Diuver

General characteristics. Structure:

1 tablet contains active agent - a torasemida of N 5 or 10 mg and excipients - lactose monohydrate, starch corn, sodium of a glikolyat starch, silicon colloid anhydrous, magnesium stearate.
Description: tablets of 5 mg - white or almost white round, biconvex tablets with the line of a break on one party and an engraving "915" on other party;
tablets of 10 mg - white or almost white round, biconvex tablets with the line of a break on one party and an engraving "916" on other party.

Pharmacological properties:

The main mechanism of effect of drug is caused by reversible linkng of a torasemid with the kontransporter of Na+/2Ci-/K+ located in an apical membrane of a thick segment of the ascending Henle's loop therefore decreases or the reabsorption of ions of sodium is completely inhibited and the osmotic pressure of intracellular liquid and a reabsorption of water decreases.
Torasemid to a lesser extent, than furosemide, causes a hypopotassemia, at the same time he shows big activity and its action is more long.

Pharmacokinetics. After intake торасемид it is quickly and almost completely soaked up in digestive tract. The maximum concentration of a torasemid in plasma is noted in 1-2 hours after intake after food. Bioavailability - about 80% with insignificant individual variations.
Communication with proteins of plasma - more than 99%. The seeming volume of distribution makes 16 liters.
It is metabolized in a liver by system of P450 cytochrome with formation of three metabolites (M1, MZ and M5).
The elimination half-life of a torasemid and its metabolites at healthy volunteers makes 3-4 hours. On average about 83% of the accepted dose are removed through renal tubules: in an invariable look (24%) and in the form of preferential inactive metabolites (M1 - 12%, MZ - 3%, M5 - 41%)
At a renal failure the elimination half-life of a torasemid does not change.

Indications to use:

The hypostases caused by heart failure, diseases of a liver, kidneys and lungs.

Route of administration and doses:

Inside, once in days, after food. A therapeutic dose - 5 mg a day. If necessary the dose is increased to 20 mg a day, and in some cases to 40 mg.
Patients of advanced age do not need special selection of doses.

Features of use:

• At prolonged treatment by Diuver it is recommended to carry out control of electrolytic balance, glucose, uric acid, creatinine and lipids to blood.
• To Diuver's appointment it is necessary to carry out correction of water and electrolytic balance.
• To take at gout or tendency to increase in level of uric acid with caution. Recognize by this reference as Diuver is combined with drugs furosemide and верошпирон.
• In the presence of a diabetes mellitus of type 1 or 2 it is necessary to control glucose level in blood.

Influence on ability to drive the car and dangerous mechanisms
During treatment by Diuver patients have to abstain from driving and occupation the types of activity demanding concentration of attention.

Side effects:

From blood: in some cases changes of a picture of blood can be noted: decrease in number of erythrocytes, leukopenia, thrombocytopenia.
From cardiovascular system: in some cases, because of a pachemia, there are circulatory disturbances and a thrombembolia, a lowering of arterial pressure.
From a digestive tract: various dysfunctions of a digestive tract, appetite loss, dryness in a mouth; seldom - pancreatitis.
From kidneys and urinary tract: with obstruction of urinary tract can cause an ischuria in patients; sometimes - increase in levels of urea and creatinine.
From the central nervous system: headache, dizziness, weakness, drowsiness, confusion of consciousness, spasm, and also paresthesia of extremities.
From a liver: increase in activity of "hepatic" enzymes can be noted.
Change of laboratory indicators: a hypovolemia, disturbances of water and electrolytic balance, a hypopotassemia, increase in level of uric acid in blood serum, a hyperglycemia and a lipidemia.
Allergic reactions: skin itch, rashes and photosensitization.
From sense bodys: vision disorders, sonitus, deafness.

Interaction with other medicines:

• Torasemid increases sensitivity of a myocardium to cardiac glycosides at a hypopotassemia and a hypomagnesiemia;
• at a concomitant use with mineralo-and glucocorticoids, purgatives potassium removal can increase;
• strengthens action of antihypertensives;
• торасемид, especially in high doses, can strengthen nefro-and ototoksichesky effects of antibiotics of group of aminoglycosides. toxicity of drugs of Cisplatinum, nephrotoxic effects of cephalosporins and kardio-and neurotoxic effects of drugs of lithium;
• торасемид can strengthen action of kuraresoderzhashchy muscle relaxants and theophylline;
• at use of high doses of salicylates their toxic action can amplify;
• торасемид can reduce efficiency of hypoglycemic (antidiabetic) means;
• the consecutive or concomitant use of a torasemid with inhibitors of the angiotensin-converting enzyme (ACE) can lead to passing falling of the ABP. It can be avoided, having reduced an initial dose of APF inhibitor or having lowered a dose of a torasemid (or having temporarily cancelled it);
• non-steroidal anti-inflammatory drugs and пробеницид can reduce diuretic and hypotensive action of a torasemid.
• Colestyraminum can reduce absorption of a torasemid from a GIT (according to preclinical studying at animals).

Contraindications:

• hypersensitivity to a torasemid and sulfonamides; anury;
• hepatic coma and prekomatozny state;
• a renal failure with the accruing azotemia;
• arterial hypotension;
• arrhythmias;
• pregnancy;
• the lactation period (there are no data on use in the period of a lactation);
• age up to 18 years (efficiency and safety are not established)

With care: at predisposition to a hyperuricemia, gout, at the hidden and expressed diabetes mellitus.

Overdose:

Symptoms - there is no typical picture of poisoning.
At overdose - the forced urination which is followed by a hypovolemia disturbance of electrolytic balance with the subsequent falling of arterial pressure, drowsiness and confusion of consciousness, a collapse. Gastro intestinal frustration can be observed. There is no specific antidote. The symptomatic treatment assumes a dose decline or drug withdrawal and at the same time completion of losses of liquid and electrolytes.

Storage conditions:

At a temperature not above 30 °C, in the place, unavailable to children. Period of validity 2 years. Not to use after the date specified on packaging.

Issue conditions:

According to the recipe

Packaging:

Tablets on 5 mg and 10 mg. On 10 tablets in the blister from a film (PVH/PVDH) and aluminum foil. On 2 or 6 blisters together with the application instruction in a cardboard pack.