Diuver

Diuver – loopback diuretic.

Form of release and structure

Is issued in tablets: round, biconvex, white or almost white color, with a facet, on one party – an engraving "915" (5 mg) or "916" (10 mg), on another – risk (on 10 pieces in blisters, 2 or 6 blisters in a cardboard pack).

Active ingredient: торасемид, in 1 tablet – 5 or 10 mg.

Additional components: lactoses monohydrate, starch corn, carboxymethylstarch of sodium, silicon dioxide colloid anhydrous, magnesium stearate.

Indications to use

• The edematous syndrome of various nature of an origin including caused by chronic heart failure, diseases of lungs, a liver and kidneys;
• Arterial hypertension.

Contraindications

Absolute:

• Lactose intolerance, deficit of lactase, glyukozo-galaktozny malabsorption;
• Hepatic prekoma and coma;
• Renal failure with an anury;
• Sharply expressed disturbances of outflow of urine of any genesis (including hemilesion of urinary tract);
• Dehydration and hypovolemia (including with arterial hypotension);
• Acute glomerulonephritis;
• The expressed hyponatremia or hypopotassemia;
• Hyperuricemia;
• Hypertrophic subaortic stenosis;
• Dekompensirovanny aortal and mitral stenosis;
• Increase in the central venous pressure (more than 10 mm hg);
• Glikozidny intoxication;
• Age up to 18 years;
• Lactation;
• Hypersensitivity to components of drug or sulfonamides (drugs of sulphonylurea or sulfanamide antimicrobic means).

Relative (diseases/states at which Diuver it is necessary to apply with care in connection with risk of development of complications):

• Arterial hypotension;
• The stenosing atherosclerosis of cerebral arteries;
• Hypoproteinemia;
• Predisposition to a hyperuricemia;
• Urine outflow disturbance (for example, owing to a benign hyperplasia of a prostate, an urethrostenosis or a hydronephrosis);
• Ventricular arrhythmia in the anamnesis;
• Acute myocardial infarction;
• Pancreatitis;
• Diarrhea;
• Gepatorenalny syndrome;
• Diabetes mellitus;
• Anemia;
• Gout;
• Pregnancy.

Route of administration and dosage

Diuver it is necessary to accept in 1 times a day (after a breakfast), washing down with enough water.

Recommended one-time (and daily allowance at the same time) doses:

• Edematous syndrome: an initial dose – 5 mg if the effect is not enough, raise a dose to 20-40 mg, in some cases – to 200 mg. It is necessary to accept drug until disappearance of hypostases, long therapy is possible;
• Arterial hypertension: an initial dose – 2,5 mg (1/2 tablets), if necessary increase a dose to 5 mg.

Side effects

• Water and electrolytic and acid-base balance: a hypocalcemia, a hypopotassemia, a hypochloraemia, a hypomagnesiemia, a hyponatremia, a metabolic alkalosis (can point the following symptoms to development of these disturbances: a headache, muscular weakness, a tetany, spasms, confusion of consciousness, dispepsichesky frustration, disturbances of a heart rhythm), dehydration and a hypovolemia (is more often at patients of advanced age; can result in haemo concentration with a tendency to development of thrombosis);
• Cardiovascular system: arrhythmias, tachycardia, an excessive lowering of arterial pressure, decrease in volume of the circulating blood, orthostatic hypotension, a collapse;
• Metabolism: passing increase in concentration of creatinine and urea in blood, a gipertriglitseridemiya, a hypercholesterolemia, decrease in tolerance to glucose (manifestation latentno of the proceeding diabetes mellitus is in certain cases possible), increase in concentration of uric acid in blood that can strengthen or cause gout;
• Urinary system: an acute ischuria and an oliguria (especially at an urethrostenosis, a prostate hyperplasia, a hydronephrosis), a hamaturia, intersticial nephrite, decrease in a potentiality;
• Alimentary system: diarrhea, increase in activity of liver enzymes, nausea, vomiting, intra hepatic cholestasia, acute pancreatitis;
• Central nervous system and acoustic organ: a hearing disorder (as a rule, reversible) and/or a sonitus (especially at the accompanying hypoproteinemia or a renal failure);
• Peripheral blood: agranulocytosis, leukopenia, aplastic or hemolitic anemia, thrombocytopenia;
• Integuments: a small tortoiseshell, violent damage of skin or other types of rash, exfoliative dermatitis, a skin itch, a photosensitization, a vasculitis, a purpura, fever, an eosinophilia, a mnogoformny erythema, anaphylactoid or anaphylactic reactions up to shock.

Special instructions

Diuver it is necessary to accept strictly on doctor's orders.

The diuretic effect of drug remains till 18 o'clock thanks to what during the first hours after its reception there are no very frequent desires to an urination limiting activity of the patient.

At reception of high doses of Diuver the risk of development of a hypopotassemia, hyponatremia and metabolic alkalosis in this connection it is recommended to adhere to a diet with the sufficient content of table salt increases for a long time and in addition to accept potassium drugs.

At patients with a renal failure the risk of development of disturbances of water and electrolytic balance therefore during treatment control of concentration of electrolytes in a blood plasma (including sodium, potassium, calcium and magnesium), an acid-base state, residual nitrogen, uric acid and creatinine is necessary is increased. In certain cases the corresponding correctional therapy, especially at patients with frequent vomiting or receiving parenterally liquids can be required.

In case of emergence or strengthening of an oliguria and an azotemia at patients with the serious progressing illness of kidneys treatment by Diuver is recommended to be suspended.

Selection of a necessary dose for patients with the ascites which developed owing to cirrhosis should be carried out in the conditions of a hospital as disturbances of water and electrolytic balance at them can lead to development of a hepatic coma. Besides, this category of patients needs to control blood plasma electrolytes regularly.

At patients with reduced tolerance to glucose and a diabetes mellitus it is necessary to check constantly concentration of glucose in urine and blood.

Due to the risk of an acute ischuria control of a diuresis is necessary for patients with narrowing of ureters and a hyperplasia of a prostate, and also patients in unconsciousness.

During Diuver's use it is necessary to refrain from control of vehicles and performance of potentially dangerous types of the works requiring special attention and speed of reactions.

Medicinal interaction

• Aminoglycosides, cephalosporins, Acidum etacrynicum, B Amphotericinum, chloramphenicol, Cisplatinum: their concentration and risk of development from - and nephrotoxic action increases;
• Theophylline, diazoxide, antihypertensives: their action amplifies;
• Muscle relaxants (for example, succinylcholine): their neuromuscular blockade amplifies;
• Not depolarizing muscle relaxants (for example, tubocurarine), Allopyrinolum, hypoglycemic means: their efficiency decreases;
• Torasemid, pressor amines: mutual decrease in effect is noted;
• The medicines blocking canalicular secretion: concentration of a torasemid in blood serum increases;
• Lithium drugs: their renal clearance and probability of development of intoxication increases;
• Cyclosporine: the risk of development of gouty arthritis increases;
• Amphotericinum In, glucocorticosteroids: the probability of development of a hypopotassemia increases;
• Cardiac glycosides: risk of development of glikozidny intoxication owing to a hypopotassemia and lengthening of an elimination half-life;
• Sukralfat, non-steroidal anti-inflammatory drugs: the diuretic effect of Diuver decreases;
• Salicylates in high doses: the risk of manifestation of their toxicity increases;
• Angiotensin-converting enzyme inhibitors, antagonists of receptors of angiotensin II: perhaps severe lowering of arterial pressure;
• Methotrexate, пробенецид: their renal elimination decreases, efficiency of a torasemid decreases.

Patients with high risk have development of a nephropathy, accepting Diuver, at introduction of X-ray contrast means of a renal failure is observed more often than patients with high risk have development of a nephropathy by which before introduction of X-ray contrast means carried out intravenous hydration.

Terms and storage conditions

To store at a temperature up to 30 ºС. To protect from children.

Period of validity – 3 years.