Description overdue on 04/07/2014
- Latin name: Diuver
- ATC code: C03CA04
- Active substance: Torasemide (Torasemide)
- Manufacturer: Pliva Hrvatska d.o.o. (Republic of Croatia)
- Composition
- Product form
- Pharmacological action
- Pharmacodynamics and pharmacokinetics
- Indications Diuvera
- Contraindications
- Side effects
- Diuver, instructions for use (method and dosage)
- Overdose
- Cooperation
- Terms of sale
- Storage conditions
- Shelf life
- Analogs
- Synonyms
- During pregnancy (and lactation)
- Reviews
- Price, where to buy
Composition
In addition to the active component torasemide , Which may be in Dosage 5 or 10 mg depending from forms of release, in structure medicament are present following auxiliary substances (mass fraction contains the respectively amount of active component):
- lactose monohydrate - 58, 44/116, 88 mg;
- cornstarch - 14, 56/29, 12 mg;
- Sodium carboxymethyl - 0, 8/1, 6 mg;
- anhydrous silica - 0, 6/1, "mg;
- magnesium stearate - 0, 6/1, 2 mg.
Product form
Tablets are milky-white, round shaped, biconvex with beveled on one side and a digital engraving on the other, which varies depending on the dosage of the main active ingredient. Mass part 5 mg torasemide It corresponds to digit 915, as well 10 mg - 916 on the reverse pills.
Marketed pharmaceutical blister packs from plastic film and aluminum foil, in each such circuit 10 tablets. The cardboard box contains two plates (20 pieces in a box).
Pharmacological action
Diuver (INN - Diuver ) - A diuretic drug group loop mochestimuliruyuschih substances, ie main action medicament is directed to loop of Henle (one of the main components of the structural units of the kidney - nephron ). The predominant pharmacological effects - reuptake inhibition of sodium ion and chlorine Upstream knee hinge, that is a decrease in the osmotic performance intracellular fluid. As a result of inhibited renal reabsorption of water It increases daily diuresis and excess fluid removed from the body.
The mechanism of action of the pharmaceutical preparation is produced by block ion transporters in the top part of the ascending (another name for the segment - thick) of the loop of the nephron. Also, it is blocked receptors aldosterone Located in the heart muscle. This allows further increase the excretion of water As adrenal hormone has no effect on the way stimulating the reabsorption of liquid.
Cardiac effects allow normalize diastolic function By preventing an overload high volume (main pathophysiological cause of heart valve insufficiency and subsequent hypertrophy of the heart). By lengthening the cycle of attack and a longer diastole decreases fibrosis and sclerotherapy muscle internal pump.
Diuver also can act as antihypertensive drug Because the effect of torasemide, the main active component is implemented by reduce peripheral vascular resistance (transloading component leads to increased heart work and, consequently, improve Blood Pressure ). The mechanism of this action is to stimulating the activity of potassium ions a layer of smooth muscle cells of the vascular bed, thereby reducing the response to exposure to biological wall compressors (endogenous substances, such as catecholamines or vasopressin , Posterior pituitary hormone).
It should be noted that Torasemide , as thiazide diuretic It has a number of advantages in comparison with the main pharmaceutical formulations of the action - Furosemide :
- to a lesser extent developing a pathological condition as hypokalemia ;
- Activity based medicament torasemide above;
- effect exerted Diuverom, longer, allowing prolonged conservative treatment with this drug.
Pharmacodynamics and pharmacokinetics
Diuver accepted orally Quickly and relatively complete ( bioavailability the drug is 80-90 percent , Depending from individual singularities organism) is adsorbed from the gastrointestinal-intestinal tract. Maximum plasma concentration of active ingredients is noted 1-2 hours after receiving the tablets. In blood Torasemide bound to plasma proteins, allowing diuretic effect over the next eighteen hours . The frequency of urination increases uniformly over the entire period of the drug, which is certainly a positive feature of the drug (as opposed to furosemide, not forced to restrict the activity of the patient immediately after taking the pills).
Metabolised drug in the liver by the action of enzymes P450 . As a result of chemical reactions formed hydroxylated metabolites , Which bind to plasma proteins of blood on the 86-97 percent (accessibility of communication depends on the biological conversion components and sequence oxidation reaction and the annular hydroxylation).
Displayed Diuver mostly kidneys (renal clearance torasemide is 10 ml / min, with the overall - 40 ml / min) as inactive metabolites, about eighty percent razovoprinyatoy dose. The half-life pharmaceutical preparation is about 3-4 hours (renal failure rate does not change). A small part of the metabolites torasemide derived by hemodialysis and hemofiltration.
Indications Diuvera
The absolute indication for use of diuretic-based drug torasemide It is edematous syndrome against the backdrop of various pathologies. So when kidney, liver, lung in complex therapy should include a drug such action.
Chronic heart failure and much more effectively treated if apply loop diuretics Promoting reduction of fluid accumulation in the cavities and tissues.
Indications when Diuvera hypertension They are not absolute, but most physicians use this preparation in medical treatment scheme, as it has a strong and long-acting in comparison with other diuretics. A positive feature of the use Diuvera are also his ability and pharmacokinetic dose-dependent effect Allowing to regulate precisely the desired therapeutic effect.
Contraindications
- hypersensitivity or intolerance constituent components of the pharmaceutical preparation;
- stage renal failure anurii ;
- lactase deficiency (lactose intolerance and how to effect) or insufficient absorption of glucose and galactose;
- dehydration . exsicosis , Hypovolemic state;
- hepatic coma ;
- period Lactation ;
- intoxication cardiac glycosides ;
- expressed hypokalemia or hyponatremia ;
- sharp glomerulonephritis ;
- decompensated heart valves defects (in particular stenosis of the aortic and mitral orifices );
- enhance central venous pressure above 10 mm Hg;
- age category up to 18 years.
Also, there are a number of pathological conditions, when the drug should only be taken under the supervision of qualified in-patient treatment (to the development of adverse effects of conservative therapy assistance was provided as soon as possible). Such conditions include:
- hypotension ;
- atherosclerosis (especially arterial cerebral circulation);
- predisposition to increased plasma concentrations of urate;
- violation of the outflow of urine from the urethra (the most common cause - benign prostatic hyperplasia male or constrictive inflammation in women);
- acute stage myocardial infarction (increasing the risk of cardiogenic shock and progression of pathological process);
- diabetes (cells reduces glucose tolerance and reduce the hypoglycemic effects of drugs);
- anemia ;
- hepatorenal syndrome .
Side effects
The drug can cause the following adverse reactions during treatment of edematous syndrome complex:
- On the side Cardiovascular : acute circulatory failure Excessive reduction in blood pressure up to collapse . Arrhythmia (advantageously tachycardia ), Decrease volume of circulating blood.
- On the side urinary system : acute urinary retention Increasing the concentration of uric acid in blood plasma, hematuria (blood in the urine), interstitial nephritis . hydronephrosis .
- On the side VEB and KSCHB : Reducing plasma content of sodium, potassium, chlorine, magnesium, calcium, metabolic alkalosis . hypovolemia . dehydration . exsicosis . haemoconcentration and an increase in blood viscosity.
- On the side Metabolism : hypercholesterolemia, hypertriglyceridemia and atherosclerosis As a consequence, increase in the concentration of creatinine and blood urea arthritic diseases , Impaired glucose tolerance (possible provocation manifestations of diabetes ).
- Alimentary tract : dyspeptic symptoms (nausea, vomiting, epigastric pain, diarrhea ), Violation of of activity of hepatic enzymes, pancreatitis (mainly acute).
- On the side CNS and Hearing : Reversible disorders of hearing aids, noise in ears , headache, dizziness . paresthesia .
- Skin : hives . itching , Focal lesions, Dermatitis . photosensitization . vasculitis , Anaphylactic and anaphylactoid reactions (up to the development allergic shock ).
- On the side Peripheral Blood : Reduction in the number of platelets and white blood cells (the latter is shown in the form of agranulocytosis ) aplastic or hemolytic anemia .
Diuver, instructions for use (method and dosage)
The tablets are taken orally With a little water. It is recommended to use the drug after breakfast when adsorption in the gastrointestinal tract stimulated bolus.
The dosage regimen of the drug is the attending physician taking into account the individual and the indications for conservative rehabilitation, usually at Edema syndrome various origins therapeutic dose is 5 mg torasemide once a day. Gradually, the daily dose can be increased up to 20 and even 40 mg single dose, if required by the patient's pathological condition. Cease treatment only after the disappearance of of edemas (for confirmation positive effect is used control weighing and Sample McClure-Aldrich for hidden edema).
Instructions for use when Diuvera hypertension It is somewhat different. The initial dose is 2.5 mg, that is half a tablet with a mass part torasemide 5 mg (or quarter, respectively at 10 mg of active ingredient). If necessary, increase the therapeutic effect of the daily dose can be increased up to 5 mg.
Overdose
Increased plasma concentrations when uncontrolled dosage causes the following symptoms of intoxication:
- frequent urination Low urine specific gravity;
- excessive deficiency of circulating blood ;
- marked decrease in blood pressure, up to orthostatic hypotension ;
- violation of electrolyte and acid-base balance of the body;
- gastrointestinal disorders ;
- drowsiness ;
- confusion ;
- collapse - Acute circulatory failure.
Specific antidote Which would help intoxication Diuverom the pharmaceutical market there, but there are methods of conservative treatment, compensating pathological condition of the body. So it is used abundant Intravenous infusions isotonic and crystalline solutions to compensate for loss of BCC. Under the control of serum concentrations of electrolytes and join gemtokrita CBS regulators and VIB . In particularly difficult situations may be used blood substitutes and blood components .
When drug poisoning occurred against the backdrop of the recently adopted an increased dose, the effective gastric lavage . provocation of vomiting , Gastric emptying in various ways (used as a conservative, drug therapy, and physical therapy techniques influence).
Cooperation
Torasemide - Extremely active pharmaceutical ingredients that can actively interact with a large list of drugs. So diuretic increases the concentration, and thus the risk of side effects and adverse reactions (especially Oto-and nephrotoxicity) drugs such as antibiotics groups cephalosporin and aminoglycosides . chloramphenicol, cisplatin, ethacrynic acid . Amphotericin B (interact with the type of competitive renal excretion).
Separately it is worth noting, that the Diuver reduces the effectiveness of gipoglikemischeskih funds That requires appropriate correction medical treatment of diabetes mellitus. Otherwise, it may develop hyperglycemic or ketoatsidoticheskaya coma and irreversible changes in the microcirculatory bloodstream. It also reduces the pharmaceutical effect allopurinol If integrated therapy combines the drug with diuretic-based torasemide.
Diuver to a considerable least reduces renal clearance lithium preparations As a large amount of poorly concentrated urine (at high fluid levels glomerular apparatus is significantly less). This action threatens development lithium intoxication Which can be shown as follows:
- dyspepsia (nausea, vomiting, and so on);
- increase neuromuscular excitability;
- seizures and stupor ;
- ataxia ;
- large tremor ;
- confusion . delirium ;
- kidney failure.
Nonsteroidal anti-inflammatory agents greatly reduce the diuretic effect of torasemide As inhibit the synthesis prostaglandins That is shown in violation of such activity of a biologically active component such as renin in blood plasma. Consequently, it decreases renal blood flow and urination is not so active. The same mechanism of action of NSAIDs increases the hypotensive effect of diuretics ( renin - The main component of renal blood pressure regulation, providing pressor effect on the bloodstream).
Should not be combined in the treatment and drugs that inhibit angiotensin-converting enzyme or angiotensin receptor agonists together with loop diuretics Such treatment can lead to an excessive reduction in blood pressure and the development of acute circulatory failure up to the collapse. When absolute indications, it is recommended to reduce or suspend the conservative treatment torasemide in this case.
In patients at high risk of developing renal disease ( nephropathy various etiologies) should avoid simultaneous reception cyclosporine and torasemide Since it can serve as a factor of trigger very severe disease. A side effect of cyclosporin - disorders excretion of uric acid salts kidneys and torasemide, in turn, causes an increase in their concentration in the bloodstream. Such reciprocal action will inevitably lead to the deposition of urate or development gouty arthritis .
Terms of sale
Diuver available without prescription forms from pharmacies.
Storage conditions
The drug is is necessary to store away from children, in dry rooms with a constant temperature regime from 15 to 30 degrees Celsius.
Shelf life
3 years.
Analogs Diuvera
Trifas
Lasix
Furosemide
Analogs Diuvera represent an entire group loop diuretics Ie pharmaceuticals that act on the thick section of the loop of the nephron. Among the most popular drugs worth mentioning names such as: Torasemide . Tigers . Britomar .
Price analogues tend to be somewhat lower than Diuvera, but the incidence of side effects and adverse reactions much more. Also losing Diuveru similar drugs in the strength and duration of the pharmaceutical activities.
Synonyms
Trifas . Torasemide .
During pregnancy and lactation
Biologically active components have not Diuvera terato- or mutagenic effects Not have foetotoxic action, but can penetrate through barrier between the placenta and the fetus . In this Torasemide It may cause a decrease in the number of blood platelets, or violations of water-electrolyte balance, which will have a destructive impact on the tab organs and tissues of the child. Because the pharmaceutical preparation can be used only if the beneficial therapeutic effect for the mother is much higher than the potential risk to the fetus. When the absolute indications for Diuvera recommended to treatment under the supervision of qualified medical personnel and regular additional studies.
Reviews Diuvere
Reviews Diuvere confirmed its high efficacy in the treatment of edema syndrome with many different pathologies. So a positive opinion about the preparation consisted of patients with chronic heart disease, renal disease and diseases associated with impaired regulation of discharge of fluid from the body.
Actively used in the pharmaceutical preparation of patient treatment in the conservative part of the complex therapy, suggesting a positive opinion of qualified doctors practicing as a loop diuretic Diuver has a stronger and long-lasting effect than analog drugs.
Price Diuvera, where to buy
Price Diuvera in Russia varies in a very wide range from 200 to 1000 rubles, depending on the mass of the torasemide and the form of the drug. For example, the price Diuvera 10 mg is the largest and is 420 rubles, if the carton pack is designed for 2 stripes package (in total - 20 pieces) or 950 rubles - 6 circuits with 10 tablets each.
In Ukraine, the cost of the drug is somewhat lower, ranging from 40 to 80 hryvnia, depending on the network of kiosks.
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