In the article, we consider the instructions for use and reviews for Britomar 5 mg. It belongs to the clinical and pharmacological group of diuretics. Britomar is produced by the manufacturer in the form of tablets with a prolonged effect. The tablets are close to white or white, biconvex, round. One side is engraved in the form of letters SN.
According to the instructions, Britomar tablets have two dosages - 5 mg, 10 mg each.
5 mg dosage The main active ingredient in Britomar is torasemide. Each tablet contains 5 mg of the main substance.
As auxiliary components are used: lactose monohydrate, magnesium stearate, colloidal silicon dioxide, corn starch, guar gum.
The drug is packed in a cardboard box, in the box there can be one or two blisters, each contains 15 tablets.
This is confirmed by the instructions for use.
Britomar 10 mg. The main active ingredient is torasemide. Each tablet contains 10 mg of the main substance.
As auxiliary components are used: lactose monohydrate, magnesium stearate, colloidal silicon dioxide, corn starch, guar gum.
The drug is packed in a cardboard box, in the box there can be one or two blisters, each contains 15 tablets.
The instruction for Britomar is very detailed.
Pharmacological action of the drug
The drug is a "loop" diuretic. The main mechanism of the effect of the medication is determined by the reversible binding of the main component (torasemide) and the cotransporter of potassium, chlorine, sodium, which are located in the apical membrane of the thickened segment of the Henle loop. The result of such binding is a decrease or complete inhibition of sodium ion reabsorption, the osmotic pressure of the intracellular fluid decreases, and water reabsorption occurs.
This is indicated in the instructions for the drug Britomar.
Compared with furasemide, torasemide causes less hypokalemia, but its activity is much greater, and the effect is longer.
The development of a diuretic effect occurs within one hour after the drug was taken orally. The maximum effect occurs after 3-6 hours, lasts for 8-10 hours.
According to the instructions, Britomar causes a decrease in systolic and diastolic blood pressure.
Pharmacokinetics of the drug
The medicine "Britomar" has a prolonged effect. It is provided through the gradual release of the active substance - torasemide. At the same time, fluctuations in the level of its content in the blood are reduced. A similar effect is not observed when taking drugs based on torasemide in the form of tablets, in which the usual release is provided.
In comparison with the usual dosage form, the bioavailability of Britomar of prolonged action after ingestion of several doses reaches 102%. Absorption of the active substance occurs in the digestive tract, there is also a limited effect of the "first passage" through the liver. Eating does not significantly affect the process and completeness of absorption of the substance. A couple of hours after taking the drug in the blood, you can observe its maximum concentration. The absorption of the drug is also not affected by impaired liver and kidney function. This is described in the instructions for Britomar 10 mg.
Almost 100% of the active substance binds to proteins in blood plasma.
The distribution of the drug in the observed healthy patients and patients with moderate and mild form of renal failure, with a chronic form of heart failure reaches 12-15 liters. In a patient with cirrhosis, the volume of distribution of the substance increases approximately twice.
Torasemide is metabolized with the participation of the CYP2C9 isoenzyme in liver tissues. As a result, three metabolites are formed.
The main metabolite is a derivative of carboxylic acid, pharmacologically inactive. Both other metabolites in the body are formed in small quantities, they have weakly expressed diuretic activity. They have a low concentration, so they do not have a significant clinical effect.
Instructions for analogues of Britomar will not be presented.
Torasemide is excreted in healthy patients after four hours. 80% is excreted by the kidneys in the form of metabolites. The remaining 20% is displayed unchanged. In this case, the renal clearance is 10 ml / min, and the total is 41 ml / min. That is, renal clearance corresponds to 25% of the total.
In special clinical cases, the pharmacokinetics of Britomar is somewhat different. Renal and hepatic clearance is slightly reduced in patients suffering from chronic heart failure. In patients with this disease, the overall clearance of torasemide is reduced by an average of 50% compared with healthy volunteers. In this case, the total bioavailability of the substance and the half-life are higher.
As the instructions for use with Britomaru 5 mg indicate, the renal clearance of the main active substance is significantly reduced in patients suffering from renal failure. It does not affect the general clearance of Britomara. If the patient has renal failure, the diuretic effect of taking Britomar is achieved by using higher doses. It is worth noting that the half-life of torasemide and the total clearance in this case remain at the same level. This effect is achieved due to metabolism in the liver tissue.
In patients diagnosed with cirrhosis of the liver, the overall clearance remains at a normal level.
When torasemide is used in elderly patients, its pharmacokinetic profile corresponds to that in young patients. An exception is renal clearance - it is reduced due to characteristic age-related renal impairment. The volume of distribution and total clearance remain unchanged.
The instruction for Britomar tablets does not end there.
Indications for use of this medication
When is it better to use it? This can be read in the instructions that are in each pack.
This drug is indicated for use in the following cases:
- Diagnosed arterial hypertension.
- Syndrome of puffiness of various origins. Including with chronic heart failure, with impaired functioning of the kidneys and liver.
Contraindications to the use of the drug
According to the instructions for use, Britomar 5 mg and 10 mg are contraindicated in patients with:
- Anuria.
- Hypersensitivity to the components that make up the drug.
- Hepatic precoma and coma.
- Allergic reactions to sulfonamides. When taking sulfonamide antimicrobials, as well as drugs containing sulfonylurea, there is a likelihood of an allergy to tosemide.
- Dehydration.
- Refractory hypokalemia, hyponatremia.
- Digitalis intoxication.
- Pronounced violations of the outflow of urine of various etymologies (including in the presence of unilateral lesions of the urinary tract).
- Acute glomerulonephritis.
- Sinotrial and AV blockade of the first and second degrees.
Also, the drug is not recommended for use in patients under the age of 18 years (since the effectiveness and safety of the drug in the treatment of children have not been studied), during pregnancy, in case of lactase deficiency, with galactose intolerance and glucose-galactose malabsorption.
Britomar should be prescribed with extreme caution to patients suffering from:
- Arterial hypotension.
- Hypovolemia, accompanied by arterial hypotension, or without it.
- Violations of the outflow of urine (hydronephrosis, narrowing of the channel of urination, benign prostatic hyperplasia).
- Diarrhea.
- Ventricular arrhythmias.
- Pancreatitis
- Acute myocardial infarction (torasemide can increase the risk of cardiogenic shock).
- Diabetes mellitus (torasemide reduces glucose tolerance).
- Liver diseases (ascites, hepatorenal syndrome, cirrhosis, renal failure).
- Hyponatremia.
- Hypokalemia.
- Anemia
- Gout, hyperuricemia.
Careful monitoring by a specialist is required during the treatment with Britomar of women during lactation, as well as in the case of simultaneous use of cardiac glycosides, cephalosporins, preparations containing aminoglycosides, corticosteroids, ACTH.
This is described in detail in the Britomaru manual.
Method of use and dosage of medication
The drug "Britomar" must be taken orally. It is necessary to swallow tablets whole, avoiding chewing and grinding. Drink plenty of water. The patient can take this medication at any constant time convenient for him, regardless of the schedule of meals.
Therapy of edematous syndrome with heart failure in a chronic form involves taking Britomar in an initial dose of 10-20 mg once a day. If necessary, the dose is adjusted twice to achieve the desired effect.
Therapy of edematous syndrome with renal dysfunction involves taking Britomar in an initial dose of 20 mg once a day. To obtain the desired effect, the dose can be doubled.
Therapy of edematous syndrome with liver dysfunction involves taking the drug in an initial dosage of 5-10 mg once a day. Reception "Britomar" in this case should be combined with the use of aldosterone antagonists or potassium-sparing diuretics. If necessary, the dose can be adjusted by doubling it. Experts do not recommend consuming more than 40 mg of the drug at one time, since the effect of this dose has not been studied. The drug should be taken for a long time or until the desired effect is achieved and the swelling disappears.
Therapy of arterial hypertension should begin with a minimum recommended dose of 5 mg per day. If within 1-1.5 months an adequate decrease in blood pressure is not observed, the dosage should be increased to 10 mg. In the absence of the desired effect when taking such a dose, therapy should be supplemented by taking antihypertensive drugs of another group.
Dose adjustment in the treatment of elderly patients is not required.
Skipping the next dose of the drug does not involve taking a double dose. The missed dose of Britomar should be taken immediately as soon as they are remembered, and the next dose the next day at the usual time.
Side effects when taking the drug
In accordance with the instructions for "Britomaru", the drug is able to cause some side effects from various organ systems and organs.
Quite often, the nervous system reacts to taking the drug with the occurrence of dizziness, headache, drowsiness. In rare cases, leg cramps, fainting, confusion, paresthesia in the limbs occur.
Metabolism: polydipsia, hypertriglyceridemia, hypercholisterinemia.
The cardiovascular system can respond in rare cases with extrasystole, tachycardia, palpitations, facial flushing, excessive arterial hypotension, deep vein thrombosis, thromboembolism, hypovolemia.
On the part of the respiratory system in rare cases, there is such a side effect as nosebleeds.
Gastrointestinal tract: a fairly common occurrence - diarrhea; in rare cases, abdominal pain, dyspeptic reactions, pancreatitis, loss of appetite, vomiting, nausea, flatulence are manifested.
This can be confirmed by the instructions for use with Britomaru.
Urinary system: quite often the frequency of urination increases, nocturia, polyuria develops. In rare cases, there is an increased concentration of creatinine and urea in the blood, urinary retention occurs, urge to urinate becomes more frequent.
The sensory organs can respond to Britomar with a visual impairment, ringing in the ears, hearing loss, usually reversible.
Skin: rash and itching, photosensitivity.
In laboratory studies, in rare cases, there is an increased number of platelets, hypokalemia, hyperuricemia, hyperglycemia, a reduced number of platelets, leukocytes, erythrocytes, a slight increase in blood activity of alkaline phosphatase, increased activity of individual (for example, GGT) liver enzymes, metabolic alkalosis, hypochloraemia, hyponatra.
Among the general reactions of the body are asthenia (general exhaustion), thirst, weakness, increased fatigue, nervousness, and hyperactivity.
If any side effect from taking Britomar is aggravated, or if any other negative reaction is detected, the patient should immediately inform his attending physician about it.
What else can we tell us the instructions for use with Britomar tablets?
Drug overdose
In case of overdose with this medication, the following symptoms are observed: diuresis increases excessively, accompanied by a decrease in bcc, disturbances in the electrolyte composition of the blood. Subsequently, there is a pronounced decrease in blood pressure, drowsiness, confusion, collapse. In some cases, with an overdose, gastrointestinal upset is noted.
Currently, a specific antidote is unknown to medicine. If symptoms of an overdose of the drug are found, it is necessary to provoke vomiting, rinse the stomach immediately and take the recommended dose of activated charcoal. Symptomatic treatment should be carried out, the dose of the medication taken should be reduced, or the treatment should be canceled altogether, replenishment of the BCC, water-electrolyte balance should be made.
The hemodialysis procedure in case of an overdose is ineffective, since there is no accelerated elimination of torasemide, its metabolites.
Instructions for use with Britomaru are included in each pack.
Drug interaction with other agents
Torasemide in the composition of the drug leads to a significant increase in the toxicity of cardiac glycosides.
The simultaneous use of Britomar with laxatives, glucocorticoids causes increased excretion of potassium.
With the simultaneous administration of torasemide and antihypertensive drugs, the effect of the latter increases significantly.
High doses of torasemide can enhance the ototoxic and nephrotoxic effects of aminoglycoside drugs, atibiotics, cephalosporin-containing medicines, and platinum-containing drugs.
Torasemide enhances the effects of theophylline and curariform muscle relaxants.
The simultaneous use of high doses of salicylates with Britamar enhances their toxicity.
Torasemide has a weakening effect on the effect of hypoglycemic drugs.
The simultaneous and sequential use of the drug and ACE inhibitors leads to a short-term decrease in blood pressure. This phenomenon can be avoided by prescribing a lower initial dose of an ACE inhibitor or by reducing the dosage or temporarily discontinuing torasemide.
The diuretic and hypotensive effect of torasemide is reduced by taking probenecid and NSAIDs.
The bioavailability of torasemide and, as a result, its effectiveness decreases with the combined use of drugs containing colestyramine.
Torasemide significantly increases the toxicity of lithium preparations, the ototoxicity of ethacrine acid.
So says the instructions for use with Britomar tablets.
Special instructions for therapy
Start therapy with the use of the drug "Britomar" should be exclusively prescribed by a specialist.
In patients with sensitivity to sulfonamides when taking Britomar, cross-sensitivity to tosemide may be observed. At the beginning of drug therapy, as well as in the treatment of elderly patients, it is recommended to control the electrolyte balance, blood concentration and volume.
Long-term use of the drug involves regular monitoring of the level of potassium, uric acid, lipids, creatinine, glucose, cellular composition and the total electrolyte composition of the blood.
According to the instructions for use with Britomaru 5 mg, in order to prevent the development of metabolic alkalosis and hyponatremia, patients taking the drug in high doses should not reduce the amount of salt consumed.
The greatest risk of hypokalemia is observed with cirrhosis and severe diuresis, as well as in people who consume insufficient amounts of electrolytes with food. A similar situation is observed with complex therapy using ACTH and cortisteroids.
The Britomara 5 mg instruction reports that there is an increased risk of disturbing the water-electrolyte balance in renal failure. ( , , , ), , , , . . , , . «».
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Drug Analogs
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- "Torasemide."
- "Diuver."
The following medicines belong to analogues in the pharmacological group (diuretics and diuretics): Espiro, Furosemide, Fitonefrol, Urological collection, Torasemide, Sinepres, Oxodolin, Nebilong N, “ Moduretic, Lorvas, Lesfeflan, Lespenefril, Christepin, Kanefron N, Indapres, Indap, Diacarb, Hydrochlorothiazide, Veroshpiron, Brinalds, Arifon retard "," Arindap "," Akripamide "," Tsimalon "," Furon "," Fitolizin "," Triamtel "," Spironolactone "," Retapres "," Normatens "," Urea "," Mannitol "," Lespefril " , Lespenephril, Indapsan, Indalamide, Diuver, Hypothiazide, Veroshpilactone, Acetazolamide, Arifon, Aldacton.
A doctor should choose a replacement for the medication, self-medication is unacceptable.
Terms, storage conditions of the drug
According to the instructions for the Britomar preparation, it must be stored in a dark place inaccessible to children. Store at a temperature not exceeding 30 degrees Celsius. Subject to storage conditions, the drug retains its properties for 3 years from the date of release. After the expiration date, the use of the drug is not recommended. This is fraught with consequences.
We reviewed the Britomaru manual.
Reviews about the drug
Reviews about this drug are quite rare. However, patients taking Britomar report that the drug is acting rather slowly, its effect develops every day. This is explained by the presence of a prolonged-action drug.
Quite often, complaints have been received that increasing the dose of the drug causes such a side effect as dehydration - there is an accelerated loss of fluid due to increased sodium excretion. A similar side effect has all loop diuretics. In patients, this manifested itself in the form of heart palpitations, dizziness, fainting. General dehydration provoked a decrease in skin turgor and dry mouth. Most doctors in such cases recommend discontinuation of the drug and an increase in the amount of fluid and sodium chloride consumed.
That is, if any side effects occur, you should immediately contact a specialist.
It is generally accepted that the form of the drug with a slow release of the active substance is most acceptable, since it limits the patient’s activity less and is suitable for prolonged use. Patients tolerate the drug well if it is used for long courses and in small doses.
The article presented instructions for use and reviews of Britomar 5 mg and 10 mg.