Description
Torasemide Pharmacodynamics
Torasemide is a “loop” diuretic. Maximum diuretic effect develops 2-3 hours after oral administration. The main mechanism of action of the drug is determined by the reversible binding of thorasemide to the sodium/chloride/potassium ion transporter situated in the apical membrane of the thick segment of the ascending loop of Genle. As a result, it decreases or completely inhibits sodium ions reabsorption and decreases intracellular fluid osmotic pressure and water reabsorption. It blocks myocardial aldosterone receptors; reduces fibrosis and improves myocardial diastolic function.
Diuretic effect is maintained for up to 18 hours, which facilitates tolerance of therapy due to the absence of very frequent urination in the first hours after oral administration, which limits patient activity
Torasemide causes hypokalemia to a lesser extent than furosemide, while it is more active and its effect is more prolonged.
The use of thoracemide is the most reasonable choice for long-term therapy.
Indications
– Oedema syndrome of different genesis, including chronic heart failure, liver, lung and kidney diseases;
– arterial hypertension
Contraindications
– Hypersensitivity to thorasemide or to any of the drug components; cross-allergy to thorasemide may occur in patients allergic to sulfonamides (sulfonamide antimicrobials or sulfonylureas);
– renal failure with anuria;
– hepatic coma and precoma;
– refractory hypokalemia/refractory hyponatremia;
– Hypovolemia (with or without arterial hypotension) or dehydration;
– Severe urinary outflow disorders of any etiology (including unilateral urinary tract involvement);
– glycoside intoxication;
– acute glomerulonephritis;
– decompensated aortic and mitral stenosis, hypertrophic obstructive cardiomyopathy;
– sinoatrial and atrioventricular block of degree II-III, arrhythmias;
– Increased central venous pressure (over 10 mm Hg);
– hyperuricemia;
– under 18 years of age;
– pregnancy, breast-feeding;
– concomitant use of aminoglycosides and cephalosporins;
– Lactose intolerance, lactase deficiency or glucose-galactose malabsorption.
Dosage and administration
- Orally, once a day, without chewing, with plenty of water. The tablets may be taken at any convenient time, regardless of meals.
- Oedema syndrome in chronic heart failure
- The usual starting dose is 10-20 mg once a day. If necessary, the dose may be doubled until the desired effect is obtained.
- Edema syndrome in kidney disease
- The usual starting dose is 20 mg once a day. If necessary, the dose may be doubled until the desired effect is achieved.
- Oedema syndrome in liver disease
- The usual starting dose is 5-10 mg once daily. If necessary, the dose may be doubled until the desired effect is obtained. The maximum single dose is 40 mg; it is not recommended to exceed it (there is no experience of use). The drug is used for a long period or until the edema disappears.
- Arterial hypertension
- The initial dose is 2.5 mg once a day. If there is no therapeutic effect within 4 weeks, the dose is increased to 5 mg once a day. In the absence of an adequate decrease in blood pressure when administered in a dose of 5 mg once a day for 4-6 weeks, the dose is increased to 10 mg once a day. If the use of the drug in a dose of 10 mg per day does not give the desired effect, a hypotensive drug of another group is added to the treatment regimen.
- No dose adjustment is required in elderly patients.
