Torasemide Valium 5mg 30 pcs medisrb

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Torasemide Valium 5mg 30 pcs medisrb

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Description

Composition
Active substance:
Torasemide 5.0 mg
Excipients:
monohydrate lactose (milk sugar), potato starch, talc, magnesium stearate.
Description:
Valium round tablets White or almost white, scored on one side and a chamfer on two sides.
Product form:
Tablets of 5 mg.
10 tablets in blisters of PVC film and aluminum foil printed patent.
Or
30 tablets in plastic jars with a lid.
Each jar or 3 blisters together with instructions for use placed in a pile of cardboard boxed.
Contraindications
– increased sensitivity of torasemide or to any component of the drug;
– allergic to sulfonamides (sulfanilamide antimicrobials or sulfonylurea);
– anuric renal failure;
– hepatic coma and / or precoma;
– severe hypokalemia / hyponatremia;
– hypovolemia (arterial hypotension or without) or dehydration;
– pronounced violations of the outflow of urine from any cause (including unilateral urinary tract disease);
– glycoside intoxication;
– acute glomerulonephritis;
– decompensated aortic and mitral stenosis;
– hypertrophic obstructive cardiomyopathy;
– increase central venous pressure (above 10 mm Hg);
– hyperuricemia;
– the period of breast-feeding;
– the age of 18 years (safety and efficacy not studied);
– lactose intolerance, lactase deficiency or glucose-galactose malabsorption.
Be wary – hypotension;
– stenosing atherosclerosis of the cerebral arteries;
– hypoproteinemia;
– hypokalemia;
– hyponatremia;
– predisposed to hyperuricemia;
– violation urine outflow (benign prostatic hyperplasia, or narrowing of the urethra hydronephrosis);
– ventricular fibrillation in history;
– acute myocardial infarction (increased risk of cardiogenic shock);
– diarrhea;
– pancreatitis;
– diabetes mellitus (impaired glucose tolerance);
– hepatorenal syndrome;
– gout;
– anemia;
– pregnancy.
Dosage
5 mg
Indications
– edematous syndrome of various genesis, including chronic heart failure, liver, lung and kidney;
– arterial hypertension.
Interaction with other drugs
Torasemide concentration and increases the risk for nephrotoxic and ototoxic action cephalosporins, aminoglycosides, chloramphenicol, ethacrynic acid, cisplatin, amphotericin B (due to competitive renal excretion).
It increases the efficiency of diazoxide and theophylline reduces – hypoglycemic agents, allopurinol.
Pressor amines and torasemide mutually reduce efficiency.
Drugs that block tubular secretion, increase the concentration in plasma of torasemide.
With simultaneous application of torasemide with corticosteroids, amphotericin B increased risk of hypokalemia, with cardiac glycosides – increases the risk of glycoside intoxication due to the development of hypokalemia (for high and low polarity) and prolongation of half-life (for low polarity).
Reduces the renal clearance of lithium and drugs increases the risk of intoxication.
Nonsteroidal anti-inflammatory drugs (NSAIDs), sucralfate reduce diuretic effect by inhibiting the synthesis of prostaglandin (PG), disorders of the renin activity in blood plasma and excretion of aldosterone.
It enhances the antihypertensive effect of antihypertensive drugs, neuromuscular blockade depolarizing muscle relaxants (suxamethonium) and reduces the effect of non-depolarizing muscle relaxants (tubocurarine).
Simultaneous treatment with large doses of salicylates on the background of torasemide therapy increases the risk of manifestation of their toxicity (because of competitive renal excretion).
The sequential or simultaneous application of torasemide with inhibitors of angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor antagonists may lead to marked decrease in blood pressure. This undesirable reaction can be prevented by reducing the dose of torasemide or temporarily suspend it.
Simultaneous application of torasemide with probenecid or methotrexate may reduce the effectiveness of torasemide (same secretory pathway). On the other hand torasemide may reduce renal elimination of these drugs.
With simultaneous application of torasemide and increases the risk of cyclosporin gouty arthritis because the cyclosporin may cause disruption of the kidney urate excretion and torasemide – hyperuricemia.
It has been reported that patients with a high risk of developing nephropathy, taking into torasemide, the introduction of contrast media renal dysfunction was observed more frequently than in patients at high risk of developing nephropathy, which before the introduction of contrast media were performed intravenous hydration.
Overdose
Symptoms: excessive diuresis, accompanied by a decrease in blood volume and blood electrolyte balance violation, followed by a pronounced decrease in blood pressure, somnolence and confusion, collapse. gastrointestinal disorders may be observed.
Treatment: No specific antidote. Provocation of vomiting, gastric lavage, activated charcoal. Treatment is symptomatic, dose reduction or removal of the drug, while replenishing the circulating blood volume and performance of water-electrolyte balance and acid-base status under the control of serum concentrations of electrolytes and hematocrit.
Hemodialysis is not effective.
pharmachologic effect
Pharmacological group:
diuretic
Pharmacodynamics:
Torasemide is a “loop” diuretics. The maximum diuretic effect develops after 2-3 hours after ingestion of the drug. The main mechanism of action of the drug due to the reversible binding of torasemide with sodium / chlorine / potassium kontransporterom located in the apical membrane of the thick ascending loop of Henle segment, the resulting reduced or completely inhibited reabsorption of sodium ions and decreases the osmotic pressure of the intracellular fluid and water reabsorption. Torasemide infarction blocking aldosterone receptors, reduces fibrosis and improves myocardial diastolic function.
Torasemide less than furosemide causes hypokalemia, wherein it exhibits higher activity and its action for a longer time.
The use of torasemide is an appropriate choice for a long-term therapy.
Pharmacokinetics:
Suction
After oral torasemide is rapidly and almost completely absorbed in the gastrointestinal tract (GIT). The maximum concentration (Cmax) in plasma torasemide observed 1-2 hours after oral administration after meals. Bioavailability – 80-90% with slight individual variations.
The diuretic effect is maintained up to 18 hours, which facilitates the portability of therapy due to lack of very frequent urination during the first hours after ingestion of the drug, which limits patient activity.
Distribution
More than 99% of torasemide is bound to plasma proteins. Apparent volume of distribution of 16 l.
Metabolism
It is metabolized in the liver with the participation of cytochrome P450 isoenzymes. As a result of successive oxidation reactions, hydroxylation or three ring hydroxylation formed metabolite (M1, M3 and M5) that bind to plasma proteins by 86%, 95% and 97% respectively.
breeding
The half-life (T1 / 2) of torasemide and its metabolites is 3-4 hours and did not change with chronic renal failure.
Total clearance of torasemide is 40 ml / min and renal clearance – 10 ml / min. On average about 83% of the administered dose excreted by the kidneys: in unmodified form (24%) as a predominantly active metabolites (M1 – 12%, M3 – M5 3% – 41%.).
Pharmacokinetics in specific patient groups:
Renal failure:
In renal insufficiency T1 / 2 does not change the half-life of M3 and M5 metabolites increases. Torasemide and its metabolites are not significantly excreted in hemodialysis and hemofiltration.
Liver failure:
In hepatic insufficiency in blood plasma concentration of torasemide is increased due to a decrease in hepatic metabolism of the drug. In patients with cardiac or hepatic insufficiency T1 / 2 of torasemide and metabolite M5 significantly increased drug accumulation is unlikely.
Pregnancy and breast-feeding
Torasemide not teratogenic and fetotoxic, crosses the placental barrier, causing disturbances of water and electrolyte metabolism and thrombocytopenia in the fetus.
Torasemide during pregnancy can only be used when the benefit to the mother outweighs the possible potential risk to the fetus, only under medical supervision and only in minimal doses.
Information on the allocation of torasemide in breast milk is not, so if you need to use the drug must stop breastfeeding.
Conditions of supply of pharmacies
Prescription vacation
side effects
Adverse reactions are listed according to the anatomical and physiological classification and frequency of occurrence.
The frequency of adverse reactions listed below, was determined according to the following (World Health Organization): very often> 1/10, often> 1/100 and
special instructions
The drug should be used strictly under doctor’s prescription.
Patients with hypersensitivity to sulfonamides and sulfonylureas can be cross-sensitivity to torasemide.
Patients receiving high doses of the drug over a long period of time, to avoid the development of hyponatremia, hypokalemia, metabolic alkalosis and recommended a diet sufficient content of salt. For the prevention of hypokalemia recommended to use potassium preparations, as well as a diet rich in potassium.
Increased risk of violations of water-electrolyte balance observed in patients with renal insufficiency.
During the course of treatment is necessary to periodically monitor the concentration of electrolytes in blood plasma (including sodium, calcium, potassium, magnesium), acid-base balance, residual nitrogen, creatinine, uric acid, and carry out the appropriate corrective therapy (with higher magnification, if necessary in patients with frequent vomiting and amid parenterally administered fluids).
When new or worsening azotemia and oliguria in patients with severe progressive renal disease is recommended to suspend treatment.
Selection dosing regimen in patients with ascites amid cirrhosis should be performed under stationary conditions (violations of water-electrolyte balance may lead to hepatic coma). These patients shows regular monitoring of plasma electrolytes.
In patients suffering from diabetes or from impaired glucose tolerance requires periodic monitoring of glucose concentrations in blood and urine.
In patients in an unconscious state, with hyperplasia of the prostate, narrowing of the ureters, urinary output should be monitored due to the possibility of acute urinary retention.
Patients, especially at the beginning of treatment and elderly patients, it is recommended to carry out monitoring of electrolyte balance.
Prolonged treatment recommended regular control electrolyte balance (especially potassium concentration), glucose, uric acid, creatinine, lipids and cellular components of blood.
Patients with diseases of the cardiovascular system, especially taking cardiac glycosides, diuretic-induced hypokalemia can cause arrhythmia.
Effects on ability to drive and operate machinery
During treatment, patients should refrain from driving and other activities potentially hazardous activities that require increased attention and psychomotor speed reactions.
Storage conditions
In a dry, dark place at a temperature not higher than 25 ° C.
Keep out of the reach of children
Dosing and Administration
Inside, once a day, after breakfast, with a little water.
Edematous syndrome of various genesis, including chronic heart failure, liver, lung and kidney
The usual therapeutic dose is 5 mg orally once daily. If necessary, the dose should be gradually increased to 20-40 mg once a day, and in some cases – up to 200 mg per day. The drug is prescribed for a prolonged period or until the disappearance of edema.
Arterial hypertension
The starting dose is 2.5 mg (2.1 to 5 mg tablets) once daily. If necessary, the dose may be increased up to 5 mg once a day.
Elderly patients No dose adjustment is required.
Information
Appearance may differ from that depicted in the picture. There are contraindications. You need to read the manual or consult with a specialist

Additional information

Weight0.100 kg
Manufacturer

Medisorb

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