"Torasemide" is a modern powerful diuretic drug that is great for long-term therapy of diseases associated with the appearance of edema. Due to the smaller number of clinically important side effects, the breadth of its therapeutic application 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 renal insufficiency, even with a low glomerular filtration rate of nephrons.
Effects of "Torasemide"
"Torasemide" as a representative of the group of loop (s alt) diuretics acts in the luminal part of the epithelium of the nephron tubules in the area of the ascending loop of Henle. By exerting an inhibitory effect on the joint transport of potassium, chloride and sodium ions, it significantly lowers the electrochemical potential on the surface of the nephron epithelium. Blockade of ion transport results in reabsorptionsodium from primary urine, which increases diuresis.
Almost all loop diuretics cause electrolyte disturbances due to the strong effect on the reabsorption of potassium, sodium, magnesium and chlorine ions. "Torasemide" to a lesser extent affects the release of potassium and magnesium, which is why it causes arrhythmias, anorexia, constipation, and muscle weakness much less often. Also, the drug to a weak extent blocks the formation of thromboxane A2, dilating the vessels. It also blocks myocardial aldosterone receptors, inhibiting the processes of fibrosis of the heart muscle.
Indications
The instructions for use attached to the drug "Torasemide" 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 circulatory overload;
- symptomatic treatment of chronic kidney failure, including low filtration rate (less than 20 ml/min);
- symptomatic treatment of hepatic (associated with hypoalbuminemia) edema as an alternative to Furosemide.
In case of arterial hypertension "Torasemide", analogues and its generics are used only when thiazide diuretics are ineffective. And in case of renal failure, the drug can be prescribed for a long time due to the small number of clinically important and dangerous side effects. Torasemide has significantly fewer of them than Furosemide.
Instructions for use
Based on the clinical recommendations for Torasemide, the instructions for use contain the characteristics of the drug dosages required for the correction and treatment of the target disease. Moreover, the drug itself is available in tablets with the following content of the substance: 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg, 100 mg, 200 mg.
The drug is taken in 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 the drug, 5 mg each, cost about 400 rubles. In this case, the doses of administration are distributed as follows according to the indications:
- in the treatment of arterial hypertension, 2, 5 - 10 mg / day are taken;
- for chronic heart failure, 10-20 mg/day is taken;
- for chronic renal failure - 50 mg or more;
- in case of liver failure, an individual dose adjustment is required.
Side effects of Torasemide
The instructions for use attached to the Torasemide preparation contain information about multiple side effects. In a therapeutic dose, that is, up to 200 mg per day, the risk of developing thromboembolic complications, ischemia of the heart and brain increases. The risk of transient ischemic attack and myocardial infarction, pulmonary embolism, arrhythmia increases. There is also a possibility of allergic rashes or urticaria with a predispositionpatient.
"Torasemide" sometimes causes nausea or vomiting, rarely mediates dyspeptic symptoms, diarrhea. Isolated cases of the development of pancreatitis are described against the background of the use of Torasemide. Hepatic transaminases also increase, which indicates liver toxicity of the drug in high doses. Sometimes patients are worried about tinnitus, visual impairment.
When taken at a toxic dose, an overdose condition develops with few symptoms. An overdose is accompanied by a loss of fluid in the urine: diuresis is long and frequent, hypotension, vascular collapse, syncope, stroke against the background of cerebral ischemia may develop.
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 prohibited for use in renal failure with anuria, in liver failure in a state of hepatic coma, with tachyarrhythmias. Contraindicated in lactation and pregnancy, as well as under the age of 18, hypersensitivity to sulfonamides.
Side and combined effects of Torasemid
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 the release of uric acid occurs. Against the background of use"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 section of the loop of Henle. 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. Dangerous and significant include:
- use of high doses (from 50 mg/day) "Torasemide" when used together with platinum drugs increases the toxicity of the latter;
- large doses of Torasemide (from 50 mg/day) enhance the nephrotoxic and ototoxic effect of aminoglycoside antibiotics;
- in 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 when Torasemide is used together with corticosteroids or saline laxatives;
- "Torasemide" enhances the effect of "Theophylline" and curariform muscle relaxants.
Desired joint effects
Of the desired effects that require control, there remains a decrease in blood pressure bybackground of therapy with ACE inhibitors. "Torasemide" by removing fluid reduces the hydrostatic pressure of the blood, mediating the fall 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 makes it possible to achieve normalization of blood pressure in 90% of patients.
In the treatment of chronic heart failure, the effect of reducing the vasoconstrictive activity of catecholamines is clinically important. The heart on the background of diuretic therapy with Torasemide responds weaker to the stimulating signals of adrenaline and norepinephrine. However, the same effect reduces the effectiveness of epinephrine and norepinephrine in resuscitation.
Negative interaction effects
There are effects of inhibiting the effectiveness of drugs when used together with certain substances. Specifically:
- drugs of the group of bile acid sequestrants reduce the uptake of Torasemide from the intestine, weakening the effect of the latter;
- non-narcotic analgesics (NSAIDs) reduce the effectiveness of Torasemide;
- "Probenecid" due to the enhancement 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: "Furosemide", "Bumetanide", "Ethacrynic acid". In comparison with Furosemide, Torasemide is characterized by a slowthe onset of action and a longer effect with a corresponding increase in diuresis. Providing a diuretic effect of almost the same strength as Furosemide, Torasemide has fewer side effects associated with rapid electrolyte imbalances.
"Bumetanide" is characterized by an even stronger diuretic property, which is associated with a large number of side effects. Ethacrynic acid has a slower diuretic onset 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 "rebound" property: after increased diuresis due to the release of sodium, there is no compensatory retention in the body.
Pharmacokinetic analogues of "Torasemide"
In the drug "Torasemide" instructions contain information about its use in hypertension. Along with this drug, thiazide and potassium-sparing diuretics are also used to treat hypertension. Moreover, thiazide due to the slow onset and prolonged diuretic effect are the drugs of choice.
In connection with these pharmacokinetic features of analogues, for the drug "Torasemide" use can 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 filtrationability.
Torasemide Generics
In the drug "Torasemide" instructions for use, analogues, indications and contraindications fully characterize its main effect - increased diuresis. Moreover, the original drug and its generics have such an effect. The latter contain the same amount of Torasemide, but are produced 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, no significant differences were noted 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 can be prescribed: instructions for use justify a single dose during the day. The monthly cost of treatment is about 400 rubles, while the price of 60 tablets of the drug is 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 circulations, the cost of monthly treatment with Furosemide is about 20-30 rubles. The drug "Torasemide" price is 10-15 times more. At the same time, the latter has a mild effect, that is, it slightly increases urination in the first hours of admission. At Furosemidethe characteristics are reversed: it significantly increases the amount of urine in the first two hours with a gradual decrease in diuresis.
As a result, it is reasonable for able-bodied patients with hypertension or with chronic kidney or circulatory insufficiency to use "Torasemide", the instruction (its price is indicated above) for the use of which does not contain information about a significant increase in diuresis at the first time of admission. However, in patients of retirement age, due to the absence of the need to come to work, the rate of diuresis is practically unimportant. This does not create difficulties, and therefore allows you to take a cheap class analogue - Furosemide.
