"Torasemide" is a modern powerful diuretic drug, which is excellent for long-term treatment of diseases associated with the appearance of edema. Due to fewer clinically important side effects, the breadth of its therapeutic use is greater. It is safer than other loop diuretics and has more indications. In the treatment of various diseases, its dosage is modified. It is also applicable in cases of insufficient renal function, even at low filtration rates with nephron glomeruli.
Effects of Torasemide
"Torasemide" as a representative of a group of loop (salt) diuretics acts in the luminal part of the epithelium of the tubules of the nephron in the area of the ascending loop of Henle. By inhibiting the joint transport of potassium, chlorine and sodium ions, it significantly reduces the electrochemical potential on the surface of the nephron epithelium. The result of the blockade of ion transport is a violation of the reverse absorption of sodium from primary urine, which increases diuresis.
Almost all loop diuretics cause electrolyte disturbances due to the strong influence on the reabsorption of potassium, sodium, magnesium and chlorine ions. "Torasemide" to a lesser extent affects the excretion of potassium and magnesium, which is why it is much less likely to cause arrhythmias, anorexia, constipation, muscle weakness. Also, the drug weakly blocks the formation of thromboxane A2, dilating blood vessels. It also blocks the myocardial aldosterone receptors, inhibiting the processes of fibrosis of the heart muscle.
Indications
The instructions for use attached to the “Torasemide” preparation contain information about the diseases for the treatment of which it is used. "Torasemide" is indicated for:
- pathogenetic treatment of arterial hypertension resistant to therapy with combinations of ACE inhibitors (ARBs) with thiazide diuretics;
- treatment of chronic heart failure associated with overload of blood circulation;
- symptomatic treatment of chronic kidney failure, including at a low filtration rate (less than 20 ml / min);
- symptomatic treatment of hepatic (associated with hypoalbuminemia) edema as an alternative to Furosemide.
With arterial hypertension "Torasemide", analogues and its generics are used only with the ineffectiveness of thiazide diuretics. And with renal failure, the drug can be prescribed for a long time due to the small number of clinically important and dangerous side effects. Those of Torasemide are much less than those of Furosemide.
Instructions for use
Based on clinical recommendations for the drug "Torasemide", the instructions for use contain the characteristics of the dosages of the drug required for the correction and treatment of the target disease. Moreover, the drug itself is available in tablets with the following substance content: 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg, 100 mg, 200 mg.
The drug is taken on a tablet in the morning, regardless of food. For these dosages of the drug "Torasemide" the price is different: it is lower at the minimum dose and the highest at the maximum. According to average data, 30 tablets of 5 mg each cost about 400 rubles. In this case, the dose is distributed as follows according to the indications:
- in the treatment of hypertension, 2.5 to 10 mg / day is taken;
- in chronic heart failure, 10-20 mg / day is taken;
- in chronic renal failure - 50 mg or more;
- with liver failure, an individual dose selection is required.
Side effects of "Torasemide"
The instructions for use attached to the “Torasemide” preparation contain information about multiple side effects. At a therapeutic dose, that is, up to 200 mg per day, the risk of developing thromboembolic complications, ischemia of the heart, and the brain increases. The risk of transient ischemic attack and myocardial infarction, pulmonary thromboembolism, and arrhythmia increase. There is also the possibility of allergic rashes or hives with a patient's predisposition.
"Torasemide" sometimes causes nausea or vomiting, rarely mediates dyspeptic symptoms, diarrhea. Isolated cases of the development of pancreatitis with the use of "Torasemide" are described. Hepatic transaminases also increase, which indicates hepatic toxicity of the drug in high doses. Sometimes patients are disturbed by tinnitus, visual impairment.
When taken in a toxic dose, an overdose condition develops with a small number of symptoms. An overdose is accompanied by a loss of fluid in the urine: diuresis is long and frequent, hypotension, vascular collapse, fainting, and stroke against the background of cerebral ischemia are possible.
Contraindications and limitations of use
The drug "Torasemide", analogues and its generics cannot be used in the presence of absolute contraindications. These are allergic reactions to the drug or binders. "Torasemide" is forbidden to use in case of renal failure with anuria, with liver failure in the state of hepatic coma, with tachyarrhythmias. Reception during lactation and pregnancy, as well as under the age of 18 years, hypersensitivity to sulfonamides is contraindicated.
Side and combined effects of "Torasemide"
In the treatment of hypertension, Torasemide tablets can have a negative effect on the course of gout. Since the active substance enters the proximal tubules of the nephron by active transport, competitive inhibition of uric acid excretion occurs. Against the background of the use of “Torasemide” there is a high probability of hyperuricemia and exacerbation of the course of gout.
The drug “Torasemide” is characterized by a specific effect on the tubular epithelium of the proximal portion of the Henle loop. Due to the strong diuretic effect and electrolyte imbalance, this leads to the likelihood of clinically important pharmacological interactions. They are dangerous, insignificant and desirable. Among the dangerous and significant include:
- the use of high doses (from 50 mg / day) of “Torasemide” when used together with platinum preparations enhances the toxicity of the latter;
- large doses of “Torasemide” (from 50 mg / day) enhance the nephrotoxic and ototoxic effect of aminoglycoside antibiotics;
- cephalosporin antibiotics when used together with “Torasemide” at a dose of 50 mg / day, the property of nephrotoxicity appears;
- salicylates together with “Torasemide” (from 50 mg / day) are characterized by neurotoxicity.
- “Torasemide” against the background of relative hypokalemia enhances myocardial susceptibility to cardiac glycosides, increasing their inotropic and antiarrhythmic effect, increasing the risk of intoxication;
- the risk of hypokalemia increases with the combined use of "Torasemide" with corticosteroids or saline laxatives;
- “Torasemide” enhances the effect of “Theophylline” and curariform muscle relaxants.
Desired sharing effects
Of the desired effects requiring control, there remains a decrease in blood pressure during therapy with ACE inhibitors. "Torasemide" due to the removal of fluid reduces hydrostatic blood pressure , mediating a drop in blood pressure. This aspect is important in the treatment of hypertension and requires dose adjustment of ACE inhibitors. Moreover, in the treatment of therapy-resistant hypertension, the combination of ACE inhibitors and “Torasemide” allows to achieve normalization of blood pressure in 90% of patients.
In the treatment of chronic heart failure, the effect of reducing the vasoconstrictor activity of catecholamines is clinically important. The heart on the background of the diuretic therapy "Torasemide" is less responsive to the stimulating signals of adrenaline and norepinephrine. However, this same effect reduces the effectiveness of epinephrine and norepinephrine during resuscitation.
Negative Interaction Effects
There are effects of inhibition of the effectiveness of drugs when combined with certain substances. In particular:
- preparations of the bile acid sequestrant group reduce the capture of “Torasemide” from the intestine, weakening the effect of the latter;
- non-narcotic analgesics (NSAIDs) reduce the effectiveness of “Torasemide”;
- "Probenecid" due to the intensification of uricosuric processes inhibits the release of "Torasemide" into the lumen of the tubules, reducing its effectiveness.
Comparative characteristics of "Torasemide"
The drug "Torasemide" analogues can be class, kinetic and generics. Among the class analogues are presented: "Furosemide", "Bumetanide", "Ethacrylic acid." Compared with Furosemide, Torasemide is characterized by a slow onset of action and a longer effect with a corresponding increase in diuresis. Having a diuretic effect of almost the same strength as Furosemide, Torasemide has fewer side effects associated with rapid electrolyte imbalance.
“Bumetanide” is characterized by an even stronger diuretic property, which is associated with a large number of side effects. Ethacrinic acid has a lower rate of onset of the diuretic effect and remains a rarely used drug. In the pharmacokinetics of the drug "Torasemide" reviews of experts highlight another important point. The drug does not have the “ricochet” property: after increased urine output due to sodium excretion, there is no compensatory delay in the body.
Pharmacokinetic analogues of "Torasemide"
In the drug "Torasemide" the instruction contains information about its use in arterial hypertension. Along with this drug, thiazide and potassium-sparing diuretics are also used for the treatment of hypertension. Moreover, thiazide ones are the drugs of choice due to the slowly onset and prolonged diuretic effect.
In connection with these pharmacokinetic characteristics of the analogues, for the preparation of “Torasemide” the use may be as follows: treatment of hypertension resistant to therapy with standard combinations of ACE inhibitors (or angiotensin receptor blockers) with thiazides. Also, "Torasemide" is used in the treatment of chronic kidney failure with reduced filtration capacity.
Generic Torasemide
The drug "Torasemide" instructions for use, analogues, indications and contraindications entirely characterize its main effect - increased urine output. Moreover, the original drug and its generics have such an effect. The latter contain the same amount of “Torasemide”, but are released under other trade names.
The most famous are: Britomar, Diuver, Torasemid Sandoz, Trifas, Torsid, Trigrim. In the course of numerous trials of pharmacological preparations in Russia, there were no significant differences between them. Each of the above drugs fully replaces the other of them.
Economic aspects of treatment with "Torasemide"
In the treatment of arterial hypertension, when thiazide diuretics are ineffective in combination with ACE inhibitors (or with ARBs), treatment with Torasemide may be prescribed: the instructions for use argue a single dose during the day. The monthly cost of treatment is about 400 rubles at a price of 60 tablets of the drug about 760-800 rubles. For comparison: the monthly price of treatment with Furosemide rarely exceeds 20 rubles. But for the permanent treatment of hypertension, the latter is of little use.
In chronic heart failure with edema in both circles of blood circulation, the cost of a monthly treatment with Furosemide is about 20-30 rubles. The drug "Torasemide" price is 10-15 times higher. Moreover, the latter has a mild effect, that is, it slightly increases urination in the first hours of admission. “Furosemide” has the opposite characteristics: it significantly increases the amount of urine in the first two hours with a gradual weakening of urine output.
As a result, it is reasonable for able-bodied patients with hypertension or with chronic kidney or blood circulation insufficiency to use “Torasemide”, the instruction (the price of which is indicated above) on the use of which does not contain information on a significant increase in diuresis at the first time of administration. However, in patients of retirement age, due to the lack of the need to come to work, the rate of urine output is practically unimportant. This does not create difficulties, and therefore allows you to accept a cheap class analogue - "Furosemide".