trigrim are essential hypertension. It is also used for edema that occurs due to heart failure.

Trifas is prescribed to eliminate effusions and swelling in heart failure. It is administered intravenously when a quick effect is needed (acute heart failure, pulmonary edema).

Furosemide is prescribed for edema and chronic heart and kidney failure. In addition, indications for the use of this drug are swelling in liver disease and arterial hypertension.

An analogue such as Frusemide is used for pulmonary and cerebral edema, nephrotic syndrome and liver cirrhosis. The drug is also indicated for cardiac asthma, in the case of some forms of hypertensive crises and for the formation of diuresis.

Release form, price and storage conditions

Tablets are produced in 10 pieces per plate. One box can contain from 2 to 10 records.

Price – from 100 to 500 rubles.

Shelf life - up to 2 years, but provided that the product is stored correctly (dry room, where the temperature is not higher than 25 degrees). The video in this article will additionally provide some facts about the drug and hypertension.

Torsemide belongs to the group of diuretics - loop diuretics.

Small doses of the drug successfully treat arterial hypertension because it has a weak saluretic and antihypertensive effect. Higher doses of the drug have enhanced diuretic effects depending on the dose used.

Oral administration of tablets leads to rapid absorption of the drug from the stomach. After 60–120 minutes, the maximum concentration is observed, bioavailability is 85%, the active substance is 99% bound to blood plasma proteins.

Maximum activity of Torasemide is observed 2–3 hours after ingestion.

Clinical and pharmacological group

Diuretic.

Terms of sale from pharmacies

Can buy according to a doctor's prescription.

Price

How much does Torasemide cost in pharmacies? The average price is 350 rubles.

Composition and release form

The drug Torasemide Canon is available in the form of tablets for oral administration. The tablets are white, round, with a score on one side, packaged in blister packs of 10 pieces (1-10 blisters in a cardboard box), the box with the drug contains instructions with a detailed description.

Each tablet of the drug contains 5 mg or 10 mg of the active ingredient - Torasemide, as well as a number of additional auxiliary agents, including lactose.

pharmachologic effect

Torsemide is a loop diuretic. The main effect of the substance is due to its connection with sodium, chlorine, and potassium transporters, which are located in the membrane of the ascending segment of the loop of Henle. Because of this, the absorption of sodium and water ions decreases, and the fluid pressure inside the cells decreases. The drug is able to block aldosterone receptors in the myocardium, fibrosis resolves and the function of the heart muscle improves.

The drug substance, unlike other known diuretics, causes hypokalemia to a lesser extent, acts longer and with greater activity. The medication reduces blood pressure well in any body position. It is the drug of choice for long-term treatment. Its medicinal effect is about 18 hours and the absence of very frequent urination after taking it makes life easier for patients (there are no restrictions for people's normal life).

The diuretic effect develops 60 minutes after ingestion, its maximum amount accumulates in the body after 3 hours. Metabolism of the drug occurs in the liver using enzymes of the cytochrome system. As a result of chemical reactions (hydroxylation and oxidation), the resulting metabolites bind to blood plasma proteins. About 80% of the dose taken is excreted by the kidneys (20% unchanged).

Indications for use

For people with arterial hypertension, the indications for the use of Torasemide are obvious, since the rapid removal of sodium salts and water from the body helps reduce blood pressure. After all, it is precisely elevated blood pressure that provokes hypertension.

The use of “Torasemide” in different dosages is indicated for the treatment of three diseases:

. With it, the drug is prescribed in the smallest dose for two months, only after this time can one say whether the drug is effective or not. If the effect is insufficient, the dose is increased 4 times.
. It is used to eliminate edema due to this disease. If there is no positive dynamics during therapy, another drug is prescribed. It makes no sense to increase the dosage. Prescribed for prophylactic use to avoid recurrence of edema.
Renal failure in the chronic phase. Indications for use are the volume of urine excreted. At least 200 ml, with lower levels diuretics are not prescribed.

Contraindications

Absolute:

increased central venous pressure (more than 10 mm Hg);
hypertrophic obstructive cardiomyopathy;
galactose intolerance, lactase deficiency, glucose-galactose malabsorption;
combination therapy with aminoglycosides and cephalosporins;
renal failure in combination with anuria;
refractory hypokalemia/hyponatremia;
precoma and hepatic coma;
decompensated mitral/aortic stenosis;
hypovolemia (with or without arterial hypotension) or dehydration;
pronounced disturbances in the outflow of urine of any etiology (including unilateral damage to the urinary tract);
sinoatrial and atrioventricular blockade of II–III degree;
acute glomerulonephritis;
hyperuricemia;
glycoside intoxication;
allergy to sulfonamides (sulfonylureas or sulfonamide antimicrobials);
age under 18 years;
pregnancy and breastfeeding;
individual intolerance to the components of the drug.

Relative (diseases/conditions in which the use of Torasemide requires caution):

hypoproteinemia;
hypokalemia/hyponatremia;
hepatorenal syndrome;
indications in the anamnesis of ventricular arrhythmia;
diarrhea;
pancreatitis;
arterial hypotension;
anemia;
gout;
stenosing atherosclerosis of cerebral arteries;
disturbances in the outflow of urine (hydronephrosis, benign prostatic hyperplasia or narrowing of the urethra);
predisposition to the appearance of hyperuricemia;
acute myocardial infarction (due to an increased risk of cardiogenic shock);
renal/hepatic dysfunction;
diabetes mellitus (due to decreased glucose tolerance).

Prescription during pregnancy and lactation

While pregnant, Torasemide can be taken only under the strict supervision of the attending physician, who, before prescribing this drug, must carefully weigh the possible benefits for the mother, as well as the potential risks for the development of the fetus.

If it is necessary to carry out therapy with this drug during breastfeeding, it should be interrupted in consultation with the treating specialist.

Dosage and method of administration

As indicated in the instructions for use, Torasemide SZ is taken orally 1 time/day, at any convenient (but at the same) time, regardless of food intake. The tablets should be swallowed without chewing and with plenty of water.

Edema syndrome in chronic heart failure:

The recommended initial dose is 10-20 mg 1 time / day. If necessary, the dose can be doubled until the desired effect is obtained.

Edema syndrome in kidney disease:

The recommended starting dose is 20 mg 1 time/day. If necessary, the dose can be doubled until the desired effect is obtained.

Edema syndrome in liver disease:

The recommended initial dose is 5-10 mg 1 time / day. If necessary, the dose can be doubled until the desired effect is obtained.

Arterial hypertension:

The initial dose is 2.5 mg (1/2 tablet of 5 mg) 1 time/day. If there is no therapeutic effect within 4 weeks, the dose is increased to 5 mg 1 time / day. In the absence of an adequate reduction in blood pressure when taken at a dose of 5 mg 1 time / day for 4-6 weeks, the dose is increased to 10 mg 1 time / day. If the use of the drug at a dose of 10 mg/day does not give the required effect, an antihypertensive drug of another group is added to the treatment.

In elderly patients, no dose adjustment is required.

The drug is used for a long period or until swelling disappears.

Side effects

During therapy, the following undesirable effects may occur:

metabolic alkalosis;
visual impairment;
tinnitus, hearing loss (usually these effects are reversible);
itching, rashes, photosensitivity;
pathological thirst, increased levels of cholesterol and triglycerides in the blood;
nosebleeds;
an increase or decrease in the number of platelets, a decrease in leukocytes and red blood cells;
decreased levels of potassium, sodium, chlorine in the blood;
increased levels of sugar and uric acid in the blood;
dizziness, headaches, muscle cramps in the legs, impaired consciousness, drowsiness, sensitivity disorder in the extremities;
increased frequency of urination, increased amount of urine, urine retention, nocturia, increased levels of creatinine and urea in the bloodstream;
loose stools, abdominal pain, bloating, nausea, vomiting, lack of appetite, inflammation of the pancreas, dyspepsia;
decrease in the amount of circulating blood, thromboembolism, severe decrease in blood pressure, deep vein thrombosis, increased and increased heart rate, extrasystole, facial flushing;
fatigue, weakness, hyperactivity, nervousness.

Overdose

When ingesting large doses of the drug or uncontrolled use of Torasemide Canon tablets, the patient gradually develops signs of overdose, which are clinically expressed by an increase in the adverse reactions described above, a decrease in blood pressure, collapse, confusion, even coma.

Treatment of overdose consists of gastric lavage, restoration of circulating blood volume, and normalization of water-salt balance. There is no antidote for the drug. In case of unintentional ingestion of a large number of tablets, the patient should induce vomiting, lavage the stomach, give activated charcoal and, if necessary, undergo symptomatic treatment.

special instructions

The drug should be used strictly as prescribed by a doctor.

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

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

Dose selection for patients with ascites against the background of liver cirrhosis should be carried out in a hospital setting (violations of water and electrolyte balance can lead to the development of hepatic coma). This category of patients requires regular monitoring of blood plasma electrolytes.

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

For patients receiving Torasemide-SZ in high doses for a long period, in order to avoid the development of hyponatremia, metabolic alkalosis and hypokalemia, a diet with sufficient sodium content and the use of potassium supplements are recommended.

An increased risk of developing fluid and electrolyte imbalances is observed in patients with renal failure. During the course of treatment, it is necessary to periodically monitor the concentration of blood plasma electrolytes (including sodium, calcium, potassium, magnesium), acid-base status, residual nitrogen, creatinine, uric acid and, if necessary, carry out appropriate corrective therapy (with a higher frequency in patients with frequent vomiting and against the background of parenterally administered fluids).

In unconscious patients with prostatic hyperplasia and narrowing of the ureters, diuresis control is necessary due to the possibility of acute urinary retention.

Interaction with other drugs

The combination of Torasemide and cardiac glycosides can increase the sensitivity of the myocardium to drugs and lead to magnesium and potassium deficiency. Other drug interactions between medications are indicated in the instructions for use:

The medication increases the effect of Theophylline, curare-like muscle relaxants, enhances the toxic activity of salicylates, cardiotoxicity and neurotoxicity of lithium preparations.
The combination of Torasemide with non-steroidal anti-inflammatory drugs, Probenecid, and mineralocorticoids leads to a weakening of its diuretic and hypotensive effect.
The drug enhances the effect of antihypertensive drugs and angiotensin-converting enzyme inhibitors. To eliminate the problem, dose adjustment is needed.
Combining medications with laxatives, glucocorticoids, and mineralocorticoids can lead to potassium deficiency.
The medication reduces the results of using antidiabetic drugs and weakens the vasoconstrictor effect of Epinephrine and Norepinephrine.
High doses of the drug potentiate the ototoxic and nephrotoxic effects of antibiotics from the aminoglycoside group (Tobramycin, Kanamycin, Gentamicin), the nephrotoxic effect of cephalosporins, and the toxicity of platinum drugs.
The combination of the drug with cholestyramine leads to a decrease in absorption of the former and a weakening of the effect.