How to take furosemide diuretic tablets. Torasemide - a new opportunity in the treatment of patients with chronic heart failure and arterial hypertension Instructions for use and compatibility

The question of creating a good diuretic has always been very acute. The vast majority of diuretics have a huge number of side effects, such as furosemide.

Specialists from our catalog will be happy to help you

Trifas, which is classified as a long-acting loop diuretic, is the only drug to date with the original active ingredient Torasemide.

The drug is made from a branded substance (Swiss company Roche) and is currently recognized as the most successful development of pharmacologists.

Trifas is the optimal solution for a large list of pathologies associated with the need to take diuretics, including for patients with arterial hypertension.

On our website, you can familiarize yourself with scientific articles regarding complete information about the drug, its pharmacological action, and the peculiarities of taking it. This saves ordinary patients and cardiologists and therapists from searching the web and specialized literature for data. All articles have been prepared for you by pharmacologists.

Research results of Japanese scientists - Nippon Yakurigaku Zasshi magazine

The results of studies carried out in a clinic have shown clear advantages of the drug Trifas in comparison with other diuretics, for example, with the popular furosemide.

Studies have revealed fundamental differences that allow cardiologists to make a choice in most cases in favor of Trifas.

The main advantage of Trifas was the stable bioavailability (not less than 80–90%), which did not decrease in patients with chronic coronary insufficiency. For example, furosemide shows a persistent decrease in bioavailability.

The next important factor is long-term action drug and a higher diuretic activity in comparison with most prescribed diuretics.

Cardiologists and therapists are required to proceed when prescribing medications of the two main indicators - the maximum possible therapeutic effect of the drug and the minimum of side effects.

Trifas has, in comparison with other diuretic agents (furosemide), a significantly lower potassiumuretic effect, which is of great importance for patients with heart failure.

Diuretics should not have rebound syndrome. The developers of Torasemide managed to achieve this quality due to the combination of two factors - the duration of the pharmacological action of the active substance and antialdosterone activity.

Many diuretics on the market and widely used in medicine for the treatment of arterial hypertension are ototoxic, which makes them impossible to prescribe to people at risk. Trifas has minimal ototoxicity.

The route of excretion from the body is predominantly hepatic. When using the drug, it is possible to obtain a smooth predictable diuretic effect, which is observed within 10-12 hours after administration.

The researchers' conclusion is unambiguous:

Trifas can be recommended for widespread use, since in terms of high therapeutic effect and health safety, it has shown clear and undeniable advantages over other prescribed diuretics, in particular over furosemide.

Trifas can be prescribed to patients with edematous syndromes (detailed information on clinical trials of the drug is published by Japanese scientists, Nippon yakurigaku zasshi, 2001, August).

Over the years, data were obtained from various researchers, which confirms:

By the strength of the therapeutic effect, the drug Trifas exceeds other popular diuretics (including furosemide) by 2-3-5 times.

Some differences in the data depend on the types and characteristics of pathological processes in the body of a particular patient.

Arterial hypertension and diuretics. When is it worth making a choice in favor of Trifas?

The drug Trifas (Torasemide) is recommended for patients for the treatment of edematous syndrome of various origins, which also distinguishes this particular drug from others. The best result in patients with arterial hypertension was obtained with the use of Trifas.

Patients in Russia, Ukraine, Belarus and Kazakhstan are at risk

Reference. High blood pressure is a major risk factor for the development of a number of serious pathologies and severe coronary diseases, including atherosclerosis, left ventricular hypertrophy, heart failure, ischemia and myocardial infarction, cerebrovascular disease, and renal failure.

Excess blood pressure to significant indicators increases the risks of cerebral stroke and the development of coronary heart disease several times, and plays the role of a factor of persistent increase over a long period of time.

Doctors call specific numbers: high blood pressure values \u200b\u200bincrease the risk of stroke and heart attack 3-4 times, and the risk of coronary heart disease increases seven (!) And even more times in comparison with those who have blood pressure within the normal range.

It is known that Russia, Belarus, Ukraine and Kazakhstan occupy the sad first places in the frequency of cerebral strokes, heart attacks and cardiovascular mortality in the world.

Experts say that such high numbers are explained by the fact that out of about 12 million Russians and Ukrainians who have been diagnosed with arterial hypertension, only about 15-17% receive adequate comprehensive treatment. This figure refers to large settlements, in the provinces the indicator is even lower and is only about 5-6%.

Arterial hypertension - this is the forerunner of all coronary diseases and vascular problems, and the appointment of a good modern diuretic in combination with individually selected drugs for the treatment of specific pathologies, in the vast majority of cases, can preserve health, and even life.

The purpose of taking diuretics is to reduce the risk of complications in cardiovascular pathologies. "Target" level

The ultimate goal of therapeutic measures in the treatment of hypertension is to prevent the development of cardiovascular complications.

And this is an increase in the life expectancy of patients and the quality of their existence. To achieve this goal, the physician is faced with the task of prescribing antihypertensive therapy to the patient, which will maintain blood pressure at the "target" level.

"Target" level Are established as a result of randomized clinical research indicators.

reference... A blood pressure of no more than 140/90 mm Hg is relatively safe for the health of all people. Art. and even lower. With concomitant pathologies (diabetes mellitus, chronic kidney disease), it is recommended to maintain blood pressure values \u200b\u200bbelow 130/85–80 mm Hg. For patients suffering from proteinuria (more than one g per day), as well as renal failure, this level should be even less than 125/75 mm Hg. Art.

Physicians and patients should be aware that monotherapy is not effective and cannot be used alone. So, the researchers note that a relatively positive result was obtained only in half of the patients who received monotherapy, and these patients were diagnosed with a very moderate increase in blood pressure (about 140-160 / 90-100 and not higher than 160-180 / 100-110 mm mercury column).

Important! The use of antihypertensive therapy alone does not give good indicators of blood pressure reduction. According to Japanese scientists, in about 60% of patients suffering from arterial hypertension and no concomitant pathologies, such as diabetes mellitus, and in 52-54% of patients with diabetes mellitus, there was a decrease in blood pressure when taking only one antihypertensive drug.

And besides, if we take all the existing pathologies of the cardiovascular system, then it is arterial hypertension that is most "provided" from the medicinal point of view. Despite this, it is precisely the same blood pressure that is the most difficult diagnosis in terms of prescribing a particular drug.

An individual selection of funds for a specific patient is needed, which must include an effective and safe diuretic agent.

The main drugs are hypothiazide, furosemide, ethacrynic acid.

Individual therapeutic doses vary widely: for example, the dose of hypothiazide

ranges from 25 mg 1-2 times a week to 200 ml daily. Drugs are prescribed

in 1-2 doses, usually in the morning and afternoon. Thiazide diuretics (hypothiazide,

brinaldix) is prescribed in combination with veroshpiron, which provides

potassium-saving action. The action of veroshpiron appears on the 3-4th day

use, so it should be prescribed a few days before the start of treatment

the main diuretic. The average dose of hypothiazide is mg per day,

brinaldix-mg per day. With significant edema, furosemide is used in

tablets (40 mg per dose, on an empty stomach) or uregit (0.05 g) in the background

preliminary intake of veroshpiron (in tablets of 25 mg) - 150-250 mg per

day. A clear diuretic effect is achieved using combined

diuretics - triampura (a combination of the potassium-sparing drug triamterene and

hypothiazide), similar in action to brinerdine, cristepine. To receive

rapid diuretic effect (in acute left ventricular failure)

lasix (furosemide) is prescribed intravenously (20-60 mg).

All diuretics, and hypothiazide the most, cause loss

potassium. This negatively affects myocardial metabolism and contributes to

violation of the heart rhythm. Therefore, when treated with diuretics

a diet enriched with potassium is needed (dried apricots, raisins, baked potatoes,

peeled potatoes (in their skins), bananas). In addition, appoint

potassium preparations (panangin, asparkam, potassium chloride) after meals.

With insufficient therapeutic effect of diuretic drugs

it is advisable to prescribe them in various combinations (hypothiazide with furosemide,

furosemide with uregite, furosemide with fonurite).

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Treatment with diuretic drugs is also used during the period

compensation, but in small, maintenance doses, under constant control with

The best diuretics according to customer reviews

Diuretics are widely used in medicine to treat many diseases. The main purpose of these drugs is to remove excess fluid, chemicals, salts that have accumulated in the walls of blood vessels or tissues from the body. Drugs are classified into several main groups, which differ in mechanism, speed, strength and duration of action. This article covers best drugs each group, their areas of application, the advantages and disadvantages of a single drug.

Which diuretic company to choose

As a rule, quality medicines are produced by the largest pharmaceutical companies. Leaders in the production of quality medical supplies have large-scale production, powerful scientific and technical potential and, of course, consumer confidence, which determines high sales.

To get a safe and effective diuretic, be sure to check with the manufacturer.

Medicines from these brands are widespread and you can easily find them in almost every pharmacy.

The best diuretics of the saluretic group

Saluretics are thiazide derivatives. These synthetic diuretics have a long-term hypotensive effect. The main feature of saluretics is to enhance the excretion of sodium ions from the body and, to a lesser extent, potassium ions.

Furosemide

It is a potent diuretic. It is used for the accelerated elimination of puffiness of various origins, to reduce pressure. The medicine is used as needed. The drug is not suitable for long-term use. The active ingredient, furosemide, reduces the tone of venous vessels, reduces the volume of intercellular fluid and circulating blood, which leads to a decrease in blood pressure. After intravenous administration, the effect occurs in a few minutes, after taking the tablets - in an hour. Release form: granules for suspensions, tablets, solution.

• has a pronounced natriuretic, chloruretic action;
• reduces stress on the heart;
• low cost;
• the duration of the effect is up to 6 hours;
• helps to quickly get rid of excess fluid that causes puffiness.

• adverse reactions of the body after taking: allergies, disruption of the nervous system, cardiovascular, sensory organs, etc.;
• reduces the amount of potassium in the body;
• contraindications: diabetes, gout, renal failure, glomerulonephritis, pancreatitis, hypersensitivity, etc.

Bumetanide

It is a potent diuretic. It is used for edema of various origins, late toxicosis, liver cirrhosis, arterial hypertension. It is recommended for people for whom high doses of Furosemide do not bring the expected drug result. The active substance, bumetamide, interferes with the reabsorption of chlorine and sodium ions; increases the excretion of magnesium, calcium, potassium ions. It is prescribed by injection or by mouth.

• unlike Furosemide, it is absorbed much faster and almost completely, this causes a more powerful effect of Bumetanide;
• the maximum effect of the diuretic develops after a quarter of an hour;
• effectively reduces puffiness.

• short action;
• the drug lowers blood pressure, therefore it is not recommended for people with hypotension;
• long-term use is prohibited;
• removes calcium, potassium, magnesium with urine;
• adverse reactions: dizziness, loss of energy, hyponatremia, hypokalemia, dehydration, abdominal pain, nausea, etc.;
• contraindications: hypersensitivity, age after 60 years, renal coma, acute hepatitis, gout, etc.

Indapamide

It has an average strength of hypotensive and diuretic action. The main component, indapamide, is a sulfonylurea derivative. Acts in vessels and kidney tissues: changes the membrane permeability for calcium, dilates arterioles, reduces the contractility of vascular smooth muscle cells. In the tissues of the kidneys, the drug reduces sodium reabsorption, increases the excretion of potassium, magnesium, chlorine with urine, which contributes to the formation of a larger volume of urine. Available in capsules and tablets.

• reduces the total cardiac load;
• the duration of the effect is up to 24 hours;
• long-term admission is allowed;
• helps to reduce edema of various origins;
• low price.

• adverse reactions: dehydration, constipation, abdominal discomfort, blurred vision, cough, allergies;
• removes magnesium and potassium from the body;
• promotes a moderate decrease in blood pressure, therefore it is not recommended for people suffering from hypotension;
• contraindications: hypokalemia, decompensation of liver function, anuria, pregnancy, lactation.

Torasemid

It is a mild diuretic. Used for swelling caused by heart failure, high blood pressure. The active ingredient is torasemide. The duration of treatment depends on the course of the disease. The maximum diuretic effect occurs several hours after application. Dosage form: pills.

• enhances diuresis;
• has a moderate anti-edema effect;
• duration of action up to 18 hours;
• the drug is allowed to be taken until the puffiness disappears completely;
• well absorbed in the digestive tract;
• gradually eliminates fluid retention in the body.

• the drug has some hypotensive effect, therefore it is not recommended for persons suffering from low blood pressure;
• reduces the amount of potassium in the blood, but to a lesser extent than Furosemide;
• side reactions: an increase in certain liver enzymes, urea, creatine in the blood; violation digestive tract; disorders of the nervous system;
• contraindications: hypersensitivity to the components of the diuretic, precoma or coma of the liver, arrhythmia.

The best diuretics of the potassium-sparing diuretic group

Medicines provoke an accelerated excretion of sodium, but at the same time block the excretion of potassium. A distinctive feature is that there is practically no toxicity. This group of drugs is often prescribed for patients with edema caused by heart failure.

Triamteren

It is a mild diuretic. It is used for edema of various origins, high blood pressure, signs of liver cirrhosis. The active ingredient, triamterene, inhibits the secretion of potassium that forms in the distal tubules. The maximum effect of the intake occurs 2 hours after application. Dosage form: powder, capsules.

• admission to children is allowed, according to the dosage regimen;
• increases sodium excretion without affecting potassium content;
• long-term admission is allowed;
• if necessary, it is allowed to increase the dosage, but not exceed the daily rate of 30 g;
• increases the concentration of potassium in the blood;
• duration of action up to 12 hours;
• effectively removes excess fluid from the body, which helps to reduce edema.

• undesirable body reactions: dehydration, hyponatremia, dyspeptic symptoms, etc.;
• contraindications: lactation, hypersensitivity, renal or hepatic failure;
• the drug is poorly soluble, sometimes sediment in the urine, this can lead to the appearance of kidney stones.

Amiloride

This drug is a diuretic with a weak but long-lasting effect. Used with high blood pressure as a diuretic; with swelling caused by heart failure or nephrotic pathology. The active ingredient, amiloride, acts on the distal region of the renal tubules, increases the excretion of sodium and chlorine. The effect of the application comes in a few hours. Dosage form: tablets.

• the effect of the drug can last up to 24 hours;
• in combination with other diuretics, it reduces the risk of hypokalemia, hypomagnesemia;
• reduces the excretion of potassium;
• well absorbed by the liver and kidneys;
• mild hypotensive effect helps to normalize blood pressure in people suffering from hypertension;
• long-term admission is allowed.

• rarely, the following side reactions appear from the intake: disruption of the gastrointestinal tract, fatigue;
• the drug can lead to excessive accumulation of potassium, therefore, when long-term use it is necessary to periodically donate blood and check the amount of mineral in the body;
• contraindications: increased potassium content in the body, hypersensitivity, impaired renal function.

The best diuretic in the group of osmotic diuretics

Medicines of this group increase the osmotic pressure in the blood plasma, increase its circulation and prevent the reabsorption of fluid. Osmotic diuretics are potent drugs and are prescribed as part of the complex therapy of acute conditions.

Mannitol

It has a strong diuretic effect. Applied in acute edematous conditions. The active ingredient, mannitol, increases plasma pressure, inhibits reabsorption, retains fluid, and increases urine. Water moves from tissues to the vascular bed, which leads to an enhanced diuretic effect. Dosage form: solution in ampoules.

• strong diuretic effect;
• low cost;
• reduces puffiness;
• removes a large volume of liquid with a high sodium content and a small amount of potassium;
• does not increase the levels of residual nitrogen in the blood.

• contraindications: hypochloremia, hypersensitivity, hyponatremia, hemorrhagic stroke, etc.;
• a doctor's prescription is required;
• adverse events at high dosages: dehydration, dyspeptic disorders, hallucinations.

What diuretic to buy

1. If you need a drug that will help you quickly get rid of edema and excess fluid in the body, it is better to purchase Furosemide.

2. If Furosemide did not give the expected result, then Bumetanide will do, the latter is almost 2 times more powerful, but it is worth remembering that the medicine washes out minerals from the bone tissue.

3. If you need a drug with a moderate diuretic effect, it is better to purchase Triamteren. In addition, the drug does not reduce the amount of potassium in the body.

4. In acute and critical conditions, accompanied by edema of various origins, an osmotic diuretic is required - Mannitol.

5. In the presence of chronic diseases, as well as for the prevention of crises, diuretics of weak and moderate action are necessary: \u200b\u200bIndapamide, Torasemide.

6. If you need a potassium-sparing diuretic with a mild, long-lasting effect, amiloride is the best choice.

/ URINE

URINE (DIURETIC) MEANS

They enhance the excretion of salts and water by the kidneys, and thus eliminate edema or accelerate the elimination of chemicals from the body in case of poisoning.

Used for hypertension, edema. It is impossible - with obstruction of the urinary tract (stones in the kidneys and ureters).

CLASSIFICATION BY POWER OF DIURETIC ACTION

1. "Powerful" or strong diuretics: mannitol (mannitol), furosemide (lasix), bumetanide (bufenox), ethacrynic acid (uregit).

2. Moderate to moderate strength: hydrochlorothiazide (hypothiazide), cyclomethiazide, chlorthalidone (oxodoline), clopamide (brinaldix), indapamide (arifone).

3. Weak diuretics: acetazolamide (diacarb), spironolactone (verospiron), triamterene, amiloride.

4. Vegetable diuretics: bearberry leaf, lingonberry, kidney tea, juniper fruits, field horsetail herb, blue cornflower flowers, birch buds.

CLASSIFICATION OF URINE PREFERREDLY

INFLUENCE ON THE DEPARTMENTS OF NEFRON

I. Diuretics with a predominant effect on the glomerulus are xanthine derivatives.

Euphillin - The diuretic effect is associated with improved renal blood flow and increased glomerular filtration when fluid is retained as a result of heart failure. For a diuretic effect, 1-2 ml of 24% solution or 5-10 ml of 2.4% solution is administered intramuscularly.

II. Diuretics with a predominant effect on the proximal tubules.

1. Osmotic diuretics (lures, urea) are metabolically inert substances. Mechanism of action: Introduce intravenous hypertonic solutions of these substances (solutions of urea 30%, mannitol - 10-20%). At the same time, the osmotic pressure of blood plasma increases and fluid from the tissues passes into the blood. Dehydration (dehydration) of tissues occurs. In the kidneys, urea and mannitol are not reabsorbed, and are almost completely excreted in the urine, carrying water and Na +. Contraindicated in violation of renal excretory function, urinary tract obstruction. Urea should not be prescribed for liver and cardiovascular insufficiency.

MANNIT (mannitol) - refers to a strong diuretic. It is used in emergency care:

Dehydration therapy for cerebral edema;

Acute renal failure

Forced diuresis in case of poisoning;

Relief of an acute attack of glaucoma.

The diuretic effect is manifested in a minute, maximum - in a minute, the duration of action is 4-5 hours.

EF: vial 30.0 of the drug; amp 200 and 400 ml 15% solution.

UREA (UREA PURA) is a strong diuretic. Application: dehydration therapy for cerebral edema and lowering intraocular pressure. Better mannitol penetrates tissue, adduction can cause hydration of the brain and increase intracranial pressure. Duration of action is 12 hours.

PV: 90 g of a sterile preparation with the addition of 10% glucose solution (-225 ml) for the preparation of 30% solution.

2. Carbonic anhydrase inhibitors.

DIAKARB (fonurite) is a saluretic, an inhibitor of carbonic anhydrase, an enzyme involved in the hydration of carbonic acid. In the epithelium of the renal tubules, diacarb blocks carbonic anhydrase, therefore, the formation of carbonic acid is inhibited, followed by its dissociation and the release of hydrogen ions. The reabsorption of sodium ions decreases, because there is no exchange with Н + and НСО3-. The excretion of sodium and potassium ions is increased. Sodium is excreted with water in the form of bicarbonates. At the same time, there is an inhibition of extrarenal carbonic anhydrase contained in various tissues: in the ciliary body of the eye (as a result, the formation of intraocular fluid decreases); in the brain and its membranes (as a result, the production of cerebrospinal fluid, drowsiness may occur); in the gastric mucosa (as a result, the secretion of gastric juice decreases); in erythrocytes (hemolytic anemia). Side effect:

After 1-2 days, it causes acidosis associated with the depletion of sodium ion reserves, therefore, it is prescribed with a break of 1-3 days or alternated with diuretics that cause alkalosis;

Application: glaucoma, epilepsy, barbiturate poisoning.

Contraindications: urinary tract obstruction, tendency to acidosis, Addison's disease, diabetes mellitus, liver damage.

III. Diuretics acting on the ascending part of the loop of Henle (loop diuretics).

Powerful, potent diuretics that significantly remove salts, incl. ions of sodium, potassium, calcium, magnesium and chlorine, therefore saluretics are called.

The main side effect: alkalosis and hypokalemia, its prevention consists in the simultaneous administration of potassium preparations (potassium chloride, asparkam, panangin). Dyspepsia, hyponatremia, lack of calcium and magnesium ions, hyperglycemia, impaired renal function (irreversible changes in the epithelium of the renal tubules), and hearing impairment also occur.

A) emergency care in a hospital (i / v or i / m furosemide or bufenox) in case of acute renal failure, pulmonary edema, hypertensive crisis, acute heart failure, cerebral edema, glaucomatous crisis, acute poisoning with technical fluids, poisons, medicinal substances;

B) treatment of chronic patients: edema of various origins, hypertension, chronic heart failure, in contrast to hypothiazide - chronic renal failure.

Contraindications: urinary tract obstruction, hypokalemia, diabetes mellitus, Addison's disease, liver damage, torasemide is also contraindicated in hypersensitivity to sulfonamides, pregnancy, lactation, persons whose work requires an increased physical and mental reaction.

FUROSEMIDE (lasix) is one of the most active, fast and short acting drugs. Unlike hypothiazide, it enhances the release of calcium from the body.

EF tab 0.04 and solution 1% 2 ml each. When taken orally, the action occurs after a minute and lasts 3-4 hours, when administered intravenously, it acts after 3-4 minutes and within 1.5-2 hours.

Combined drug furesis (furosemide + triamterene).

TORASEMIDE (diuver) - less than furosemide causes potassium, but more active and lasting longer. F.V. tab 0.005 and 0.01 once, after meals.

BUMETANIDE (bufenox) - tab 0.001 and solution 0.025%, 2 ml each.

BRINALDIX (clopamide) - combination drug brinerdin.

K-TA ETAKRINOVA (uregit) - in the treatment of chronic patients with edema of various origins, one or more courses are prescribed for 3-5 days, with interruptions for normalization electrolyte balance, then switch to milder-acting diuretics. Tab 0.05 - taken in the morning after meals.

IV.Diuretics. acting on the initial part of the distal tubule - this group includes most modern diuretics, saluretics.

Mechanism of action: enhance the excretion of potassium, sodium, chlorine, magnesium ions from the body. They reduce the excretion of calcium and uric acid ions in the urine, therefore, increase their content in the blood.

It is used orally for long-term treatment of various chronic diseases: hypertension, edema associated with kidney disease and cardiovascular failure, toxicosis of pregnant women, diabetes insipidus, glaucoma. Assign inside in the morning before meals.

DICHLOTHIAZIDE (hypothiazide) - a medium-strength thiazide diuretic, unlike furosemide, reduces the excretion of calcium in the urine and should not be prescribed for renal failure. The action develops in 1-2 hours and lasts an hour.

Hypokalemia (prevention: taking potassium supplements);

Exacerbation of gout (reduces the production of uric acid);

Exacerbation of diabetes mellitus (increases blood sugar);

Increases blood cholesterol levels;

Fatigue, weakness, hypotension;

EF tab 0.025 and 0.1.

trirezide-K (reserpine + dihydralazine + hydrochlorothiazide + potassium chloride), moduretic (amiloride + hypothiazide),

triampur-compositum (triamterene + hydrochlorothiazide),

INDAPAMID (arifon) - the main use - hypertension and edema in heart failure. PV tab and caps 0.0025; tab-retard 0.00125 (1.25 mg).

CYCLOMETHIAZIDE is a thiazide diuretic, chemical structure and properties similar to hypothiazide, but 50 times more active. Tab 0.0005.

CHLORTALIDONE (oxodoline) - a longer action than hypothiazide - up to a day or more, tab 0.05 and 0.1.

V. Diuretics with a predominant effect in the region of the distal tubules and collecting ducts (potassium-sparing).

1. Competitive antagonists of aldosterone. Aldosterone is a hormone of the adrenal cortex. Reduces the release of sodium ions and increases the release of potassium ions in the renal tubules. An increase in the concentration of aldosterone leads to the development of edema. This occurs with congestion in the liver in chronic heart failure, when the inactivation of aldosterone in the liver is impaired.

SPIRONOLACTONE (veroshpiron) is an aldosterone antagonist. Eliminates the influence of aldosterone. It works only with aldosteronism. Promotes the elimination of sodium, chlorine and water ions. Reduces the excretion of potassium ions, their concentration in the blood increases (potassium-sparing diuretic). The acid-base balance does not break. Does not cause the accumulation of uric acid in the body. The effect develops slowly: 1-2 days after the start of the drug, the duration of action is 2-3 days, after stopping the drug for 2-3 days, a weak diuretic effect remains.

Application: edema associated with the accumulation of aldosterone (HD, chronic heart failure). Because itself is inactive, prescribed with other diuretics to prevent hypokalemia. Contraindications: kidney disease, first trimester of pregnancy. Side effects: hyperkalemia (not possible with potassium preparations), hypernatremia, nausea, drowsiness, skin rash, gynecomastia (reversible). FV tab 0.025.

2. Blockers of sodium channels. They block sodium channels in the collecting tubes, impair the reabsorption of sodium and chlorine ions and are excreted in the urine. Retain potassium in the body, reduce the release of hydrogen and magnesium ions, like veroshpiron. The effect comes in 1-2 hours, it lasts an hour. Potassium-sparing diuretics reduce the toxicity of cardiac glycosides. Often used with other more potent diuretics to reduce dosages and side effects (see combination drugs). Independent use: GB, chronic heart failure, edema of pregnant women. Side effects: hyperkalemia, dyspepsia, azotemia.

TRIAMTERENE - caps 0.05; the combined preparation triampur-compositum.

AMILORIDE - tab 0.005; combined drug moduretic.

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Hypothiazide is a diuretic

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Quite often, specialists are prescribed diuretic tablets "Hypothiazid". This is due to the fact that they not only contribute to the removal of excess fluid from the body, but also help prevent the development of stone disease. In addition, the drug eliminates edema caused by various malfunctions in the body.

Dosage form and packaging

"Hypothiazide" is available in tablet form. In color, they are either pure white or beige. On one side of the tablet there is always an engraving "H", and on the other there is a line in the form of a depression that goes through the center. There are two options for release - 0.025 and 0.1 grams each active substance... Sold by 20 tablets in a carton box.

The composition of the diuretic "Hypothiazide"

The main effect is exerted by the substance hydrochlorothiazide. Its content in 1 tablet is 25 or 1 milligram. Also, the preparation contains additional substances. First of all, it is magnesium stearate, which acts as a dietary supplement based on fatty acids. Talc and starch provide glide. Gelatin has a binding effect. Lactose monohydrate is used as a sweetener.

Pharmacology

This remedy has a diuretic effect. This effect is achieved due to the excretion of sodium and chlorine from the kidneys. The action of the tablets begins 1-2 hours after ingestion. In addition, it is prescribed to reduce blood pressure. Gynecologists sometimes ascribe the diuretic "Hypothiazide" to pregnant women with severe toxicosis. The diuretic effect on the body is not reduced by prolonged use.

Indications

The main indications include high blood pressure. Moreover, it can be used in combination with other drugs. Also, "Hypothiazid" is used for edema, which are the result of various diseases. It is effective with increased urination and as a prophylaxis of urolithiasis. Less commonly, it is prescribed for liver cirrhosis and chronic kidney disease.

Contraindications

"Hypothiazide" diuretic has a number of contraindications. First of all, it is an individual sensitivity to the constituent components of the drug. Also, do not prescribe a remedy for violations of urine flow. Severe forms of renal and hepatic failure are the reason for the withdrawal of the diuretic. In addition, with a high level of potassium, sodium and magnesium in the body, the drug is contraindicated. The same applies to patients with Addison's disease.

Side effects

The wrong way of using "Hypothiazide" or the use with existing contraindications can provoke a number of side effects. So, on the part of the gastrointestinal tract, it can be diarrhea, constipation or the development of pancreatitis. From the side of the heart, arrhythmia is possible. To others side effects include dizziness, nausea that turns into vomiting, a dry mouth, hives, and muscle cramps.

Overdose

An incorrectly selected dosage or regimen of administration leads to an abundant excretion of fluid from the body. This is fraught with a sharp drop in blood pressure and tachycardia; lack of urination or disorders in this process; vomiting, which leads to thirst. There are no means for removing hydrochlorothiazide from the body. Therefore, gastric lavage in conjunction with the intake of activated charcoal or another sorbent can help.

Method of administration and dosage

You need to take the tablets after meals with a moderate amount of liquid. The following are the average dosages of the drug for adults:

1. In the case of increased pressure, 25-50 mg of the active substance is assigned at a time. Daily rate - no more than 100 mg. The duration of the course is 3 weeks.
2. In case of application for edema, the dose is 25-100 mg of the substance. Consume once a day or every 2 days.
3. For diabetes insipidus, take 50-150 mg per day.

When prescribing the drug to children, the pediatrician calculates the dose based on 1-2 mg per kilogram of the child's weight.

special instructions

When using "Hypothiazide" long time the doctor must carefully monitor the water and electrolyte levels in the body. Symptoms of imbalance are weakness, dry mouth, nausea, and others. There may also be disorders of the parathyroid glands. It is necessary to take the drug with caution for people sensitive to lactose. Otherwise, disorders of the gastrointestinal tract are possible. At the beginning of the appointment, you need to drive the car with care.

Interaction

Use with caution together with drugs to lower blood pressure and heart medications. Reception together with drugs for normalizing blood sugar levels is undesirable, since their effectiveness drops sharply. The same goes for barbiturates. Laboratory tests can show a decrease in iodine levels in the body or an increase in bilirubin in the blood. For the accuracy of studies, the drug should be canceled.

Storage and shelf life

Store the drug in a dark place out of the reach of children, at a temperature not exceeding 25 degrees. The expiration date is indicated on the packaging and is 5 years from the date of production. After the expiration date, taking the drug can be hazardous to health. The drug is dispensed in the pharmacy only with a prescription.

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N-s-d.ru - Forum about diabetes insipidus

International non-proprietary name

1 tablet contains 40 mg of furosemide

Fast acting diuretic. Blocks the reabsorption of sodium and chlorine ions in the ascending part of the Henle loop. The drug also acts on convoluted tubules, and this effect is not associated with inhibition of carbonic anhydrase. Furosemide has a pronounced diuretic, natriuretic and chloruretic effect. In addition, it increases the excretion of potassium, magnesium, calcium ions. The drug does not affect urine pH.

The diuretic effect of Furosemide develops within a minute after oral administration and lasts about 4 hours.

The bioavailability of the drug is about 60%.

The half-life is about 2 hours.

Plasma protein binding 91-99%.

It is metabolized in the body with the formation of glucuronide.

Indications for use

edematous syndrome of various origins (with chronic heart failure, liver cirrhosis, nephrotic syndrome);

chronic and acute renal failure;

some forms of hypertensive crisis;

The dose of the drug is set individually in each case. In the course of treatment, the dosage regimen is adjusted depending on the magnitude of the diuretic response and the dynamics of the patient's condition.

With mild edematous syndrome, it is prescribed orally in a single dose of mg (usually in the morning, on an empty stomach). In case of severe edematous syndrome - inside in a single dose of mg, if necessary, the dose of the drug can be increased to 500 mg.

The drug is prescribed at the rate of 1-2 mg / kg of body weight, the maximum daily dose is 3 mg / kg of body weight.

Possible: nausea, vomiting, diarrhea.

With prolonged use of the drug, hypovolemia, hypokalemia, hyponatremia, hypochloremia may develop and, as a consequence, the development of arterial hypotension; dizziness, dry mouth, thirst, arrhythmias, convulsions.

acute renal failure with anuria;

hypersensitivity to the drug.

During pregnancy, Furosemide is taken in exceptional cases and for a short time.

If the drug is prescribed during lactation, breastfeeding should be discontinued.

Care should be taken with the simultaneous appointment of Furosemide and hypoglycemic drugs, as this may require a dose adjustment of the latter.

With the simultaneous use of Furosemide with cardiac glycosides, the risk of glycosidic intoxication increases, and when combined with glucocorticosteroids, the risk of hypokalemia.

The drug potentiates the action of curariform agents.

With the simultaneous appointment of Furosemide with aminoglycosides or cephalosporins and cisplatin, their concentration in the blood plasma may increase, which can lead to the development of nephro- and ototoxic effects.

The simultaneous use of Furosemide with lithium preparations can lead to increased reabsorption of lithium ions in the renal tubules and the appearance of toxic effects.

NSAIDs can reduce the diuretic effect of furosemide.

With the simultaneous use of Furosemide and other antihypertensive drugs, the hypotensive effect is potentiated.

50 tablets of 400 mg

Group: Diuretic substances

Manufacturer: Chinoin Pharmac. and Chemical Works, Hungary

INN: HYDROCHLOROTHIAZIDE (HYDROCHLOROTHIAZIDE);

Medium strength thiazide diuretic. Reduces Na + reabsorption at the level of the cortical segment of Henle's loop, without affecting its section passing in the medulla of the kidney, which determines a weaker diuretic effect in comparison with furosemide. Blocks carbonic anhydrase in the proximal convoluted tubules, increases urinary excretion of K + (in the distal tubules Na + is exchanged for K +), hydrocarbonates and phosphates. Virtually no effect on CBS (Na + is excreted either together with Cl- or with bicarbonate, therefore, with alkalosis, the excretion of bicarbonates increases, with acidosis - of chlorides). Increases the excretion of Mg2 +; retains Ca2 + ions in the body. The diuretic effect develops after 1-2 hours, reaches a maximum after 4 hours, lasts h. The effect decreases with a decrease in the glomerular filtration rate and stops when its value is less than 30 ml / min. In patients with diabetes insipidus, it has an antidiuretic effect (reduces the volume of urine and increases its concentration). It lowers blood pressure by decreasing the BCC, changing the reactivity of the vascular wall, reducing the pressor effect of vasoconstrictor substances (epinephrine, norepinephrine) and increasing the depressor effect on the ganglia.

Absorption - 80%, fast. Communication with plasma proteins - 60-80%. Bioavailability - 70%, TCmax. In the therapeutic dose range, the average AUC increases in direct proportion to the dose increase; when administered 1 time per day, the cumulation is insignificant. Penetrates the blood-placental barrier and into breast milk... T1 / h. Not metabolized by the liver. Excreted by the kidneys, 95% unchanged and about 4% in the form of hydrolyzate-2-amino-4-chloro-m-benzenedisulfonamide (decreases with alkaline urine) by glomerular filtration and active tubular secretion in the proximal nephron.

Arterial hypertension; edematous syndrome of various origins (heart failure, portal hypertension, nephrotic syndrome, chronic renal failure, fluid retention in obesity), pregnancy toxicosis (nephropathy, edema, eclampsia); diabetes insipidus; subcompensated forms of glaucoma; prevention of the formation of stones in the urinary tract.

To lower blood pressure: by mouth, mg / day, while a slight diuresis and natriuresis are noted only on the first day of admission (prescribed for a long time in combination with other antihypertensive drugs: vasodilators, ACE inhibitors, sympatholytics, beta-blockers). With an increase in the dose from 25 to 100 mg, a proportional increase in diuresis, natriuresis and a decrease in blood pressure is observed. In a single dose over 100 mg - an increase in diuresis and a further decrease in blood pressure are insignificant, there is a disproportionately increasing loss of electrolytes, especially K + and Mg2 +. Increasing the dose over 200 mg is inappropriate, because increased urine output does not occur. In case of edematous syndrome (depending on the condition and reaction of the patient), it is prescribed in a daily dose of mg, taken once (in the morning) or in two doses (in the morning). Elderly people - 12.5 mg 1-2 times a day. Children aged 2 months to 14 years old - 1 mg / kg / day. The maximum dose for children under the age of 6 months is 3.5 mg / kg / day, up to 2 years old - 12.5-37.5 mg / day, 3-12 years old - 100 mg / day, divided into 2-3 doses. After 3-5 days of treatment, it is recommended to take a break for 3-5 days. As a maintenance therapy at the indicated dose, it is prescribed 2 times a week. When using an intermittent course of treatment, taken after 1-3 days or within 2-3 days with a subsequent break, the decrease in effectiveness is less pronounced and side effects develop less frequently. To reduce intraocular pressure, appoint 25 mg 1 time in 1-6 days; the effect occurs within hours. With diabetes insipidus - 25 mg 1-2 times a day with a gradual increase in the dose (daily doses of mg) until therapeutic effect (reduction of thirst and polyuria), further dose reduction is possible.

Dry mouth, nausea, vomiting, diarrhea; weakness, increased fatigue, dizziness, headache, palpitations, calf muscle cramps, hypokalemia, hypomagnesemia, hyponatremia, hyperuricemia, hypercalcemia, hyperglycemia; exacerbation of gout, thrombosis, embolism, hypercreatininemia, acute interstitial nephritis, vasculitis, progression of myopia, neutropenia, thrombocytopenia, hemorrhagic pancreatitis, acute cholecystitis (with gallstone disease), orthostatic hypotension, allergic dermatitis. Overdose. Symptoms: hypokalemia (weakness, paralysis, constipation, arrhythmias), drowsiness, decreased blood pressure. Treatment: infusion of electrolyte solutions; compensation for K + deficiency (prescribing K + drugs and potassium-sparing diuretics).

Hypersensitivity, gout, diabetes mellitus (severe), chronic renal failure (CC less / min, anuria), hypokalemia, hypercalcemia, hyponatremia; pregnancy (I trimester), lactation period. With caution - II-III trimester of pregnancy.

For the prevention of K + and Mg2 + deficiency, a diet with a high content of these salts, potassium-sparing diuretics, K + and Mg2 + salts are prescribed. During treatment, it is not recommended to engage in activities that require concentration of attention and speed of psychomotor reactions. Regular monitoring of plasma levels of K +, glucose, uric acid, fats and creatinine is necessary.

Drugs that intensively bind to proteins (indirect anticoagulants, clofibrate, NSAIDs) enhance the diuretic effect. The antihypertensive effect is enhanced by vasodilators, beta-blockers, barbiturates, phenothiazines, tricyclic antidepressants, ethanol. It enhances the neurotoxicity of salicylates, weakens the effect of oral hypoglycemic drugs, norepinephrine, epinephrine and anti-gout drugs, enhances the side effects of cardiac glycosides, cardiotoxic and neurotoxic effects of Li + drugs, the effect of peripheral muscle relaxants, and reduces the excretion of quinidine. With the simultaneous administration of methyldopa, hemolysis may develop. Cholestyramine reduces absorption. Reduces the effect of oral contraceptives.

Sometimes there is a need to take a diuretic if the pressure suddenly rises. But you have to be careful with the pills - I don't advise anyone with hypothiasis. I, for example, showed all the side effects.

Ordinary green tea helps as a diuretic - drink a cup, and then go to the toilet every half hour. And from pills. Only Furosemide helps more or less.

That is, such a paradox - for us it is not a diuretic, but on the contrary

I also accepted it somehow, the effect was the opposite, then I just guessed to look into the instructions.

Here they recently prescribed carbamazepine for neuralgia, I think it's good luck, just there it says that the adiuritic action, in order to reduce the dose of the hormone, it turned out that with this native carbamazepine (which I am now being given) it has completely ceased to be absorbed, I have not been so absorbed from diabetes suffered.

But when such severe dehydration begins, it is clear that the whole body suffers, especially my heart problems begin with arrhythmia, tachycardia and blood pressure drops. In these cases, I always drink not just water, but Rehydron's solution (for dehydration). Immediately I feel relatively better.

Solutions) have become part of our life quite firmly. They are used to correct the acid-base balance in the body. After all, they perfectly remove excess acid and alkali from it. Diuretic pills, the list of which is quite impressive, are used in the treatment of poisoning, some injuries (especially when it comes to head injuries), to combat hypertension. But, unfortunately, not everyone knows not only the mechanism of action of these funds, but also the side effects that they can cause. And the improper use of diuretics can lead to serious complications.

brief information

For the treatment of many ailments, diuretic pills are used. The list of effective drugs continues to grow today. Diuretics are also called diuretics.

Their main goal is to remove excess water, chemicals, salts from the body, which tend to accumulate in the walls of blood vessels, tissues. In addition, diuretics have a positive effect on the water-salt balance.

If a large number of sodium ions accumulate in the body, then subcutaneous tissue begins to be deposited. It has a very negative effect on the functioning of the kidneys, heart, and the hematopoietic system. As a result, the patient develops a variety of diseases and disorders.

In addition, diuretics are in great demand in sports medicine. They are often used for weight loss. Very often, diuretics (tablets) are included in complex therapy to combat a variety of ailments.

According to the effect on the body, modern diuretics are divided into two main forms. The first category of drugs affects the process of urination directly in the kidneys. The second form of diuretics is responsible for hormonal regulation of urine production.

Important caveat

There is a lot of information that the diuretic pills, which are listed below, can also easily solve cosmetic problems. However, many people believe that such drugs are completely safe. Some women take such drugs on their own in order to lose weight. Athletes use drugs extensively before competition in order to lose weight. Even bodybuilders use them in an effort to create artificial dehydration so that the muscles look more prominent.

However, people who take diuretics without a medical prescription are at great risk. After all, treatment with diuretics can turn into unpleasant consequences. You should know that diuretics are capable of:

Quite often, even those patients who understand the risk believe that the latest drugs "Indapamide", "Torasemide", "Arifon" do not have a detrimental effect on metabolism. These drugs are actually much better tolerated than the older generation drugs. However, they are also harmful to health. But the negative impact of these funds is revealed much later. It is enough to understand the mechanism of their action. New and old generation medicines are aimed at one thing - to stimulate the kidneys to work more intensively. Consequently, they remove more salt and water.

It is important to understand that fluid retention in the body is a symptom of a serious illness. Puffiness cannot occur on its own. It is provoked by serious failures in the functioning of the kidneys, heart, and sometimes other reasons. Consequently, diuretics are drugs (their list is very extensive) of exclusively symptomatic action. Unfortunately, they do not eliminate the cause of the disease. Thus, medications only delay the unpleasant ending for patients. Therefore, people who want to improve their health and fight a real disease should not do with diuretics alone, much less use them on their own.

Classification of drugs

A single system according to which all diuretics would be separated, up to today no, since all drugs have a different chemical structure, differently affect the body's systems. Therefore, it is impossible to create an ideal classification.

Often the separation occurs by the mechanism of action. According to this classification, there are:

1. Thiazide drugs. They are great for treating hypertension and are excellent at lowering blood pressure. It is recommended to use them in parallel with other medicines. Thiazides are capable of negatively affecting metabolism, therefore, such diuretics are prescribed in small quantities. Drugs (a list of only the most popular is given in the article) from this group are "Ezidrex", "Hydrochlorothiazide", "Chlorthalidone", "Indapamide", "Hypothiazide", "Arifon".
2. Loop means. They remove salt and fluid from the body due to their effect on kidney filtration. These drugs are distinguished by a quick diuretic effect. Loop diuretics do not affect cholesterol levels, do not create prerequisites for the onset of diabetes. However, their biggest drawback is the many side effects. The most common drugs are "Torasemide", "Furosemide", "Ethacrynic acid", "Bumetanide".
3. Potassium-sparing agents. A fairly broad group of drugs. Such medications help to increase the excretion of chloride and sodium from the body. At the same time, the removal of potassium minimizes such diuretic tablets. The list of the most popular drugs: "Amiloride", "Triamteren", "Spironolactone".
4. Aldosterone antagonists. These diuretics work by blocking a natural hormone that keeps salt and moisture in the body. Drugs that neutralize aldosterone promote fluid removal. At the same time, the potassium content in the body does not decrease. The most popular representative is Veroshpiron.

Preparations for edema

For a good effect, potent agents can be used. The following diuretic tablets are used for edema:

• Torasemid;
• Furosemide;
• "Pyretanides";
• Xipamide;
• "Bumetanid".

Medium-strength diuretic tablets can also be used for edema:

• Hydrochlorothiazide;
• "Hypothiazide";
• Chlorthalidone;
• "Klopamid";
• "Polythiazide";
• Indapamide;
• "Metozalon".

Such drugs are used for a long time and continuously. The attending physician sets the recommended dose. Typically, it is about 25 mg per day.

For small edema, potassium-sparing diuretics, such as Spironolactone, Amiloride, Triamteren, are more suitable. They are taken in courses (2-3 weeks) at intervals of 10-14 days.

Drugs for hypertension

Diuretic medicines used for high blood pressure fall into two categories:

1. Means with a quick effect. Such drugs are used in hypertensive crisis, when it becomes necessary to quickly reduce blood pressure.
2. Means for daily use. Medicines keep your blood pressure at an optimal level.

Potent medications can help stop a hypertensive crisis. The most popular is the drug "Furosemide". Its price is low. The following remedies are no less effective in a crisis:

• Torasemid;
• "Bumetanid";
• "Ethacrynic acid";
• "Pyretanides";
• Xipamide.

The duration of taking the above drugs can be 1-3 days. After stopping the crisis, they switch from such potent drugs to drugs that can maintain the pressure at the required level daily.

• Indapamide;
• Hydrochlorothiazide;
• "Hypothiazide";
• "Klopamid";
• "Metozalon";
• "Polythiazide";
• Chlorthalidone.

These medicines are taken daily as directed by your doctor. They perfectly maintain the optimum pressure level.

Heart failure medications

As a result of this pathology, fluid retention in the body often occurs. This phenomenon creates stagnation of blood in the lungs. The patient has many unpleasant symptoms such as shortness of breath, edema, enlarged liver, and wheezing in the heart.

For people with a doctor, a diuretic must be introduced into therapy. It perfectly prevents severe consequences in the lungs, cardiogenic shock. In this case, diuretics increase the patient's tolerance to physical activity.

For patients with the first and second degree of the disease, a thiazide drug is a good diuretic. With a more serious pathology, the patient is transferred to strong remedy - a loop diuretic. In some cases, the drug "Spironolactone" is additionally prescribed. The reception of such a remedy is especially relevant if the patient has developed hypokalemia.

With the weakening of the effect of the drug "Furosemide" cardiologists recommend replacing it with the drug "Torasemide". It is noticed that the last remedy has a more beneficial effect on the body in severe forms of heart failure.

The drug "Furosemide"

The medicine is a fast-acting diuretic. Its effect occurs after ingestion for 20 minutes. The duration of exposure to the drug is about 4-5 hours.

This remedy is effective not only for arresting a hypertensive crisis. According to the instructions, the medicine helps with heart failure, edema of the brain and lungs, poisoning chemicals... It is often prescribed for late toxicosis during pregnancy.

However, the remedy also has strict contraindications. The drug is not used in the first trimester of pregnancy. Do not use it in patients with renal insufficiency, people who have hypoglycemia, urinary obstruction.

The cost of the drug "Furosemide" is low. The price is approximately 19 rubles.

The drug "Torasemid"

The medicine is a fast-acting remedy. The drug "Furosemide" undergoes biotransformation in the kidneys, therefore it is not suitable for all patients. A more effective drug for people suffering from kidney ailments is the drug "Torasemide", since it is biotransformed in the liver. But with pathologies of this organ, the medicine can cause serious harm.

Already after 15 minutes, the effect on the body begins (as reported by the price attached to the drug, the price varies from 205 to 655 rubles.

Long-term studies have confirmed the high effectiveness of the drug in heart failure. In addition, the drug perfectly removes salts and liquids. At the same time, the loss of potassium by the body is insignificant, since the effective agent blocks the hormone aldosterone.

The drug "Indapamide"

The medicine is very effective in hypertension (severe and moderate). The product perfectly reduces blood pressure and maintains its optimal level throughout the day. In addition, it prevents an increase in this indicator in the morning.

You need to take the medicine once a day, 1 tablet, as evidenced by the instructions included in the Indapamide preparation. The average price of the product varies from 22 to 110 rubles.

Before taking it, you should familiarize yourself with the contraindications, since an excellent remedy is not suitable for all patients suffering from hypertension. The drug is not intended for people who have impaired kidney and liver function. It is forbidden to take medicine for pregnant, lactating mothers. In case of cerebral circulation failures, anuria, hypokalemia, the remedy is contraindicated.

The drug "Triamteren"

The medicine is a mild diuretic. It is recommended to use it in combination with another diuretic drug - "Hydrochlorothiazide". Thanks to this combination, it is possible to reduce the loss of potassium by the body. The drug Triamteren gives a beneficial effect. The instruction positions it as a potassium-sparing agent.

The medicine should be used strictly taking into account the prescribed dosage. People with impaired kidney function may experience an unpleasant side effect - high potassium levels. Sometimes the remedy can lead to dehydration. When interacting with folic acid, the drug promotes an increase in red blood cells.

The cost of the funds is 316 rubles.

The drug "Spironolactone"

The medicine is a potassium- and magnesium-saving agent. At the same time, it effectively removes sodium and chlorine from the body. After the start of taking the drug, the diuretic effect occurs approximately 2-5 days.

The medicine can be prescribed for hypertension, chronic heart failure, cirrhosis of the liver. It is effective to use "Spironolactone" for swelling in the 2nd and 3rd trimester of pregnancy.

The drug is not intended for people who are diagnosed with diabetes mellitus, renal or liver failure, anuria. It is forbidden to use the remedy in the first trimester of pregnancy. With hyponatremia, hyperkalemia, hypercalcemia, the drug is contraindicated. It should not be introduced into therapy for people with Addison's disease.

Side effects can also be observed when using the medication. In some cases, the remedy provokes the occurrence of hives, itching, drowsiness, headache, diarrhea, or constipation.

The cost of the funds is about 54 rubles.

According to the data of epidemiological studies, the prevalence of clinically pronounced chronic heart failure (CHF) in the Russian Federation is 4.5% (5.1 million people), the annual mortality rate for this category of patients is 12% (612 thousand patients). The main reasons for the development of CHF are in 88% of cases the presence of arterial hypertension (AH), and in 59% of coronary heart disease, a combination of these diseases occurs in every second patient with CHF. At the same time, among all patients with cardiovascular diseases, the main reason for hospitalization in 16.8% in any hospital is CHF decompensation.

Decompensation of CHF is manifested in practice by increased dyspnea, congestion in the lungs and, on examination, by pronounced edema of the lower extremities. The main measure of therapy is the correction of water homeostasis as the most important tool for harmonizing neurohumoral imbalance. In this situation, diuretics are first-line drugs for the treatment of acute and chronic heart failure. In daily clinical practice, every doctor - cardiologist, therapist is faced with the need to prescribe a drug from the group of diuretics for the treatment of patients with CHF, AH, which requires tremendous medical skill, since the irrational use of drugs in this group is one of the important causes of CHF decompensation.

Diuretics are a heterogeneous group of drugs that increase urine output and sodium excretion. They differ in the mechanism of action, pharmacological properties and, accordingly, the indications for the appointment. In accordance with the mechanism of action, drugs are divided into 4 classes:

1) proximal diuretics (proximal convoluted tubule): carbonic anhydrase inhibitors (acetazolamide) and osmotic diuretics (mannitol, sorbitol, etc., currently their use is limited);
2) loop diuretics (ascending part of Henle's loop): Na + / 2Cl - / K + -transporter inhibitors: Furosemide, torasemide, bumetanide, ethacrynic acid;
3) diuretics of the distal convoluted tubule: inhibitors of Na + / Cl-cotrans-portera (hydrochlorothiazide and thiazide-like diuretics);
4) collecting duct diuretics: Na + -channel blockers (aldosterone antagonists, amiloride, triamterene).

The last 3 classes of diuretics are actively used in cardiology. Loop diuretics have the most powerful diuretic effect; it is their use that is recommended in patients with clinically pronounced manifestations of CHF. In addition to the diuretic effect, loop diuretics, through the induction of prostaglandin synthesis, can cause dilatation of the renal and peripheral vessels. A striking representative of this class is furosemide, which has been used from 1959 to the present in the treatment of acutely decompensated and terminal CHF. However, its daily use causes discomfort in patients, which is expressed in an urgent urge to urinate within 1-2 hours after ingestion, orthostatic hypotension is noted at the peak of the drug's activity, all this contributes to a decrease in adherence to treatment.

In this regard, the appearance on the domestic pharmacological market of a long-acting loop diuretic - the original torasemide in 2011 - made it possible not only to treat patients with CHF more efficiently and effectively, but also to increase patient compliance. Torasemide, like all loop diuretics, inhibits the reabsorption of sodium and chloride in the ascending part of Henle's loop, but unlike furosemide, it also blocks the effects of aldosterone, i.e., to a lesser extent, enhances renal excretion of potassium. This reduces the risk of hypokalemia, one of the main adverse drug reactions of loop and thiazide diuretics. The main advantage of torasemide is the presence of a gum-containing shell, which slows down the release of the active substance, which reduces fluctuations in its concentration in the blood and, therefore, provides a more stable and long-term effect. Pharmacokinetic properties of torasemide differ from furosemide, the differences are presented in table.

An important advantage of torasemide is its high bioavailability, which is more than 80% and exceeds that of furosemide (50%). The bioavailability of torasemide does not depend on food intake, and therefore, unlike furosemide, it becomes possible to use it at any time of the day. High and predictable bioavailability determines the reliability of the diuretic action of torasemide in CHF and allows more successful oral administration of the drug, even in cases of severe CHF. The advantage of prolonged torasemide is the slow release of the active substance, which does not lead to the development of a pronounced peak of action and avoids the phenomenon of "increased postdiuretic reabsorption". This property seems to be very important in the aspect of the discussed safety problem, since it is associated with a decrease in the risk of rebound hyperactivation of the neurohormonal system. In addition, a single dose of torasemide per day increases patient adherence to treatment according to the study data by 13% in comparison with therapy with furosemide.

Torasemide is metabolized by cytochrome P450, which explains the absence of changes in its pharmacokinetic properties in patients with heart failure or chronic illness kidneys. Only 25% of the dose is excreted in the urine unchanged (versus 60-65% when taking furosemide). In this regard, the pharmacokinetics of torasemide does not significantly depend on renal function, while the half-life of furosemide increases in patients with renal insufficiency. Torasemide, like other loop diuretics, has a rapid onset. A dose of 10-20 mg torasemide is equivalent to 40 mg of furosemide. With increasing dose, a linear increase in urine output and natriuresis was observed.

Torasemide is the only diuretic with proven efficacy in large multicenter studies. So, in one of the largest to date TORIC (TORasemide In Chronic heart failure) study, 1377 patients with CHF II-III FC (NYHA) were included, randomized to receive torasemide (10 mg / day) or furosemide (40 mg / day ), as well as other diuretics. The study evaluated the efficacy, tolerability of therapy, dynamics of the clinical picture, as well as mortality and potassium concentration in the blood serum. According to the results this study therapy with torasemide was significantly more effective and allowed to improve the functional class in patients with CHF, and hypokalemia was noted much less frequently on this therapy (12.9% versus 17.9%, respectively; p \u003d 0.013). Also, the study revealed a significantly lower overall mortality in the group of patients taking torasemide (2.2% versus 4.5% in the furosemide / other diuretics group; p< 0,05). В целом исследование TORIC показало, что у больных с ХСН терапия торасемидом по сравнению с фуросемидом или другими диуретиками ассоциируется со снижением общей, сердечно-сосудистой и внезапной смертности на 51,5%, 59,7% и 69,9% соответственно .

The data obtained indicate that torasemide therapy more effectively and safely improves the clinical status of the patient, thereby reducing the number of hospitalizations to the hospital, and also has a more favorable prognosis in patients with CHF, which directly reflects the pharmacoeconomic benefit for the state in the treatment of patients with CHF. the original long-acting loop diuretic - torasemide.

A significant decrease in overall and cardiovascular mortality in the presence of torasemide is directly related to the effect of the drug on cardiac remodeling, due to a decrease in the end-diastolic volume of the left ventricle (LV EDV). Based on these data, it was suggested that torasemide can reduce the activation of procollagen-I-carboxyproteinase, which helps to slow down fibrosis of the LV wall. The TORAFIC study examined in detail the effect of prolonged torasemide on slowing cardiac fibrosis. According to the data obtained, there was no significant effect on the level of procollagen-I-carboxyproteinase. Thus, the decrease in LV EDV due to the use of torasemide is most likely associated with a natural decrease in the volume of circulating blood. However, one thing remains an indisputable fact: torasemide significantly reduces the severity of ventricular myocardial remodeling.

Torasemide, like all diuretics, has an antihypertensive effect, but usually loop diuretics are used only for hypertensive crises and resistance to thiazide diuretics. Long-acting torasemide is the first loop diuretic to be used more widely in people with hypertension. The antihypertensive effect of torasemide is due to a decrease in the total peripheral vascular resistance due to the normalization of electrolyte imbalance, mainly - a decrease in the content of calcium ions in the smooth muscle layer of the arteries. Direct vascular effects of torasemide have been proven, expressed in a significant increase in vasodilation both in healthy volunteers and in patients with hypertension using a mechanism associated with the release of nitric oxide (NO), as well as with a blocking effect on the vasoconstrictor action of endothelin-1. In addition, there is evidence that torasemide is able to reduce the activity of the renin-angiotensin system and the sensitivity of the first type of angiotensin II receptors, preventing arterial spasm caused by them. It is also important that torasemide has an antialdosterone effect, which allows not only to strictly control blood pressure, but also to slow down the progression of target organ lesions, largely mediated by the excess of aldosterone observed in patients with hypertension.

In comparative clinical studies, it was proved that the antihypertensive effect of torasemide develops more gradually than thiazide diuretics, without causing such a pronounced peak decrease in blood pressure, which is especially important in the management of elderly patients, since this category of patients often has a pronounced orthostatic reaction against the background taking thiazide diuretics. Patients with hypertension, as a rule, are comorbid for concomitant pathology, therefore, the metabolic profile when prescribing antihypertensive treatment is one of the key points of choice. In a study by G. Brunner et al. with the inclusion of 3074 patients with hypertension, the goal was to assess the metabolic profile of torasemide therapy. The drug was administered at a dose of 5-10 mg / day for 6 months. According to the data obtained, torasemide is a metabolically neutral drug that does not increase the level of glucose, uric acid, total cholesterol, low density lipoproteins, high density lipoproteins and potassium. Based on these results, it is possible to use torasemide in patients with hypertension and diabetes mellitus, the presence of hyperuricemia, dyslipidemia. The question naturally arises as to which dose is more optimal for the treatment of hypertension, since diuretics have a dose-dependent effect. According to the study by P. Baumgart, there was no significant difference in the effectiveness of “low-dose therapy” (2.5-5 mg / day) and “high-dose therapy” (5-10 mg / day). Analyzing a meta-analysis of clinical studies evaluating the effective dose of torasemide in the treatment of hypertension, it is possible to consider the optimal dose of 2.5 mg / day. In patients with mild to moderate hypertension, this dose is effective in 60-70% of cases, which is comparable to the effectiveness of the most commonly prescribed antihypertensive drugs. Torasemide in the prolonged form is a promising drug for the treatment of patients with hypertension, both in independent therapy and in combination with angiotensin-converting enzyme inhibitors and β-blockers.

Conclusion

Thus, due to its unique pharmacological profile, pleiotropic properties, neutral metabolic effects, torasemide with prolonged action has advantages over other loop diuretics in terms of efficacy, safety and compliance in the treatment of patients with arterial hypertension and CHF. All these properties make long-acting torasemide worthy of widespread use in modern clinical practice.

Literature

1. Belenkov Yu. N., Fomin I. V., Mareev V. Yu. et al. The prevalence of chronic heart failure in the European part of the Russian Federation - data from EPOCH-CHF (part 2) // Heart failure. 2006. No. 3. S. 3-7.
2. Mareev V. Yu., Ageev F. T., Arutyunov G. P. and other National recommendations of the OSSN, RKO and RNMOT for the diagnosis and treatment of CHF (fourth revision) // Heart failure. 2013. No. 7. S. 379-472.
3. Fomin I.V. Arterial hypertension in the Russian Federation - the last 10 years. What's next? // A heart. 2007. No. 6. S. 1-6.
4. Yancy C. W., Jessup M., Bozkurt B. et al. 2013 ACCF / AHA Guideline for the Management of Heart Failure: Executive Summary // JACC. 2013. Vol. 62. P. 1495-1539.
5. Belenkov Yu. N., Mareev V. Yu. Principles of rational management of heart failure. M .: Media Medica, 2000.S. 266.
6. Kobalava J. D.Ways to optimize diuretic therapy in congestive chronic heart failure - the place of prolonged release torasemide // Cardiology. 2014. T. 54. No. 4. P. 69-78.
7. Felker G. M. Loop diuretics in heart failure // Heart Fail Rev. 2012. Vol. 17.P. 305-311.
8. Ramani G. V., Uber P. A., Mehra M. R.Chronic heart failure: contemporary diagnosis and management // Mayo Clin. Proc. 2010. Vol. 85. P. 180-195.
9. Gendlin G.E., Ryazantseva E.E. The role of diuretics in the treatment of chronic heart failure // Serd. failure. 2012. No. 10. P. 23-28.
10. Brater D. C.Torasemide. In: Cardiovascular drug therapy. Ed. F. Messerli. 2 th ed. Philadelphia 1996. P. 402-412.
11. Claxton A. J., Cramer J., Pierce C.A systematic review of the associations between dose regimens and medication compliance // Clin Ther. 2001. Vol. 23. P. 1296-1310.
12. Stauch M., Stiehl M.Controlled double blind clinical trial on the efficacy and tolerance of torasemide in patients with congestive heart failure. A multi-center study. In: Progress in Pharmacology and Clinical Pharmacology. Gustav-Fischer-Verlag // Stuttgart. 1990. Vol. 8.P. 121-126.
13. Noe L. L., Vreeland M. G., Pezzella S. M., Trotter J. P. A pharmaeco-nomical assessment of torasemide and furosemide in the treatment of patients with congestive heart failure // Clin Ther 1999. Vol. 21. P. 854-860.
14. Cosin J., Diez J.TORIC investigators. Torasemide in chronic heart failure: results of the TORIC study // Eur. J. Heart Fail. 2002. Vol. 4.P. 507-513.
15. Kasama S., Toyama T.et. al. Effects of torasemide on cardiac sympathetic nerve activity and left ventricular remodeling in patients with congestive heart failure // Heart. 2006. Vol. 92. No. 10. P. 1434-1440.
16. Lopez B., Querejeta R.et al. Effects of loop diuretics on myocardial fibrosis and collagen type I turnover in chronic heart failure // J. Am Coll. Cardiol. 2007. Vol. 50. P. 859-867.
17. TORAFIC Investigators Group // Clin. Ther. 2011. Vol. 33. P. 1204.
18. Muniz P., Fortuno A., Zalba G.et al. Effects of loop diuretics on angiotensin II-stimulated vascular smooth muscle cell growth // Nephrol. Dial. Transplant. 2001. Vol. 16.P. 14-17.
19. De Berrazueta J. R., Gonzalez J. P., de Mier I.et al. Vasodilatory action of loop diuretics: A plethysmography study of endothelial function in forearm arteries and dorsal hand veins in hypertensive patients and controls // J. Cardiovasc. Pharmacol. 2007. Vol. 49. P. 90-95.
20. Fortuno A., Muniz P., Ravassa S. Torasemide inhibits angiotensin II-induced vasoconstriction and intracellular calcium increase in the aorta of spontaneously hypertensive rats // Hypertension. 1999. Vol. 34. P. 138-143.
21. Porcellati C., Verdecchia P., Schillaci G. et al. La torasemide, nuovo diuretico del'ansa, nell trattamento dell'ipertensione ar-teriosa: Studio con trolla to in doppla cecita // BasRazion Terapia. 1990. Vol. 20.P. 407-410.
22. Brunner G., Estrada E., Plesche L. Efficacy and safety of to-rasemide (5 to 40 mg o. D.) In the treatment of oedema in patients with hydrppically decompensated liver failure // Diuretics IV: Chemistry, Pharmacology and clinical Applications. Amsterdam: Excerpta Medica. 1993. Vol. 4.P. 27-30.
23. Baumgart P., Walger P., von Eiff M., Achhammer I. Long-term efficacy and tolerance of torasemide in hypertension. In: Progress in pharmacology and Clinical Pharmacology. Gustav-Fischer-Verlag: Stuttgart. 1990; 8: 169-81.
24. Reyes A. J., Chiesa P. D., Santucci M. R.et al. Hydrochlorothiazide versus a nondiuretic dose of torasemide as once daily antihyper-tensive monopharmacotherapy in elderly patients; randomized and double-blind study. In: Progress in Pharmacology and Clinical Pharmacology. Gustav-Fischer-Verlag: Stuttgart 1990. Vol. 8.P. 183-209.
25. Boelke T., Piesche L.Influence of 2.5-5 mg torasemide o. d. versus 25-50 mg HCTZ / 50-100 triamterene o. d. on serum parameters in elderly patients with mild to moderate hypertension. In: Diuretics IV: Chemistry, Pharmacology and Clinical Applications // Excerpta Medica: Amsterdam 1993. Vol. 3.P. 279-282.
26. Achhammer I., Eberhard R. Comparison of serum potassium levels during long-term treatment of hypertension patients with 2.5 mg torasemide o. d. or 50 mg triamterene / 25 mg hydrochlorothi-azide o.d. In: Progress in Pharmacology and Clinical Pharmacology. Gustav-Fischer-Verlag // Stuttgart 1990. Vol. 8.P. 211-220.

G. I. Nechaeva 1, doctor of Medical Sciences, Professor
O. V. Drokina, candidate of Medical Sciences
N.I. Fisun,candidate of Medical Sciences
E. N. Loginova, candidate of Medical Sciences

In modern Ukrainian society, the illusion has developed that the most terrible disease is myocardial infarction. In fact, acute heart failure (AHF; acute decompensated heart failure (ADHF), acute left ventricular failure (ALVF)) is much more dangerous.

With almost the same incidence of acute heart failure and acute coronary syndrome (ACS), prehospital, nosocomial and 3-month mortality in AHF is much higher than in ACS (Table 1).

According to a number of cardiologists, the goals of therapy for ADF are not as clear as for a heart attack or unstable angina, international clinical trial results are minimal or conflicting, and evidence levels for major drug interventions, as opposed to acute coronary artery disease, are largely based on expert opinion.

ADHF treatment in the first hours after hospitalization depends on regional characteristics (Table 2). Thus, in the United States, loop diuretics are used 13.5% significantly less often than in Eastern Europe, intravenous vasodilators - 8 times, and inotropes - 6 times less often than in Western Europe. (Collins S.P. et al., 2010).

The current strategy for treating AHF at the prehospital stage and in the admission department of the hospital is shown in Fig. one .

As seen in Fig. 1, a diuretic is a first-line drug in the treatment of acute heart failure of any genesis. The decision on further drug strategy is made according to the current values \u200b\u200bof blood pressure (BP).

A. Maggioni et al. (2011) analyzed the results of treatment of 5118 patients out of 136 medical centers Europe and the USA involved in the EUR Observational Research program. Of these, 1892 (37%) had acute heart failure, the rest had acute decompensated heart failure. 84.6% of patients received IV furosemide at an average dose of 60 mg, IV nitrates - 18.5%, inotropes - 10.5% (dobutamine - 4.6%, levosimendan - 2.4%, others - 3 ,five %). As a result of the intensification of treatment, the overall mortality rate in such patients decreased from 6.7% in 2005 to 3.8% in 2009-2010. It is curious that mortality decreased in all etiological groups of AHF: with cardiogenic shock - from 39.5 to 22.0%, pulmonary edema - from 9.1 to 5.6%, hypertensive ALVF - from 1.5 to 1.2% , right ventricular ALVH - from 8.0 to 6.1%.

The frequency of diuretic use in all forms of AHF both at the prehospital stage and in the hospital is the highest and amounts to 78-100% (Fig. 2).

The need for the use of loop diuretics in the treatment of emergency conditions is not in doubt today. The type of diuretic and the modes of use are important.

The purpose of our article was to compare the efficacy and tolerability of modern intravenous diuretic therapy with torasemide in the treatment of acute left ventricular failure caused by hypertensive crises in patients with arterial hypertension (AH).

Materials and research methods

We analyzed the therapy of 96 patients with ALVH (class III according to Killip) against the background of ADF, who were treated in the cardiology department for patients with myocardial infarction with the cardiac intensive care unit of the KGKB No. 5 from January 2011 to March 2013. Among those included in the study were only patients with chronic heart failure whose pulmonary edema developed against the background of decompensation of previously existing disorders of systolic and / or diastolic function of the left ventricle (LV). At the same time, persons with pulmonary edema on the background of acute myocardial infarction, mitral stenosis, hypoproteinemia (of various origins), pneumothorax, acute obstruction of the airways, pneumonia, and the effects of toxic substances were excluded.

All patients received the following therapy: beta-blockers, ACE inhibitors, adequate anticoagulant therapy. All patients were randomly assigned into two groups. The differences between the groups were in the choice of the loop diuretic.

Group I included 42 patients who received torasemide (Trifas®, Berlin-Chemi AG) 10-20 mg intravenously bolus followed by drug infusion (up to a maximum of 100 mg per day) if necessary. Group II (comparison group) consisted of 54 patients who received furosemide 40-80 mg intravenously bolus, if necessary, followed by infusion of the drug (up to a maximum of 400 mg per day).

Therapy with ALVO (pulmonary edema) in our study was carried out according to the following scheme (Fig. 3).

Research results

As a result of treatment with loop diuretics, changes in the general condition of patients were noted in both groups.

A more rapid reduction in the symptoms of shortness of breath, palpitations, wheezing in the lungs, the disappearance of peripheral edema in combination with effective control of blood pressure was observed among patients from the torasemide group (Table 3). They showed a more complete restoration of oxygenation of peripheral tissues, increased diuresis, and a reduction in the time spent in the intensive care unit.

The general condition according to the Likert scale improved in 73.8% of patients in group I and in 61.1% in group II (relative risk (RR) 0.63; p \u003d 0.03). The number of patients without improvement or with deterioration was significantly greater in group II - in 33.3% of patients versus 21.4% of patients in group I (RR 0.71; p \u003d 0.04).

During the first month, 1 patient died in the furosemide group and none in the torasemide group.

According to our observation, the composite endpoint (death plus re-hospitalization within 6 months after discharge from the hospital) reached 3 (7.2%) patients in group I and 6 (11.2%) patients in group II (p \u003d 0.23) ...

The duration of the diuretic action of furosemide averaged 2.2 hours from the moment of injection, and torasemide - about 6 hours. Titration of the dose to achieve stabilization of the state was significantly more often required in patients of group II. Diuretic dose adjustment occurred in 27 (50.0%) patients in the furosemide group and in 14 (33.4%) patients in the torasemide group. According to A.E. Bagriya, A.I. Dyadyka (2008), the use of torasemide instead of furosemide in the treatment of pulmonary edema in the setting of hypertensive crisis in addition to opiates, oxygen and digoxin reduces by 36.5% (p< 0,05) частоту кумулятивной конечной точки (документированная смерть от всех причин плюс повторный отек легких) .

The daily urine output in our study was 2.84 and 2.66 l / day, respectively, for the torasemide and furosemide groups (the differences are not significant). Hypokalemia (K + less than 3.5 mmol / l) every other day was noted more than 2 times less often in group I - in 3 (7.2%) patients, while in the furosemide group - in 9 (16.7%) patients ...

In earlier studies (Stringer K.A., Watson W., 1994) in patients with cardiogenic pulmonary edema, the efficacy and safety of intravenous torasemide has also been proven. Thus, against the background of intravenous administration of torasemide at a dose of 20-40 mg (if necessary, followed by titration within 24 hours), the average fractional sodium excretion increased 2.35 times, the average urine volume increased from 134 to 375 ml per hour (p \u003d 0.0034). The introduction of torasemide was accompanied by a significant decrease in the number of wheezing in the lungs and a pronounced decrease in dyspnea. Importantly, none of the patients had serious adverse reactions warranting exclusion from the study. The authors concluded that intravenous administration torasemide is effective and well tolerated in patients with acute cardiogenic pulmonary edema.

Against the background of intensive diuretic therapy, we observed cardiac arrhythmias in the form of extrasystolic arrhythmias. In the torasemide group, ventricular extrasystole occurred in 1 (2.4%) patient and in 4 (7.4%) patients in the furosemide group. The average length of hospital stay for patients in group I was 14.3% less - 9.4 ± 2.6 days versus 10.1 ± 2.8 days in the furosemide group.

Discussion

Furosemide and torasemide have a strong natriuretic and, accordingly, diuretic effect, which gives reason to consider this class of diuretics as the most effective in the treatment of edema syndrome. In addition, loop diuretics have a direct antihypertensive effect, which is associated with the stimulation of the synthesis of renal vasodilating prostanoids (primarily prostaglandin E2).

Torasemide is not inferior in diuretic effect to furosemide and has an additional pronounced anti-aldosterone effect (Table 4). It has a longer diuretic effect and is less likely to cause hypokalemia. It is important that, unlike other loop diuretics - furosemide and bumetanide, torasemide does not affect the excretion in the proximal tubules and therefore causes less loss of phosphates and bicarbonates. In addition, torasemide differs from furosemide in its lower affinity for albumin, which ensures the preservation of the diuretic effect in hypoalbuminemia. This property of the drug is important for patients with manifestations of acute left ventricular failure associated with chronic use of loop diuretics, especially in situations requiring emergency care in the absence of data on the level of serum albumin.

The ability of torasemide to prevent the growth of impaired contractility of the left ventricular myocardium is manifested during chronic use of the drug and can hardly be of significant importance in the treatment of emergency conditions. As shown by the DUEL study, the incidence of adverse reactions during the use of torasemide is 14 times significantly less than with the use of furosemide.

Interesting results from a publication on the use of loop diuretics in ADHD in the USA (Vats V., DiDomenico R.J., 2007)... Thus, an analysis of care in 107 hospitals in Illinois showed that when prescribing loop diuretics, torasemide was used in 69.2% of cases.

Intravenous injection of loop diuretics in general and torasemide in particular simultaneously has a vasodilating effect, manifested by a rapid (after 5-30 minutes) decrease in right atrial pressure and pulmonary artery wedge pressure, as well as a decrease in pulmonary vascular resistance. With bolus administration of high doses of furosemide\u003e 1 mg / kg, there is a risk of reflex vasoconstriction. This risk is significantly lower in torasemide, since the drug has vasodilating properties due to partial blockade of angiotensin II receptors and a decrease in calcium content in the smooth muscle cells of the vascular wall. This should be considered primarily in patients with acute coronary syndromewhen vasodilating properties are of particular importance. In severe HF decompensation, diuretics help to normalize the filling pressure of the heart chambers and can quickly reduce neurohormonal activity. If in furosemide this is due exclusively to hemodynamic effects, then torasemide, due to its antialdosterone and antiangiotensin properties, has clear advantages in relation to the normalization of neurohormonal parameters.

Treatment of ALVN usually begins with a bolus of torasemide at a dose of 10–20 mg. In the future, the dose should be titrated until a clinical effect is achieved and the symptoms of acute fluid retention are reduced. The administration of a loading dose of the drug followed by infusion is more effective than a repeated bolus administration. The maximum daily dose of torasemide for parenteral use is 100 mg per day. The drug Trifas 20 ampoules, according to the instructions, must not be mixed with other drugs for intravenous injections and / or infusions.

Based on the above features of the pharmacological effects of furosemide and torasemide, one should draw the following conclusions, important in practical terms:

1. The strength of the diuretic effect of loop diuretics depends on the dose of drugs: the larger the dose, the stronger the diuretic effect.

2. The diuretic furosemide has advantages over torasemide only in the speed of development of the diuretic effect.

3. The loop diuretic torasemide has significant and fundamental advantages over furosemide:

By the effect on the metabolic and electrolyte profile (does not cause significant loss of K +, Mg 2+, phosphates and bicarbonates, to a lesser extent contributes to the retention of urates), which leads to a more favorable profile of the pharmacological safety of torasemide and greater adherence to treatment. The absence of a negative effect of torasemide on the indicators of the glucose tolerance test, fasting glucose level, glycosylated hemoglobin, insulin, C-peptide was proved. Special attention should be paid to research data proving the complete absence of a negative effect of torasemide on the parameters of carbohydrate metabolism in patients with type 2 diabetes mellitus and lipid metabolism with prolonged use;

In terms of bioavailability, the nature of absorption and connection with food (it has a significantly higher lipophilicity and bioavailability, complete absorption and no dependence on food intake), torasemide is more effective in severe patients who have impaired absorption processes. The drug can be prescribed regardless of food intake (both before and after), which also leads to greater patient adherence to treatment;

By the nature of the diuretic action and, to a certain extent, its reliability (in contrast to furosemide, torasemide has a more predictable and stable diuretic effect, which is primarily associated with a significantly better bioavailability of the drug);

According to the duration of the diuretic effect (unlike furosemide, torasemide has a significantly longer half-life). The drug should be prescribed once a day, in the morning (whereas furosemide should be prescribed at least 2 times a day). The use of furosemide once a day may be accompanied by the development of the phenomenon of rebound (the phenomenon of postdiuretic Na + retention), when a significant increase in urine output in the first half of the day is replaced by Na + and fluid retention in the second half. As a result, the daily excretion of fluid can change slightly, which does not make it possible to obtain a satisfactory clinical effect (reduction of shortness of breath and edema syndrome);

By the presence of two ways of excretion of torasemide (renal and hepatic), which reduces the risk of drug accumulation in cases of dysfunction of one of the organs. The pharmacokinetics of furosemide is more dependent on renal function than liver function, and renal dysfunction may lead to drug accumulation. It should be noted that some studies prove the fact of a decrease in the elimination of torasemide in women compared to men. The latter is considered as the reason for the greater number of torasemide adverse reactions in female patients;

According to the significantly better tolerability of the drug (a rather important point in practical terms is that, unlike furosemide, torasemide does not cause intense diuresis) and high adherence of patients to treatment, as evidenced by other important advantages of the drug.

Benefits of torasemide over furosemide based on evidence-based medicine:

1. Improving the prognosis and reducing the overall and cardiovascular mortality of patients with AHF.

2. Significant decrease in the severity of dyspnea and functional class, increase in exercise tolerance and improvement in the quality of life of patients with ADF.

3. Reducing the frequency and duration of hospitalizations for AHF.

4. Improvement functional state left ventricle, anti-remodeling effect (decrease in end-diastolic size, LV myocardial mass).

5. Reducing the frequency of recording hypokalemia.

6. Improvement of neurohumoral status (decrease in the concentration of sodium-uretic peptide, activity of renin and aldosterone in blood plasma).

7. Increase in vasodilation due to activation of NO release, secretion of prostaglandin I 2 and lack of stimulation of thromboxane release, suppression of the activity of angiotensin II and endothelin-1.

findings

Based on the literature data and our own clinical experience of use, it can be concluded that the parenteral form of torasemide (Trifas®) should be used more widely than that of furosemide in the treatment of various forms of acute heart failure due to its greater effectiveness. Torasemide in terms of safety profile is significantly superior to furosemide, which gives the right to use it in severe decompensated patients when prescribing the parenteral form in emergency cardiology.

List of references

1. Bonow R.O., Ganiats T.G., Beam C.T. et al. ACCF / AHA / AMA-PCPI 2011 Performance Measures for Adults With Heart Failure. Report of the American College of Cardiology Foundation / American Heart Association Task Force on Performance Measures and the American Medical Association - Physician Consortium for Performance Improvement // J. Am. Coll. Cardiol. 2012; 59 (20): 1812-1832.

2. Smith W.R., Poses R.M., McClish D.K. et al. Prognostic judgments and triage decisions for patients with acute congestive heart failure // Chest 2002; 121 (5): 1610-7.

3. Weintraub N.L., Collins S.P., Pang P.S. et al. Acute heart failure syndromes: emergency department presentation, treatment, and disposition: current approaches and future aims: a scientific statement from the American Heart Association // Circulation 2010; 122 (19): 1975-96.

4. Peacock W. F., Costanzo M. R., De Marco T. et al. Impact of intravenous loop diuretics on outcomes of patients hospitalized with acute decompensated heart failure: insights from the ADHERE registry // Cardiology 2009; 113 (1): 12-9.

5. Maisel A. S., Peacock W. F., McMullin N. et al. Timing of immunoreactive B-type natriuretic peptide levels and treatment delay in acute decompensated heart failure: an ADHERE (Acute Decompensated Heart Failure National Registry) analysis // J. Am. Coll. Cardiol. 2008; 52 (7): 534-40.

6. Peacock W.F., Fonarow G.C., Emerman C.L. et al. Impact of early initiation of intravenous therapy for acute decompensated heart failure on outcomes in ADHERE // Cardiology 2007; 107 (1): 44-51.

7. Cosin J., Diez J .; TORIC investigators. Torasemide in chronic heart failure: results of the TORIC study // Eur. J. Heart Fail. 2002; 4: 507-13.

8. Murray M., Deer M., Ferguson J. et al. Open-label randomized trial of torsemide compared with furosemide therapy for patients with heart failure // Am. J. Med. 2001; 111 (7): 513-520.

9. Spannheimer A., \u200b\u200bMuller K., Falkenstem P. et al. Long-term diuretic treatment in heart failure: are there differences between furosemide and torasemide? // Schweiz. Rundsch. Med. Prax. 2002; 91 (37): 1467-1475.

10. Muller K., Gamba G., Jaquet F., Hess B. Torasemide vs. furosemide in primary care patients with chronic heart failure NYHA II to IV - efficacy and quality of life // Eur. J. Heart Fail. 2003; 5 (6): 793-801.

11. Yamato M., Sasaki T., Honda K. et al. Effects of torasemide on left ventricular function and neurohumoral factors m patients with chronic heart failure // Circ J. 2003; 67 (5): 384-390.

12. Veeraveedu P. T., Watanabe K., Ma M. et al. Torasemide, a long-actingloop diuretic, reduces the progression of myocarditis to dilated cardiomyopathy // Eur. J. Pharmacol. 2008; 581: 121-31.

13. Tanaka H., Watanabe K., Harima M. et al. Effects of various diuretics on cardiac function in rats with heart failure // Yakugaku Zasshi. 2009; 129: 871-9.

14. Negishi K., Kasama S., Araki Y. et al. Torasemide treatment improves cardiac sympathetic nerve activity as well as combined furosemide and spironolactone treatment in patients with heart failure // Circ. J. 2008; 72: Abst PJ-155.

15. De Berrazueta J.R., Gonzalez J.P., de Mier I., Poveda J.J., Garcia-Unzueta M.T. Vasodilatory action of loop diure-tics: A plethysmo-graphy study of endothelial function in forearm arteries and dorsal hand veins in hypertensive patients and controls // J. Cardiovasc. Pharmacol. 2007; 49: 90-5.

16. Liguori A., Casini A., Di Loreto M., Andreini I., Napoli C. Loop diuretics enhance the secretion of prostacyclin in vitro, in healthy persons, and in patients with chronic heart failure // Eur. J. Clin. Pharmacol. 1999; 55: 117-24.

17. Fortuno A., Muniz P., Ravassa S. Torasemi-de inhibits angiotensin II-induced vasoconstriction and intracellular calcium increase in the aorta of spontaneously hypertensive rats // Hypertension. 1999; 34: 138-43.

18. Fortuno A., Muniz P., Zalba G., Fortu-no M.A., Diez J. The loop diuretic torasemide interferes with endothelin-1 actions in the aorta of hypertensive rats // Nephrol. Dial. Transplant. 2001; 16: 18-21.

19. Muniz P., Fortuno A., Zalba G., Fortu-no M.A., Diez J. Effects of loop diuretics on angiotensin II-stimulated vascular smooth muscle cell growth // Nephrol. Dial. Transplant. 2001; 16: 14-17.

20. Lyseng-Williamson K.A. Torasemide prolonged release // Drugs. 2009; 69: 1363-72.

21. Ivanov V.P. Diuretics: Aspects of the Clinical Use of Diuretics for Family and General Practitioners // Cardiology: From Science to Practice. - 2012. - No. 4. - S. 108-122.

22. Baumgart P. Torasemide in comparison with thiazides in the treatment of hypertension // Cardiovasc. Drugs Ther. 1993; 7 (suppl. 1): 63-68.

23. Spannbrucker N., Achhammer I., Metz P., Glocke M. Comparative study on the hypertensive efficacy of torasemide and indapamide in patiehts with essential hypertension // Drug Res. 1988; 38 (1): 190-193.

24. Porcellati C., Verdecchia P., Schillaci G. et al. La torasemide, nuovo diuretico del'ansa, nell trattamento dell'ipertensione arteriosa: Studio con trolla to in doppla cecita // BasRazion Terapia 1990; 20: 407-10.

25. Baumgart P., Walger P., von Eiff M., Achhammer I. Long-term efficacy and tolerance of torasemide in hypertension // Progress in pharmacology and Clinical Pharmacology. Gustav-Fischer-Verlag: Stuttgart 1990; 8: 169-81.

26. Reyes A.J., Chiesa P.D., Santucci M.R. et al. Hydrochlorothiazide versus a nondiuretic dose of torasemide as once daily antihyper-tensive monopharmacotherapy in elderly patients; randomized and double-blind study // Progress in Pharmacology and Clinical Pharmacology. Gustav-Fischer-Verlag: Stuttgart 1990; 8: 183-209.

27. Boelke T., Piesche L. Influence of 2.5-5 mg torasemide o.d. versus 25-50 mg HCTZ / 50-100 triamterene o.d. on serum parameters in elderly patients with mild to moderate hypertension // Diuretics IV: Chemistry, Pharmacology and clinical Applications. Excerta Medica: Amsterdam 1993; 279-82.

28. Voelke T., Achhammer I., Meyer-Sabel-lek W.A. Blutdrucksenkung und meta-bolische Veranderungen bei essentiellen Hypertoni-kem nach Langzeitgabe unterschiedlicher Diuretika // Hochdruck 1990; 9: 40-1.

29. Achhammer I., Metz P. Low dose loop diuretics in essential hypertension: Expe-rience with torasemide // Drugs 1991; 41 (Suppl. 3): 80-91.

30. Achhammer I., Eberhard R. Comparison of serum potassium levels during long-term treatment of hypertension patients with 2.5 mg torasemide o.d. or 50 mg triamterene / 25 mg hydrochlorothi-azide o.d. // Progress in Pharmacology and Clinical Pharmacology. Gustav-Fischer-Verlag: Stuttgart 1990; 8: 211-20.

31. Roca-Cusachs A., Aracil-Vilar J., Calvo-Gomez C. et al. Clinical effects of torasemide prolonged release in mild-tomo-derate hypertension: a randomized non-inferiority trial versus torasemide immediate release // Cardiovasc. Ther. 2008; 26: 91-100.

32. Kult J., Hacker J., Glocke M. Comparison of efficacy and tolerance of different oral doses of torasemide and furosemide in patients with advanced chronic renal failure // Arzneimittel-Forschung / Drug Research. 1998; 38: 212-214.

33. Clasen W., Khartabil T., Imm S., Kindler J. Torasemid for diuretic treatment of advanced chronic renal failure // Arzneimittel-Forschung / Drug Research. 1988; 38: 209-211.

34. Mourad G., Haecker W., Mion C. Dose-dependent efficacy of torasemide in comparison with furosemide and placebo in advanced renal failure // Arzneimittel-Forschung / Drug Research. 1988; 308: 205-208.

35. Vasavada N., Saha C., Agarwal R. A double-blind randomized crossover trial of two loop diuretics in chronic kidney disease // Kidney Int. 2003; 64 (2): 632-640.