Pharmacological properties of the drug Torasemide
Fast acting diuretic. The mechanism of diuretic action is due to inhibition of the reabsorption of sodium and chlorine ions in the ascending part of the loop of Henle. Reduces pre- and afterload on the myocardium. Torsemide lowers blood pressure, reducing peripheral vascular resistance, which is explained by a decrease in the increased activity of free Ca2+ in the smooth muscle cells of arterial vessels. As a result, increased contractility and a correspondingly increased vascular response to endogenous pressor substances (for example, catecholamines) are probably also reduced.
Indications for use of Veroshpiron
- Essential hypertension (as part of combination therapy);
- edema syndrome in chronic heart failure (can be used in monotherapy and in combination with standard therapy);
- conditions in which secondary hyperaldosteronism may be detected, including cirrhosis of the liver accompanied by ascites and/or edema, nephrotic syndrome, as well as other conditions accompanied by edema;
- hypokalemia/hypomagnesemia (as an adjuvant for its prevention during treatment with diuretics and when it is impossible to use other methods of correcting potassium levels);
- primary hyperaldosteronism (Conn's syndrome) - for a short preoperative course of treatment;
- to establish the diagnosis of primary hyperaldosteronism.
Use of the drug Torasemide
For edema syndrome in patients with heart failure, the initial single dose for intravenous injection is 10 mg; if necessary, the dose is increased to 20 mg. Torsemide in a single dose of 40 mg can be used for no more than 3 days. Administer only intravenously slowly. If long-term therapy is necessary, switch to taking torasemide orally. Maintenance dose: 5 mg/day orally. If effectiveness is insufficient, the dose is increased to 20 mg/day. In case of acute pulmonary edema, 20 mg of solution for injection is administered intravenously. If indicated, torasemide can be re-administered at this dose every 30 minutes. The maximum daily dose is 100 mg. The solution is administered only intravenously slowly. IV administration should be continued for no more than 7 days. For edema in patients with impaired renal function, the initial dose for intravenous infusion is 50 mg. Infusions are carried out using a perfusor. If diuresis is insufficient, the dose can be increased to 100 mg/day. The infusion is carried out over 1 hour. The maximum daily dose is 200 mg. IV administration should be continued for no more than 7 days. If long-term therapy is necessary, it is necessary to switch from intravenous torasemide to oral administration as quickly as possible. The initial dose for oral administration is 50 mg. If diuresis is insufficient, the dose can be increased to 100 mg. The maximum daily dose for oral administration is 200 mg.
Comparison of side effects of Veroshpiron and Torasemid-sza
Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.
Veroshpiron has almost the same level of adverse events as Torasemid-sza. They both have few side effects. This implies that the frequency of their occurrence is low, that is, the indicator of how many cases of an undesirable effect of treatment are possible and registered is low. The undesirable effect on the body, the strength of influence and the toxic effect of Veroshpiron are similar to Torasemid-sz: how quickly the body recovers after taking it and whether it recovers at all.
Contraindications to the use of the drug Torasemide
Arterial hypotension, end-stage renal failure, severe liver dysfunction, precoma, coma, hypovolemia, hyponatremia, hypokalemia, urinary disorders, hypersensitivity to torasemide or sulfonylurea derivatives. The use of torasemide in high doses is contraindicated in mild renal impairment, as there is a risk of loss of significant amounts of water and electrolytes. Relative contraindications: gout, severe conduction disorders (2nd and 3rd degree AV blockade), cortical impairment, simultaneous therapy with lithium, aminoglycosides or cephalosporins, blood diseases (including thrombocytopenia or anemia), toxic kidney damage, pregnancy and lactation , age up to 12 years.
Comparison of addiction between Veroshpiron and Torasemid-sza
Like safety, addiction also involves many factors that must be considered when evaluating a drug.
So, the totality of the values of such parameters as “syndrome o” in Veroshpiron is quite similar to the similar values in Torasemid-sza. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible. At the same time, in Veroshpiron the meaning of the “syndrome” is quite small, however, the same as in Torasemid-sza.
Side effects of the drug Torasemide
Possible hypovolemia, hypokalemia and/or hyponatremia, metabolic alkalosis; headache, dizziness, general weakness, convulsions, confusion, arterial hypotension, thrombosis, heart rhythm disturbances, angina pectoris, acute myocardial infarction, syncope; lack of appetite, stomach pain, nausea, diarrhea, constipation; increased activity of liver enzymes; thrombocytopenia, erythrocytopenia, leukopenia; itching, rash, photosensitivity, anaphylactic shock; feeling of dry mouth, paresthesia; increased concentrations of uric acid, creatinine and urea, glucose, triglycerides and cholesterol in the blood plasma; visual impairment; Patients with urinary disorders may experience urinary retention.
Comparison of ease of use of Veroshpiron and Torasemid-sza
This includes dose selection taking into account various conditions and frequency of doses. At the same time, it is important not to forget about the release form of the drug; it is also important to take it into account when making an assessment.
The ease of use of Veroshpiron is approximately the same as Torasemide-sz. However, they are not convenient enough to use.
The drug ratings were compiled by experienced pharmacists who studied international research. The report is generated automatically.
Last update date: 2021-01-10 10:01:37
Interactions of the drug Torasemide
Torsemide enhances the effect of antihypertensive drugs (including ACE inhibitors), theophylline, and curare-like drugs. When used simultaneously with cardiac glycosides, the risk of developing glycoside intoxication increases. Torsemide may weaken the effect of hypoglycemic drugs and the vasoconstrictor effect of catecholamines. Probenecid, cholestyramine and NSAIDs weaken the diuretic and hypotensive effects of torasemide. When used simultaneously with salicylates in high doses, torasemide may enhance their toxic effect on the central nervous system. In high doses, torasemide enhances the nephro- and ototoxic effects of aminoglycoside antibiotics and cisplatin. With simultaneous use of torasemide with laxatives or mineralo- and glucocorticoids, the risk of developing hypokalemia increases, and with lithium preparations, an increase in the concentration of lithium in the blood plasma is possible.
Comparison of the safety of Veroshpiron and Torasemid-sza
The safety of a drug includes many factors.
At the same time, in Veroshpiron it is quite similar to Torasemid-sz. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing the metabolism of Veroshpiron, as well as Torasemid-sza, we look at which organ is the metabolizing organ and how critical the effect on it is.
The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Veroshpiron does not have any risks when used, just like Torasemid-sza.
Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of the use of Veroshpiron and Torasemid-sza.
Torasemide
special instructions
With caution: arterial hypotension; hypovolemia (with or without arterial hypotension); disturbances in the outflow of urine (benign prostatic hyperplasia, narrowing of the urethra or hydronephrosis); history of ventricular arrhythmia; acute myocardial infarction (increased risk of developing cardiogenic shock); diarrhea; pancreatitis; diabetes mellitus (decreased glucose tolerance); liver diseases complicated by cirrhosis and ascites, renal failure, hepatorenal syndrome; gout, hyperuricemia; anemia; simultaneous use of cardiac glycosides, amnoglycosides or cephalosporins, corticosteroids or ACTH; hypokalemia; hyponatremia; lactation period.
Patients with hypersensitivity to sulfonamides and sulfonylureas may have cross-sensitivity to torsemide.
In patients, especially at the beginning of treatment with torasemide and in the elderly, it is recommended to monitor the electrolyte balance, volume and concentration of circulating blood.
During long-term treatment with torasemide, it is recommended to regularly monitor electrolyte balance (especially potassium levels), glucose, uric acid, creatinine, lipids and cellular blood components.
In patients receiving torasemide in high doses, in order to avoid the development of hyponatremia and metabolic alkalosis, it is not advisable to limit salt intake.
The risk of hypokalemia is greatest in patients with liver cirrhosis, severe diuresis, insufficient dietary electrolytes, and concomitant treatment with corticosteroids or ACTH.
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 patients who have developed fluid and electrolyte disturbances, hypovolemia, or prerenal azotemia, laboratory findings may include: hyper- or hyponatremia, hyper- or hypochloremia, hyper- or hypokalemia, acid-base imbalance, and increased blood urea levels. If these disorders occur, it is necessary to stop taking torasemide until normal values are restored, and then resume treatment with torasemide at a lower dose. If azotemia and oliguria appear or worsen in patients with severe progressive kidney disease, it is recommended to suspend treatment.
The selection of a dosage regimen in patients with ascites against the background of liver cirrhosis should be carried out in a hospital setting (imbalances in water and electrolyte balance can lead to the development of hepatic coma). This category of patients requires regular monitoring of blood plasma electrolytes.
To prevent hypokalemia, it is recommended to use potassium supplements and potassium-sparing diuretics (primarily spironolactone), as well as follow a diet rich in potassium.
The use of torasemide may cause an exacerbation of gout.
In patients with diabetes mellitus or with reduced glucose tolerance, periodic monitoring of glucose concentrations in the blood and urine is required.
In patients with prostatic hyperplasia and narrowing of the ureters, diuresis control is necessary due to the possibility of acute urinary retention.
In patients with diseases of the cardiovascular system, especially those taking cardiac glycosides, diuretic-induced hypokalemia can cause the development of arrhythmias.
Impact on the ability to drive vehicles and operate machinery
During the treatment period, patients should avoid engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions.
Drug interactions
Reduces the effect of anticoagulants, indirect anticoagulants (heparin, coumarin derivatives, indanedione) and the toxicity of cardiac glycosides (since normalization of potassium content in the blood prevents the development of toxicity).
Enhances the metabolism of phenazone (antipyrine).
Reduces the sensitivity of blood vessels to norepinephrine (care is required when performing anesthesia), increases T1/2 of digoxin - digoxin intoxication is possible.
Increases the toxic effect of lithium due to decreased clearance.
Possibly enhances the effect of non-depolarizing muscle relaxants (for example, tubocurarine).
Accelerates the metabolism and excretion of carbenoxolone.
Carbenoxolone promotes sodium retention by spironolactone.
GCS and diuretics (thiazides and thiazide-like, furosemide, ethacrynic acid) enhance and accelerate the diuretic and natriuretic effects.
Enhances the effect of diuretic and antihypertensive drugs.
NSAIDs reduce the diuretic and natriuretic effects, increasing the risk of hyperkalemia.
Alcohol (ethanol), barbiturates, and narcotic substances increase orthostatic hypotension.
GCS enhance the diuretic and natriuretic effect in hypoalbuminemia and/or hyponatremia.
The risk of developing hyperkalemia increases when taken with potassium preparations, potassium supplements and potassium-sparing diuretics, ACE inhibitors (acidosis), angiotensin II receptor antagonists, aldosterone blockers, indomethacin, cyclosporine.
Salicylates and indomethacin reduce the diuretic effect of spironolactone.
Ammonium chloride and cholestyramine contribute to the development of hyperkalemic metabolic acidosis.
Fludrocortisone causes a paradoxical increase in tubular secretion of potassium.
Spironolactone reduces the effect of mitotane.
Enhances the effects of triptorelin, buserelin, gonadorelin.
Overdose
Symptoms: nausea, vomiting, dizziness, diarrhea, skin rash, hyperkalemia (paresthesia, muscle weakness, arrhythmias), hyponatremia (dry mouth, thirst, drowsiness), hypercalcemia, dehydration, increased urea concentration.
Treatment: gastric lavage, symptomatic treatment of dehydration and arterial hypotension. In case of hyperkalemia, it is necessary to normalize the water-electrolyte balance with the help of potassium-removing diuretics, rapid parenteral administration of a 5-20% dextrose (glucose) solution with insulin at the rate of 0.25-0.5 units per 1 g of dextrose (glucose); can be re-entered if necessary. In severe cases, hemodialysis is performed.
