When a person suffers from hypertension and edema syndrome, he is faced with the question of choosing an effective remedy for the treatment of edema. Torasemide and Furosemide are loop diuretics and have a diuretic effect on the body. But what is better to choose in each individual case, we will understand in more detail later in the article.

Review of Torasemide and Furosemide and their principle of action

Torasemide is available in tablet form. It has antihypertensive, saluretic and diuretic effects. The maximum absorption of the drug occurs several hours after administration. Bioavailability of Torasemide is up to 90%, it is completely removed from the body after 3-4 hours.

Some of the drug's effects are not well understood due to its relatively recent introduction on the market compared to Furosemide. It is prescribed for the treatment of essential hypertension, edema with congestive heart and renal failure, as well as with high blood pressure.

Effect of Torasemide on Collagen Metabolism

Refers to sulfonamides, begins to act quickly enough - 5 minutes after intravenous administration. The agent has a natriuric effect, increases the excretion of potassium, calcium and magnesium ions. Begins to be absorbed after 30 minutes for intravenous administration and after 1-2 hours for oral administration.

The substance binds well to blood plasma proteins (by 98%), is metabolized by the liver and excreted by the kidneys. It is prescribed for congestive heart failure of the second and third stage, liver cirrhosis, arterial hypertension and other pathologies.

The appointment of Furosemide during emergency treatment for pulmonary edema is explained by its vasodilating effect (i.e., the effect aimed at vasodilation), which is manifested when administered intravenously even before the diuretic effect.

Torasemide and Furosemide are both loop diuretics. Their comparison consists in assessing the duration of the effect, as well as in the difference in dosages and side effects. These agents remove sodium from the body, inhibiting its absorption in the loop of Henle in the kidneys, and sodium, in turn, removes water with it. Apart from the main effect, they also reduce the level of aldosterone in the body.

But the effectiveness of drugs tends to decrease with the age of patients - the older the person, the more difficult it is for doctors to find the right dose.

Indications and contraindications

These diuretics are prescribed for patients with symptoms of heart failure, depending on the desired effect, the dosage of the drug also varies - the higher the dose, the more pronounced the effect.

Indications for use:

1. Arterial hypertension.
2. Chronic renal failure.
3. Edematous syndrome in heart failure.

Indications and mechanism of action of Furosemide

Contraindications for drugs are mostly associated with electrolyte imbalance, and these include the following pathologies:

1. Hyponatremia.
2. Hypovolemia.
3. Hypokalemia.
4. Hypotension.

Also, Furosemide and Torasemide are contraindicated in pregnant women and during lactation, in patients with impaired urinary tract patency and severe liver and kidney pathologies (glomerulonephritis).

Children should take drugs with caution, Furosemide is not prescribed for children weighing less than 10 kg. Torasemide does not yet have an evidence base on the appropriateness of use in children.

Instructions for use and compatibility

Both medicines are taken on an empty stomach, before meals. As a rule, the doctor sets the dosage depending on the patient's condition, the degree of swelling, hypertension.

To date, Furosemide remains the main diuretic in the treatment of chronic heart failure, manifested by high blood pressure and edema syndrome. In such cases, the dosage ranges from 20-80 mg to 250-1500 mg per day. Torasemide is prescribed in doses from 20 to 200 mg.

The compatibility of these drugs is not fully understood and remains open to question. Now they are appointed separately, as they are quite effective individually.

Key differences, safety and effectiveness

What are the main differences between Furosemide and Torasemide? First of all, these drugs differ in the duration of the effect. Torasemide acts 6 hours from the moment of injection, which is almost 3 times longer than the duration of action of Furosemide. The latter is more suitable for emergency conditions, since it begins to act within 5 minutes after intravenous administration (Torasemide - only after 15).

Excretion of electrolytes in the urine depending on the dose of torasemide

But Torasemide copes much more quickly with symptoms such as wheezing, shortness of breath, heart palpitations and swelling in the limbs. It increases daily urine output, increases tissue oxygenation and reduces the average number of days spent by patients in intensive care, much better than Furosemide.

Torasemide is more effective than Furosemide. The drug has fewer side effects, their severity is weaker, it is much more effective in coping with edema syndrome, shortness of breath, heart palpitations, and a decrease in blood pressure.

The mortality rate in patients who take it is less than in those who take Furosemide.

Torasemide is a new generation of loop diuretics. The only drawback is that the onset of action of Torasemide is three times longer than that of its analogue, which does not make Torasemide the drug of choice for emergency conditions.

Side effects can occur with both drugs, but they are more characteristic of Furosemide. They include various manifestations of allergic reactions, metabolic disorders, skin manifestations, malfunctions of the cardiovascular, urinary and immune systems:

Most of the undesirable effects of drugs are manifested in the case of an incorrectly selected dosage, uncontrolled use and overdose.

Interaction with other drugs and analogues

The drugs can be combined with other classes of diuretics such as amiloride. Cannot be administered in conjunction with nephrotoxic and ototoxic drugs in order to avoid potentiation of undesirable effects.

Also, they are not prescribed with first-generation NSAIDs, since they are antagonists at the molecular level. Very carefully prescribed with drugs that also bind to blood plasma proteins. As diuretic displacement may occur

Analogues of Furosemide and Torasemide are thiazide diuretics. These include:

1. Chlorothiazide.
2. Lorvas.
3. Retapres.
4. Indapamide.
5. Tenzar.

These drugs are prescribed mainly for the treatment of arterial hypertension. The drugs have been used for quite a long time in patients with high blood pressure and edema of various origins (cardiac, hepatic, renal origin, as well as with edema with prolonged use of glucocorticosteroids).

In countries such as the USA, Great Britain, Germany, they are used as first-line drugs in the treatment of hypertension. They are quite well absorbed in the digestive tract, bind to blood proteins, and then enter the glomeruli of the kidneys, where they exert their diuretic effect.

Their significant advantages are a fairly reasonable price, efficacy regardless of the size of the dose, good tolerance by patients and the fact that these drugs do not decrease their effectiveness when used by elderly patients.

Thiazide diuretics can normalize a hypertrophic heart, but at the same time, this group of drugs has a number of contraindications, such as gout, metabolic syndrome, diabetes mellitus and pregnancy.

For citation:Karpov Yu.A. Torasemide: recommendations for clinical use in chronic heart failure and arterial hypertension // BC. 2014. No. 23. S. 1676

Diuretics are among the most widely used cardiovascular medications. This popularity is due to their high efficiency in the treatment of arterial hypertension (AH) and edema syndrome, mainly in patients with chronic heart failure (CHF). The most widely used thiazide (or thiazide-like) diuretics are hydrochlorothiazide in Europe and chlorthalidone in the USA, which have been used in the treatment of hypertension since the late 1950s. of the last century, as well as indapamide, which has joined them in recent years. According to the new recommendations of the European Society of Hypertension / European Society of Cardiology in 2013, diuretics, along with drugs blocking the renin-angiotensin system (RAS), β-blockers (BAB) and calcium channel blockers (CCB), are first-line drugs for the treatment of hypertension. ...

In the early 60s. of the last century, loop diuretics - furosemide, and then ethacrynic acid, which got their name from the site of application of the action - along the thick part of the ascending knee of Henle's loop, entered clinical practice. In this segment of the ascending knee of Henle's loop, from 20 to 30% of the filtered sodium chloride is reabsorbed, which is 2-3 times more than after taking thiazide diuretics. These drugs have found wide application in the treatment of edema syndrome in various diseases, especially in CHF. Furosemide and ethacrynic acid cause a more pronounced diuretic effect than thiazide diuretics, but this effect is more short-lived. After the introduction or ingestion of these loop diuretics (approximately within 2-6 hours after a single dose), the excretion of sodium ions in the urine increases significantly, but after the cessation of the diuretic effect of drugs, the rate of excretion of sodium ions decreases to a level below the initial level. The described "phenomenon of rebound", due to a number of intra- and extrarenal mechanisms for maintaining water-electrolyte balance in conditions of insufficient intake of sodium chloride in the body, and further promotes the activation of RAS.
The pronounced excretion of sodium ions (the diuretic effect of short-acting loop diuretics), occurring within several hours a day, is compensated by a significant retention of sodium ions after the end of their diuretic action (i.e., for most of the day). The "rebound phenomenon" is an explanation for the fact that when taken 1 r. / Day, loop diuretics (furosemide) usually do not increase the daily excretion of sodium ions and do not have a significant antihypertensive effect. To remove excess sodium ions from the body, loop diuretics should be prescribed 2-3 r. / Day. Studies have shown that furosemide and bumetanide, when administered once or twice a day, are usually not effective enough as antihypertensive drugs. The decrease in blood pressure when prescribing furosemide 2 r. / Day is less than hydrochlorothiazide when taking 1 r. / Day. These data led to the fact that short-acting loop diuretics were not recommended for widespread use in patients with hypertension, and their use was limited to cases associated with chronic renal failure.
In the 80s. XX century a new loop diuretic, torasemide, has appeared in clinical practice. Torasemide is characterized by high bioavailability and a longer lasting effect, which leads to a number of favorable pharmacodynamic properties of the drug. Unlike furosemide, a short-acting diuretic, torasemide is not characterized by a "rebound phenomenon", which is associated not only with its longer duration of action, but also with its inherent anti-aldosterone activity (blockade of aldosterone receptors on the membranes of epithelial cells of the renal tubules) and a decrease in aldosterone secretion in adrenal glands (experimental data).
Like other loop diuretics, torasemide acts on the inner surface of the thick segment of the ascending knee of Henle's loop, where it inhibits the Na + / K + / 2Cl- transport system. The drug enhances the excretion of sodium, chlorine and water without significantly affecting the glomerular filtration rate, renal blood flow, or acid-base balance. It has been established that furosemide additionally affects the proximal convoluted tubules of the nephron, where most of the phosphates and bicarbonates are reabsorbed. Torasemide has no effect on the proximal tubules, causes less loss of phosphates and bicarbonates, as well as potassium in the urine.
Torasemide after oral administration is rapidly absorbed with a maximum concentration after 1 hour. The bioavailability of the drug is higher than that of furosemide (80% versus 53%), and it remains high in the presence of concomitant diseases and in elderly and senile persons. The half-life of torasemide in healthy individuals is 4 hours; it practically does not change with CHF and chronic renal failure. Compared with furosemide, the sodium and diuretic effect of torasemide occurs later and lasts much longer. The duration of the diuretic action of furosemide with intravenous administration is on average 2-2.5 hours and torasemide - about 6 hours; when taken orally, the effect of furosemide lasts about 4-6 hours, torasemide - more than 12 hours. Torasemide is removed from the circulation, undergoing metabolism in the liver (about 80% of the total amount), and is excreted in the urine (about 20% of the total amount in patients with normal kidney function).
Recently, in clinical practice in our country, an original delayed-release torasemide, Britomar, has appeared. The prolonged form of torasemide provides a gradual release of the active substance, reducing fluctuations in the concentration of the drug in the blood, compared with the usual form of release of the drug. The drug is released for a longer time, due to this, diuresis begins approximately 1 hour after taking the drug, reaching a maximum after 3-6 hours, the effect lasts from 8 to 10 hours. This allows you to achieve additional clinical benefits in treatment. Sustained-release torasemide with long-term use does not cause changes in blood potassium levels, does not significantly affect the level of calcium and magnesium, glycemic and lipid profiles. The sustained-release drug does not interact with anticoagulants (warfarin, phenprocoumon), cardiac glycosides or organic nitrates, BAB, ACE inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs) II, CCB and spironolactone. It should be noted that the simultaneous use of ACE inhibitors with diuretics, and especially mineralocorticoid receptor antagonists (MCR), prevents the development of electrolyte disturbances in the vast majority of cases.
The prolonged form of torasemide is recommended for edematous syndrome due to CHF, kidney and liver diseases; with hypertension - as monotherapy or in combination with other antihypertensive drugs.
Chronic heart failure
Currently, diuretics occupy one of the leading places in the treatment of CHF. Despite the fact that there is no data on their effect on the prognosis in patients with CHF, there is no doubt about the effectiveness and clinical necessity of this class of drugs for the treatment of patients with cardiac decompensation. Diuretics cause a rapid decrease in the symptoms of CHF associated with fluid retention (peripheral edema, shortness of breath, pulmonary congestion), in contrast to other CHF therapy. In accordance with the algorithm for the treatment of systolic CHF in the recommendations of the European Society of Cardiology 2012, diuretics are prescribed, regardless of the functional class, to all patients with existing edematous syndrome. Rational use of diuretics can improve clinical symptoms and reduce the number of hospitalizations, or achieve two of the most important of the six goals in the treatment of CHF.
Only with the help of diuretics can the water status be adequately controlled in patients with CHF. Adequacy of control largely ensures the success of therapy with BAB, ACE inhibitors, ARBs, and MCR antagonists. In the case of relative hypovolemia, the risk of developing a decrease in cardiac output, hypotension, and deterioration of renal function significantly increases. For the treatment of CHF, diuretics should be used only in combination with other drugs (BAB, RAS blockers, MCR antagonists). Table 1 shows diuretics and their doses for the treatment of CHF.
According to current clinical guidelines, the use of torasemide has a number of additional advantages over other diuretics. It should be noted that torasemide is more safe and tolerated than furosemide. Torasemide is the first loop diuretic that affects the progression of heart failure and the course of pathological processes in the myocardium. Experts identify antialdosterone and antifibrotic effects, proven in experimental and clinical studies. In a study by B. Lopes et al. it was shown that torasemide in comparison with furosemide leads to a decrease in the volume fraction of collagen and reduces the development of fibrosis. In one of the Russian studies, the effect of torasemide on left ventricular remodeling and the ability to normalize the ratio of indicators of synthesis and collagen breakdown was proved.
In the TORIC study, torasemide demonstrated the ability to better influence the prognosis of patients with CHF. This study analyzed the results of a 9-month comparative treatment with torasemide at a daily dose of 10 mg and furosemide 40 mg in patients with CHF. In the group of patients receiving therapy with torasemide, the functional class of circulatory insufficiency improved significantly more often, cardiovascular and overall mortality significantly decreased. According to the results of the study, American experts concluded that torasemide is the drug of choice among diuretics in the treatment of congestive heart failure. In the Russian multicenter study, DUEL torasemide, in comparison with furosemide, led to compensation faster, was more effective and caused fewer undesirable effects (0.3% versus 4.2% on furosemide), including metabolic and electrolyte ones.
Recently I.V. Zhirov et al. conducted a single-center, randomized, open-label study to determine the comparative efficacy of prolonged-release torasemide and furosemide in patients with CHF II-III FC, edema syndrome and increased levels of natriuretic peptides (NP) on the degree of decrease in the concentration of NT-proBNP. The study included 40 patients with CHF II-III FC of ischemic etiology with LVEF less than 40%, divided into two equal groups by randomization in envelopes. The first group received long-acting torasemide as a diuretic (Britomar, Takeda pharmaceutical company), the second - furosemide. Dose titration was performed according to the standard scheme, depending on the severity of the edema syndrome. Treatment and observation lasted 3 months, the average dose of sustained-release torasemide was 12.4 mg, furosemide - 54.2 mg. In both groups, during treatment, a significant improvement in exercise tolerance, an improvement in the quality of life of patients, and a decrease in the concentration of natriuretic hormones were observed. In the sustained-release torasemide group, there was a trend towards a more significant improvement in the quality of life (p \u003d 0.052) and a significantly more pronounced decrease in NT-proBNP levels (p<0,01). Таким образом, согласно данным этого исследования, торасемид замедленного высвобождения благоприятно влиял на течение и качество жизни пациентов с ХСН.
Scheme of using torasemide in CHF. In patients with CHF, the usual starting dose of the drug is 2.5-5 mg 1 r. / Day, which, if necessary, is increased to 20-40 mg until an adequate diuretic response is obtained.
Arterial hypertension
As noted earlier, diuretics belong to the first line of antihypertensive drug groups in the treatment of patients with hypertension. According to the new American guidelines, they remain a priority drug for controlling blood pressure in all patients, if patients do not have clinical situations or conditions for preferential administration of any of the classes of antihypertensive drugs. All this indicates a significant position of diuretics both in mono- and especially in combination therapy of hypertension. Diuretics as a class have become nearly ideal remedies when a second drug is required, since they potentiate the action of drugs of all other classes. However, it should be noted that we are talking primarily about thiazide and thiazide-like diuretics (hydrochlorothiazide, bendroflumethiazide, chlorthalidone, indapamide, etc.). These diuretics have been studied in large-scale long-term clinical trials that have shown efficacy not only in controlling blood pressure, but also in reducing the risk of cardiovascular complications when using most of them. In many studies in recent years, the effectiveness of diuretics has been compared with the effectiveness of newer groups of drugs - CCBs (INSIGHT, STOP-2 studies), ACE inhibitors (CAPPP, STOP-2), CCBs and ACE inhibitors (ALLHAT). Criticism of thiazide diuretics comes down mainly to negative metabolic disorders (lipid and carbohydrate metabolism), which was most clearly manifested in the ASCOT study (when attached to BAB atenolol), as well as to possible electrolyte metabolism disorders (hypokalemia).
Other diuretics (loop diuretics) are usually prescribed instead of thiazides if serum creatinine reaches 1.5 mg / dL in a hypertensive patient or the glomerular filtration rate<30 мл/мин/1,73 м2 . Эти ограничения связаны главным образом с их кратковременным и относительно слабым антигипертензивным эффектом, что требовало их приема несколько раз в сутки, более слабым вазодилатирующим эффектом, а также выраженной активацией контррегуляторных механизмов, направленных на задержку солей и жидкости в организме. Как показали многочисленные клинические исследования по изучению эффективности и безопасности нового петлевого диуретика торасемида, препарат может наряду с тиазидными диуретиками использоваться для регулярного контроля АД при АГ.
Antihypertensive efficacy
and safety of torasemide
Most studies evaluating the effectiveness of torasemide were carried out back in the 90s. XX century. In a 12-week double-blind study in 147 hypertensive patients, torasemide at doses of 2.5-5 mg / day was significantly superior in antihypertensive activity to placebo. Diastolic blood pressure returned to normal in 46-50% of patients receiving torasemide and 28% of patients in the placebo group. The drug was compared with various thiazide and thiazide-like diuretics, including in various combination therapy regimens. According to one of the studies, the natriuretic, diuretic and antihypertensive effects of torasemide in daily doses of 2.5 to 5 mg are comparable to the effects of 25 mg of hydrochlorothiazide, 25 mg of chlorthalidone and 2.5 mg of indapamide per day and were superior to the effect of furosemide prescribed at a dose of 40 mg 2 rubles / day Torasemide reduced the serum potassium concentration to a much lesser extent than hydrochlorothiazide and other thiazide diuretics, and practically did not cause disturbances in carbohydrate and lipid metabolism.
In another placebo-controlled study, 2.5 mg torasemide and 25 mg chlorthalidone per day compared with placebo for 8 weeks. treatment caused the same decrease in systolic and diastolic blood pressure. There was no significant effect of torasemide on serum potassium, magnesium, uric acid, glucose and cholesterol concentrations. In this study, the chlorthalidone group experienced significant reductions in blood potassium and significant increases in uric acid, glucose, and cholesterol levels.
In a 12-week, randomized, double-blind study, the effects of 2.5 mg torasemide and 2.5 mg indapamide were compared in 66 hypertensive patients with grade 1 and 2 BP. Doses of drugs were doubled if, after 4 weeks, DBP remained above 100 mm Hg. Art. Both diuretics caused the same and significant decrease in DBP, with the maximum decrease observed after 8-12 weeks. after starting therapy. Doubling of the diuretic dose was required in 9 (28%) of 32 patients receiving torasemide and 10 (29%) of 32 patients taking indapamide. DBP decreased<90 мм рт. ст. к концу исследования у 94% больных, получавших торасемид, и у 88% больных, принимавших индапамид .
Longer-term observations of the effectiveness of torasemide were also carried out. A 24-week randomized study investigated the effects of 2.5 mg torasemide and 25 mg hydrochlorothiazide in combination with 50 mg triamterene in duplicate doses after 10 weeks. with insufficient decrease in DBP in 81 patients with hypertension. In both groups, the same and significant reduction in blood pressure was obtained, although the antihypertensive effect of the combination of diuretics was slightly more pronounced. Similar results were demonstrated in another study of the same duration with a similar design in 143 patients with hypertension. With the same antihypertensive efficacy of torasemide and the combination of hydrochlorothiazide with triamterene (or amiloride), both types of therapy did not cause significant changes in either the concentration of electrolytes in the blood serum, or indicators of carbohydrate and lipid metabolism.
In the work of O.N. Tkacheva et al. studied the effect of torasemide 5-10 mg in combination with 10 mg of enalapril and 12-25 mg of hydrochlorothiazide in combination with 10 mg of enalapril on electrolyte balance, carbohydrate, lipid and purine metabolism in women with uncontrolled hypertension in the postmenopausal period. There was a significant decrease in potassium and magnesium levels after 24 weeks. hydrochlorothiazide therapy by 11 and 24%, respectively (p<0,05), в то время как в группе торасемида статистически значимых изменений уровня калия и магния не было выявлено. Торасемид не оказывал влияния на углеводный, липидный и пуриновый обмен, тогда как в группе тиазидного диуретика было зарегистрировано достоверное повышение индекса инсулинорезистентности и уровня мочевой кислоты.
Consequently, torasemide in doses up to 5 mg / day, which are used in the treatment of hypertension, is comparable in antihypertensive efficacy to thiazide diuretics (hydrochlorothiazide, chlorthalidone and indapamide), however, it causes hypokalemia much less frequently. Unlike other loop and thiazide diuretics, long-term treatment with torasemide does not require control over the content of electrolytes, uric acid, glucose and cholesterol. Thus, torasemide in low doses is an effective antihypertensive drug, which, when taken 1 r. / Day, causes a long and uniform decrease in blood pressure throughout the day. Unlike all other loop and thiazide diuretics, torasemide rarely causes hypokalemia and has little effect on the parameters of purine, carbohydrate and lipid metabolism. When treating with torasemide, repeated laboratory monitoring of biochemical parameters is less often required, which reduces the overall cost of treating hypertension.
Comparison of the clinical effects of conventional torasemide and the form of the drug with prolonged release of the drug showed that the latter had no less effect on the decrease in DBP, and the degree of decrease in SBP was also similar for both drugs.
Scheme of using torasemide for the treatment of hypertension. The drug is recommended at an initial dose of 5 mg 1 r. / Day. If the target BP (<140/90 мм рт. ст. для большинства больных) не было достигнуто за 4 нед., то в соответствии с рекомендациями врач может повысить дозу до 10 мг 1 р./сут или в схему лечения добавить гипотензивный препарат другой группы, лучше всего из группы препаратов, блокирующих РАС (иАПФ или БРА), или БКК. Таблетки пролонгированного действия назначают внутрь 1 р./сут, обычно утром, независимо от приема пищи.
In studies in patients with hypertension, long-acting torasemide slightly reduced potassium levels after 12 weeks. treatment. The drug had virtually no effect on biochemical parameters such as urea, creatinine and uric acid, and the incidence of gout was similar in the placebo group. In long-term studies, the appointment of prolonged-release torasemide at a dose of 5 and 20 mg throughout the year did not cause significant changes in blood lipid levels compared to the initial values.
Conclusion
Torasemide is a loop diuretic recommended for patients with CHF and hypertension. In the treatment of patients with CHF, the drug is not inferior to furosemide in terms of the diuretic effect, additionally has antialdosterone and antifibrotic effects. The drug can be successfully used in case of impaired renal function and impaired absorption of furosemide in patients with severe heart failure. In hypertension, torasemide lowers blood pressure when applied 1 r. / Day at a dose of 5-10 mg for 4 weeks; if necessary, can be used in combination with drugs blocking ASD. There is evidence of efficacy in the treatment of women with hypertension in the postmenopausal period in combination with an ACE inhibitor. Torasemide therapy is well tolerated and rarely leads to metabolic and electrolyte disturbances.

Literature
1.2013 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) // J. Hypertens. 2013. Vol. 31 (7). P. 1281-1357.
2. Blizzard V.I. Handbook of Clinical Pharmacology of Cardiovascular Medicines, 3rd ed. M., 2005.1527 p.
3. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 // Eur. Heart J. 2012. Vol. 33. P. 1787-1847.
4. Brater D.C., Leinfelder J., Anderson S.A. Clinical pharmacology of torasemide, a new loop diuretic // Clin. Pharmacol. Ther. 1987. Vol. 42. P. 187-192.
5. Britomar. Monograph. Ferrer Internationale, 2011.26 p.
6. National recommendations of the OSSN, RKO and RNMOT for the diagnosis and treatment of CHF (fourth revision) // Heart failure. 2013. T. 14, No. 7 (81).
7. Lopez B., Querejeta R., Gonzales A. et al. Effects of loop diuretics on myocardial fibrosis and collage type I turnover in chronic heart failure // J. Am. Coll. Cardiol. 2004. Vol. 43 (11). P. 2028-2035.
8. Ageev F.T., Zhubrina E.S., Gilyarevsky S.R. et al. Comparative efficacy and safety of long-term use of torasemide in patients with compensated heart failure. Influence on markers of myocardial fibrosis // Heart failure. 2013. No. 14 (2). S. 55-62.
9. Cosin J., Diez J., TORIC investigators. Torasemide in chronic heart failure: results of the TORIC study // Eur. J. Heart Fail. 2002. Vol. 4 (4). P. 507-513.
10. Mareev V.Yu., Vygodin V.A., Belenkov Yu.N. Diuretic therapy Effective doses of oral diuretics torasemide (diuver) and furosemide in the treatment of patients with exacerbation of chronic heart failure (DUEL-CHF) // Heart failure. 2011. No. 12 (3). S. 3-10.
11. Zhirov I.V., Goryunova T.V., Osmolovskaya Yu.F. and other Place of slow-release torasemide in the treatment of CHF // BC. 2013.
12. Go A. S., Bauman M. A., Sallyann M. et al. AHA / ACC / CDC Science Advisory An Effective Approach to High Blood Pressure Control // Hypertension. 2013. Nov. 21.
13. Achhammer I., Metz P. Low dose loop diuretics in essential hypertension. Experience with torasemide // Drugs. 1991. Vol. 41 (Suppl. 3). P. 80-91.
14. Baumgart P. Torasemide in comparison with thiazides in the treatment of hypertension // Cardiovasc. Drugs Ther. 1993. Vol. 7 (Suppl. 1). P. 63-68.
15. Spannbrucker N., Achhammer I., Metz P., Glocke M. Comparative study on the hypertensive efficacy of torasemide and indapamide in patients with essential hypertension // Drug. Res. 1988. Vol. 38 (1). P. 190-193.
16. 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 hydrochlorothiazide o.d. // Prog. Pharmacol. Clin. Pharmacol. 1990. Vol. 8.P. 211-220.
17. Tkacheva O.N., Sharashkina N.V., Novikova I.M. and others. The use of a loop diuretic torasemide in the combined treatment of hypertension in postmenopausal women // Consilium Medicum. 2011.T.13 (10). S. 54-59.

Catad_tema Heart failure - articles

Clinical efficacy and safety of the torasemide loop diuretic

S.V. Moiseev
Moscow Medical Academy. THEM. Sechenov; 119881 Moscow, st. Bolshaya Pirogovskaya, 2/6; Moscow State University M.V. Lomonosov

Clinical Efficacy and Safety of Administration of Loop Diuretic Torasemide

S.V. Moiseev
I.M. Sechenov Moscow Medical Academy; ul. Bolshaya Pirogovskaya, 2/6, 119881 Moscow, Russia; M.V. Lomonosov Moscow State University

Depending on the mechanism of action, diuretics are divided into 3 groups: loop, thiazide (thiazide-like) and potassium-sparing. All loop diuretics have a fast, powerful and relatively short-lived diuretic effect, which increases with increasing dose. In this regard, they are widely used in acute situations when it is necessary to quickly achieve an effect, for example, with pulmonary edema. In addition, loop diuretics remain the treatment of choice in the treatment of heart failure and renal and hepatic edema, while thiazides are generally preferred in hypertension. Torasemide is a loop diuretic that has several advantages over furosemide, in particular it is characterized by predictable bioavailability and a longer half-life and less likely to cause hypokalemia.

Pharmacokinetics

Torasemide is rapidly absorbed after oral administration, its concentration in blood plasma reaches a maximum after about 1 hour. The pharmacokinetics of torasemide, like other loop diuretics, was linear in the dose range of 2.5-40 mg in healthy people and 20-200 mg in patients with renal failure. In this regard, an increase in the dose of the drug is accompanied by a proportional increase in diuretic activity. The bioavailability of torasemide in various studies was 79-91% and exceeded that of furosemide (on average, 80 and 53%, respectively). A high and predictable bioavailability is important as it determines the “robustness” of the diuretic effect of torasemide. Another feature of the drug is a rather long half-life (3-5 hours), which turned out to be comparable with oral and intravenous administration and exceeded that of furosemide, bumetanide and pyrethanide (about 1 hour). Due to this, torasemide has a longer effect than furosemide. The volume of distribution of torasemide is 12-16 liters and corresponds to the volume of extracellular fluid. 99% of the drug binds to plasma proteins.
Torasemide undergoes active biotransformation in the liver with the formation of several metabolites, some of which have weak diuretic activity (about 10% of that of the unchanged drug). Due to intensive metabolism, only 25% of the dose is excreted in the urine unchanged (compared to 60-65% when taking furosemide and bumetanide). 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. At the same time, with cirrhosis of the liver, there was an increase in AUC (2.5 times) and the duration of the half-life of torasemide (up to 4.8 hours). Nevertheless, in such patients, about 80% of the dose of the drug was excreted in the urine per day (unchanged and in the form of metabolites), so its cumulation is not expected with prolonged use.

Pharmacodynamics

Like other loop diuretics, torasemide acts on the ascending part of Henle's loop, where it inhibits sodium and chloride reabsorption. Unlike furosemide, torasemide also blocks the effects of aldosterone and, accordingly, enhances potassium excretion to a lesser extent. This prevents the development of hypokalemia, which is one of the main side effects of loop and thiazide diuretics.
The diuretic effect of torasemide at doses of 2.5 and 5 mg with a single dose corresponds to that of hydrochlorothiazide at a dose of 25 mg, and at doses of 10 and 20 mg - furosemide at a dose of 40 mg. During acute tests, an increase in torasemide doses was accompanied by a linear increase in diuresis and excretion of sodium and chloride, while no similar changes in potassium excretion were detected. When administered intravenously, the effect of the drug begins quickly and reaches a maximum within 15 minutes. When taken orally, torasemide also has a quick effect. In the elderly, the diuretic effect of the drug is weaker than in young patients, which is explained by the age-related decrease in creatinine clearance. There were no signs of a clinically significant interaction of torasemide with digoxin, spironolactone and warfarin.

Heart failure

In one of the first placebo-controlled studies, the efficacy of torasemide in doses of 5, 10 or 20 mg for 7 days was studied in 66 patients with heart failure of II-III functional class (FC). Change in body weight was the primary endpoint. At doses of 10 and 20 mg, torasemide caused a statistically significant decrease in body weight compared with placebo (by 1.62 and 1.30 kg, respectively). The drug was well tolerated; the incidence of adverse events did not increase with increasing doses.
In the post-marketing non-randomized study TORIC (TORasemide In Congestive heart failure), the efficacy and safety of torasemide 10 mg / day and furosemide 40 mg / day or other diuretics were compared in 1377 patients with chronic heart failure II-III FC. Torasemide was more effective than furosemide and other diuretics. Thus, a decrease in FC according to NYHA was noted in 45.8 and 37.2% of patients in groups 2, respectively (p \u003d 0.00017). In addition, torasemide was less likely to cause hypokalemia, the frequency of which at the end of the study in 2 groups was 12.9% and 17.9% (p \u003d 0.013). An unexpected result of the study was a lower mortality rate in the torasemide group (2.2% versus 4.5% in the comparison group; p<0,05). Таким образом, это крупное исследование продемонстрировало более высокую клиническую эффективность и безопасность торасемида по сравнению с таковыми фуросемида.
M. Yamato et al. in a randomized open 6-month study compared the efficacy of torasemide and furosemide in 50 patients with chronic heart failure II-III FC who did not respond to treatment with low-dose furosemide and angiotensin-converting enzyme inhibitors. Patients in the main group were prescribed torasemide at a dose of 4-8 mg / day, while patients in the comparison group continued to take furosemide at the same dose (20-40 mg / day). Torasemide therapy for 6 months resulted in a decrease in the end-diastolic size (p<0,005) и индекса массы миокарда левого желудочка (p<0,005), улучшению параметров его наполнения в диастолу, а также снижению концентрации натрийуретического пептида (p<0,001) и повышению активности ренина (p<0,005) и альдостерона (p<0,001) плазмы. В группе фуросемида сходные изменения отсутствовали. По мнению авторов, выявленные изменения могли объясняться блокадой рецепторов альдостерона под действием торасемида.
In an open-label study, the results of 12-month therapy with torasemide or furosemide were compared in 234 patients with chronic heart failure. In patients receiving torasemide, the frequency of hospitalizations for heart failure was lower than in patients in the furosemide group (17 and 39%, respectively; p<0,01). Сходные результаты были получены при анализе частоты госпитализаций в связи с сердечно-сосудистыми причинами (44 и 59%; p=0,03) и длительности пребывания больных в стационаре в связи с сердечной недостаточностью (106 и 296 дней; p=0,02). Лечение торасемидом сопровождалось более значительным уменьшением индексов одышки и утомляемости, хотя достоверная разница между группами была выявлена только при оценке утомляемости через 2, 8 и 12 мес.
The results of this study were confirmed in a retrospective analysis of 12 months of experience with torasemide and furosemide in Switzerland and Germany in more than 1200 patients with heart failure. In both countries, the hospitalization rate with torasemide was lower (3.6 and 1.4% in Switzerland and Germany, respectively) than with furosemide (5.4 and 2.0%). The reasons for the more frequent hospitalizations in the Swiss study were the advanced age of the patients examined and the duration of heart failure. The use of torasemide made it possible to reduce the total cost of treating patients by about 2 times by reducing the average number of days spent in the hospital.
K. Muller et al. in a prospective randomized study compared the effects of torasemide and furosemide on quality of life and hospitalization rate in 237 patients with chronic heart failure. The treatment lasted 9 months. Torasemide therapy provided a more significant decrease in FC and an improvement in the quality of life of patients, although the frequency of hospitalizations for heart failure did not significantly differ between groups.
Thus, torasemide is at least as effective as furosemide in treating heart failure. Moreover, in some studies, it had advantages over the latter, which may reflect the more predictable bioavailability of torasemide and / or its ability to block aldosterone receptors.
In some cases, in severe heart failure, accompanied by impaired renal function and absorption of furosemide in the gastrointestinal tract, it is advisable to replace furosemide with torasemide, since its bioavailability in these cases, according to the study by D. Vargo et al. , does not change.
Torasemide is included in the European Society of Cardiology's Guidelines for the Diagnosis and Management of Chronic Heart Failure (2005 revision) and in the American College of Cardiology's Guidelines for the Diagnosis and Management of Chronic Circulatory Failure in Adults.

Arterial hypertension

In recent years, low-dose thiazide diuretics have been commonly used to treat mild to moderate hypertension. Indications for the appointment of loop diuretics may be severe hypertension, as well as the presence of heart or renal failure. In addition, drugs in this group are less likely to cause metabolic disorders. If, for one reason or another, loop diuretics are prescribed to a patient with arterial hypertension, then the choice of torasemide seems rational, given its longer half-life. In a 12-week double-blind study in 147 patients with arterial hypertension, torasemide at doses of 2.5-5 mg / day was significantly superior in antihypertensive activity to placebo. Diastolic blood pressure returned to normal in 46-50% of patients receiving torasemide and 28% of patients in the placebo group. In comparative studies, torasemide, taken at a dose of 2.5-5 mg once a day, was not inferior to chlorthalidone and indapamide in terms of effectiveness in the treatment of arterial hypertension. It should be noted that, according to daily monitoring of blood pressure, the antihypertensive effect of torasemide, which is prescribed once a day, persisted throughout the entire dosing interval.

Renal failure

Loop diuretics are the agents of choice in the treatment of edema and arterial hypertension in patients with acute and chronic renal failure. The drugs of this group remain effective even in end-stage renal failure, while the diuretic effect of thiazide diuretics is lost when the glomerular filtration rate is less than 20 ml / min. As mentioned above, the half-life and duration of action of torasemide do not depend on renal function, and the drug does not accumulate in renal failure. Like other loop diuretics, torasemide for renal failure is prescribed in higher doses (100-200 mg / day or more). In patients with impaired renal function, the difference between the effective doses of torasemide and furosemide decreases due to the cumulation of the latter.
Two small studies examined the dose of torasemide required to maintain a response to furosemide in patients with severe chronic renal failure. In the first study, patients receiving 500 mg of furosemide were switched to torasemide in doses of 100 or 200 mg or continued therapy with furosemide at a dose of 250 mg for 14 days. At a dose of 100 mg, torasemide was somewhat inferior to furosemide in terms of its effect on diuresis and urinary sodium excretion, but at a dose of 200 mg, the drug had a more pronounced effect. In a similar study, torasemide 400 mg and furosemide 1000 mg caused similar increases in urine volume and sodium excretion in patients with chronic renal failure. Unlike furosemide, torasemide had no significant effect on calcium excretion. Reduced calcium excretion with torasemide was noted by some other authors. N. Vasavada et al. compared the diuretic and antihypertensive effects of torasemide and furosemide in patients with chronic renal failure. Treatment for 3 weeks with both drugs led to a comparable decrease in blood pressure. Natriuresis also increased to the same extent.
Thus, torasemide is comparable in efficacy and safety to furosemide in patients with renal insufficiency. It should be borne in mind that such patients need higher doses of loop diuretics (100-200 mg torasemide or more).

Cirrhosis of the liver

For the treatment of edematous syndrome in patients with decompensated liver cirrhosis, loop diuretics are used in combination with the aldosterone antagonist spironolactone. A. Gerbes et al. in a double-blind crossover study compared the results of a single dose of furosemide (80 mg) and torasemide (20 mg) orally in 14 patients with liver cirrhosis and ascites. Torasemide was superior to furosemide in diuretic and natriuretic activity. In 5 patients, there was a weak response to receiving furosemide, while torasemide caused a significant increase in natriuresis and diuresis. In a double-blind, randomized study in 28 patients with ascites, the results of 6-week therapy with torasemide (20 mg / day) and furosemide (50 mg / day) were compared. All patients received spironolactone (200 mg / day). Both drugs had comparable effects on body weight, urine output, and excretion of uric acid, sodium and chloride, while excretion of potassium, calcium, inorganic phosphates, and magnesium was lower in the torasemide group. In another randomized study, 46 patients with liver cirrhosis complicated by ascites were treated with torasemide 20 mg / day or furosemide 40 mg / day in combination with spironolactone 200 mg / day. If it was not possible to achieve a decrease in body weight by 300 g / day, the doses of diuretics were increased every 3 days to 60, 120 and 400 mg / day, respectively. Torasemide caused a more pronounced increase in urine output than furosemide, although in general the results of treatment in the 2 groups were comparable. An increase in diuretic doses was required in 2 patients in the torasemide group and in 9 patients in the furosemide group (p<0,05).
Thus, torasemide can serve as an alternative to furosemide in the treatment of edematous-ascitic syndrome in patients with decompensated liver cirrhosis.

Portability and safety

The nature of the undesirable effects of torasemide is generally comparable to that of other loop diuretics. In clinical trials, the main adverse reactions were dizziness (2.1%), headache (1.7%), weakness (1.7%), nausea (1.5%), and muscle cramps (1.4%). In double-blind controlled studies in patients with arterial hypertension, the incidence of adverse events with 4-week use of placebo (n \u003d 490), torasemide (n \u003d 517), and hydrochlorothiazide / potassium-sparing diuretics (n \u003d 198) was 9.1, 10.7, and 24 , 8% respectively. Among patients with heart failure who received torasemide (n \u003d 584) or furosemide (n \u003d 148), adverse events were reported in 9.2% and 14.6%, respectively.
The main undesirable effect of diuretics, especially thiazide ones, is hypokalemia. Torasemide had a minimal effect on serum potassium levels; it remained stable even with prolonged use of the drug at doses of 5-20 mg in patients with heart failure. In long-term studies in patients with arterial hypertension and heart failure, there was a slight increase in the level of uric acid, which in most cases was transient. There was also no significant increase in serum glucose and lipoprotein levels during treatment with torasemide.

Conclusion

Torasemide is a loop diuretic that is not inferior in diuretic effect to furosemide, which also has a blocking effect on aldosterone receptors. It has a longer diuretic effect and is less likely to cause hypokalemia than furosemide. In controlled studies in patients with heart, renal failure and decompensated liver cirrhosis, torasemide was not inferior to furosemide in terms of efficacy and safety. The drug can be successfully used in case of impaired renal function and impaired absorption of furosemide in patients with severe heart failure instead of furosemide. The absorption of torasemide does not depend on the degree of heart failure. Torasemide is the diuretic of choice for heart failure of varying severity.
In patients with arterial hypertension, comparable antihypertensive efficacy of torasemide in low doses (2.5-5 mg) and thiazide / thiazide-like diuretics has been demonstrated.
In 2006, torasemide, manufactured by Pliva Khrvatska doo, appeared on the Russian market. called diuver at a dosage of 5 and 10 mg.

Literature

1. Bolke T., Achhammer I. Torasemide: a review of its pharmacology and therapeutic use. Drugs of Today 1994; 30: 8: 1-28.
2. Friedel H., Buckley M. Torasemide. A review of its pharmacological properties and therapeutic potential. Drugs 1991; 41: 1: 81-103.
3. Brunner G., von Bergmann K., Hacker W. et al. Comparison of diuretic effects and pharmacokinetics of torasemid and furo-semid after a single oral dose in patients with hydropically decompensated cirrhosis of the liver. Arzt-Forsch / Drug Res 1998; 38: 176-179.
4. Reyes A. Effects of diuretics on outputs and flows or urine and urinary solutes in healthy subjects. Drugs 1991; 41: Suppl 3: 35-59.
5. Patterson J., Adams K., Applefeld M. et al. Oral torsemide in patients with chronic congestive heart failure: effects on body weight, edema, and electrolyte excretion. Torsemide Investigators Group. Pharmacotherapy 1994; 14: 5: 514-521.
6. Cosin J., Diez J. and TORIC investigators. Torasemide in chronic heart failure: results of the TORIC study. Eur J Heart Fail 2002; 4: 4: 507-513.
7. Yamato M., Sasaki T., Honda K. et al. Effects of torasemide on left ventricular function and neurohumoral factors in patients with chronic heart failure. Circulat J 2003; 67: 5: 384-390.
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., Falkenstein P. et al. Long-term diuretic treatment in heart failure: are there differences between furo-semide 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. Vargo D.L., Kramer W.G., Black P.K. et al. Bioavailiability, pharmacokinetics and pharmacodynamics of torsemide and fu-rosemide in patients with congestive heart failure. Clin Pharmacol Ther 1995; 57: 6: 601-609.
12. Guidelines for the diagnosis and treatment of Chronic Heart Failure: full text (update 2005). The Task Force for the diagnosis and treatment of CHF of the European Society of Cardiology.
13. ACC / AHA 2005 Guideline Update for the Diagnosis and Management of chronic heart Failure in the Adult.
14. Achhammer I., Metz P. Low dose loop diuretics in essential hypertension. Experience with torasemide. Drugs 1991; 41: Suppl 3: 80-91.
15. Baumgart P. Torasemide in comparison with thiazides in the treatment of hypertension. Cardiovasc Drug Ther 1993; 7: Suppl 1: 63-68.
16. Spannbrucker N., Achhammer I., Metz P., Glocke M. Comparative study on the hypertensive efficacy of torasemide and indapam-ide in patiehts with essential hypertension. Drug Res 1988; 38: 1: 190-193.
17. Risler T., Kramer B., Muller G. The efficacy of diuretics in acute and chronic renal failure. Focus on torasemide. Drugs 1991; 41: Suppl 3: 69-79.
18. Kult J., Hacker J., Glocke M. Comparison of eacy and tolerance of different oral doses of torasemide and furosemide in patients with advanced chronic renal failure. Arznt-Forsch / Drug Res 1998; 38: 212-214.
19. Clasen W., Khartabil T., Imm S., Kindler J. Torasemid for diuretic treatment of advanced chronic renal failure. Arzneimittel-Fors-chung / Drug Research 1988; 38: 209-211.
20. 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.
21. 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.
22. Gerbes A., Bertheau-Reitha U., Falkner C. et al. Advantages of the new loop diuretic torasemide over furosemide in patients with cirrhosis and ascites. A randomized, double blind cross-over trial. J Hepatol 1993; 17: 3: 353-358.
23. Fiaccadori F., Pedretti G., Pasetti G. et al. Torasemide versus furosemide in cirrhosis: a long-term, double-blind, randomized clinical study. Clin Invest 1993; 71: 7: 579-584.
24. Abecasis R., Guevara M., Miguez C. et al. Long-term efficacy of torasemide compared with furosemide in cirrhotic patients with ascites. Scand J Gastroenterol 2001; 36: 3: 309-313.

And fluid retention in the body is used diuretic drugs. The choice of funds depends on the nature of the disease and the patient's health.

One of the modern and effective means is a drug with an international non-proprietary name (INN) - Torasemide. It is used for varying degrees of edema due to insufficient functioning of the heart, liver or kidneys, or chronic hypertension. The wide range of indications is explained by greater safety and the presence of minimal side effects.

Torasemide is a diuretic

Torasemide is a potent diuretic. The minimal occurrence of side effects makes it possible to prescribe this medication for prolonged therapy of many diseases that are accompanied by edema.

Torasemide is produced in one form - in the form of tablets for oral administration. They have a round, flat shape in white. The package can consist of 2 or 10 blisters of 10 tablets each.

The composition of the tablets can contain from 2.5 or 200 mg of the active substance - torasemide. Additional components include lactose, magnesium, starch, etc.

The medicine is provided only with a doctor's prescription.

Pharmacology

Torasemide belongs to the group of loop drugs. The active ingredient has the following therapeutic effects:

• Diuretic
• Saluretic
• Antihypertensive
• Decongestant

The effectiveness of the remedy appears within a couple of hours after ingestion. Absorption is carried out within the gastrointestinal tract. The highest density of the main substance in the blood is provided by high bioavailability in the range of 80-90% and occurs a couple of hours after the use of the drug. Eating food has practically no effect on the rate of absorption.

Torasemide has almost complete association with blood proteins, which reaches 99%. In relatively healthy people, the spread is up to 16 liters. In patients with hepatic cirrhosis, this figure doubles.

Due to the metabolic activity of the liver, inactive or inactive metabolites are formed. Removal of the drug from the body takes up to 4 hours. Renal function does not affect the rate of excretion of Torasemide.

When appointed

High blood pressure is an indication for the use of Torasemide

Torasemide is prescribed in the complex therapy of diseases accompanied by edema and fluid retention. For each type of pathology, a specific dose of medication is used.

The indications for the appointment of Torasemide are:

• High level
• Disruption of the heart
• Kidney dysfunction
• Liver pathology

The dose and duration of treatment is prescribed by the attending physician based on the severity of the disease individually in each case.

Contraindications

With atherosclerosis, Torasemide should be used with caution.

Like any drug, Torasemide has certain contraindications. Before using it, you need to consult with your doctor and take into account precautions.

Torasemide is contraindicated in the following cases:

• When anuria is detected
• With a hepatic coma
• With hypovolemia
• With dehydration of the body
• With or sodium in the body
• If there are violations in the outflow of urine
• In case of poisoning
• With glomerulonephritis
• With mitral stenosis
• With extensive
• Under the age of 18
• For lactose intolerance
• For individual cases of intolerance to the active substance
• Lactation period

In addition, there are relative prohibitions when prescribing a drug is possible, but with great care:

• With prostatitis
• With acute
• With gout
• With hydronephrosis
• With pancreatitis
• With diabetes mellitus
• With hepatic dysfunction
• During pregnancy

For patients over 65 years of age, the drug can be prescribed in small doses and under the constant supervision of the attending physician.

Torasemide should be used with caution by people who drive vehicles or operate complex equipment.

During pregnancy, the agent may be prescribed only under the constant supervision of a doctor after assessing the risks to the child and the benefits to the mother. The studies did not reveal the toxic effect of Torasemide on the fetus, however, its use can cause a water-alkaline imbalance in a child. To eliminate edema in a pregnant woman, it is better to select safer drugs.

How to apply

Treatment with Torasemide should be performed until the edema is completely eliminated.

The tablets are taken orally. Dividing the tablet is possible, but chewing and crushing it is not allowed. After that, you need to drink a glass of water.

The greatest effectiveness of the therapeutic effect is achieved when the drug is taken in the morning meal. The daily dosage of Torasemide is contained in one tablet and is prescribed in one dose.

The duration of therapy and dosage are prescribed by the attending physician based on the nature of the disease and the strength of the manifestation of the symptoms of puffiness.

In chronic manifestation, a daily dose of 2.5 mg is used. Exceeding the dose is allowed no earlier than after 2 months and in the absence of the desired result from the initial dosage. Dose increases over 5 mg are not advised. With low effectiveness of Torasemide in this situation, an agent from another group is prescribed.

In case of heart failure, a daily dose of 10 mg is used. If necessary, the dosage is doubled.

In case of malfunctioning of the kidneys, a daily dosage of 20 mg is initially used. It is allowed to exceed the dosage up to a maximum daily value of 200 mg.

Therapy usually lasts until the puffiness disappears completely. With a longer use of the drug, you should periodically check the blood for electrolytes, glucose, creatinine and uric acid.

The use of Torasemide is allowed only as directed by your doctor. Self-treatment and dosage selection can worsen health and lead to serious complications.

Possible negative actions

Dizziness can be a side symptom of Torasemide use

In case of non-compliance with the doctor's instructions on the dosage and regimen of taking the drug, as well as with self-therapy, side effects may occur.

Depending on the state of health and the individual characteristics of the organism, they can occur in the work of various internal organs and systems.

Side effect:

• On the nervous system - headache, drowsiness, rapid fatigue, confusion, feeling of numbness in the limbs, apathy
• Sensory organs - noises and ringing in the ears, decreased vision, hearing distortion for a short time
• On the cardiovascular system - a drop in blood pressure, a decrease in blood volume, veins
• On the digestive tract - painful sensations in the stomach, nausea, heartburn, a feeling of thirst and dry mouth, lack of appetite, bad breath
• On the urinary system - frequent urge to urinate, increased volume of night urination over daytime, redness of urine due to a large volume of red blood cells, urinary retention
• On the reproductive system - the disappearance of libido
• On the skin - rashes, itching, erythema, vasculitis, urticaria
• On the musculoskeletal system - painful sensations in muscles and joints
• On metabolic processes - the development of a deficiency of potassium, sodium, magnesium and calcium in the blood
• On the circulatory system - the occurrence of thrombocytopenia and

If the above signs are detected, you should stop using the medication and consult a doctor for a change in the remedy.

With self-treatment with Torasemide or when taking large doses, the risk of drug overdose is high.

Overdose symptoms are manifested in increased expression of side effects. In this case, consciousness arises, gets confused and a coma may occur.

In the event of an overdose with Torasemide, treatment is prescribed, which consists in washing the stomach, normalizing the water and alkaline balance, and also in restoring the total blood volume in the body. This drug has no antidote.

In case of accidental use of an excessive dose of Torasemide, the following actions are necessary:

1. Vomiting is caused
2. The stomach is washed
3. Several tablets of activated carbon are drunk
4. Additionally, treatment of accompanying symptoms is carried out

Compliance with all dosage and administration guidelines will reduce the risk of side effects.

Combination with other medicines

Torasemide increases the effectiveness of certain drugs when used simultaneously

Torasemide has a certain character of interaction with some groups of drugs. This must be taken into account when prescribing and taking it.

Manifestation of action when combined with other means:

1. Joint reception of cardiac glycosides with Torasemide increases their effect
2. The combination of the use of funds with muscle relaxants increases the effectiveness of the latter
3. Combining Torasemide with laxatives or corticosteroids increases the risk of developing
4. The action of Torasemide enhances the effectiveness of antihypertensive drugs, therefore, the pressure level should be kept under control and the dosage of the diuretic should be adjusted
5. The interaction of this drug with hypoglycemic agents and epinephrine derivatives leads to a decrease in the therapeutic effect of the latter
6. High dosages of Torasemide lead to increased nephrotoxic and ototoxic effects on the body of substances such as platinum, cephalosporins and aminoglycosides
7. The simultaneous use of salicylates causes a neurotoxic effect on the body
8. While taking Torasemide with non-narcotic analgesics and probenecid reduces its effectiveness
9. Lithium preparations cause the concentration of Torasemide in plasma
10. The combination of cholestyramine with Torasemide leads to a decrease in its absorption

When using the medication, you should carefully study the instructions and take into account the negative consequences of the combined use of certain drugs with Torasemide.

Important conditions

Before using Torasemide, you must pass a complete blood count

During the use of Torasemide, some specific conditions must be observed:

1. The drug can only be prescribed by the attending physician
2. Before use, it is required to donate and urine
3. There is a high risk of side effects in people with intolerance to sulfa drugs.
4. With long-term use of high dosages of the drug, it is necessary to replenish salt reserves to avoid hyponatremia
5. In the presence of ascites (accumulation of fluid in the abdominal cavity), the dosage is prescribed individually and under the constant supervision of doctors in a hospital due to the high likelihood of developing a coma of the liver
6. In diabetes mellitus, blood glucose should be monitored constantly
7. At the time of using Torasemide, it is recommended to limit driving and complex equipment due to the risk of a decrease in concentration

Compliance with these instructions will avoid the negative consequences of taking the drug.

Analogs

Diuver is analogous to Torasemide

Torasemid has several analogs, which can be divided into two groups:

1. Compositional analogs
2. Action analogs

The first group is generic drugs. These funds contain the same amount of the basic substance, but are produced under a different name. They have no significant differences between themselves and can replace each other.

Generic Torasemide:

• Diuver is most often prescribed for cardiac dysfunction and hypertension.
• Bitomar is used for kidney, liver or heart dysfunction
• Torixal is prescribed for the treatment and heart failure
• Torsid has intravenous use and is indicated for pulmonary edema or
• Trigrim is often used for hypertension
• Trifas also has intravenous administration and is used for severe forms of edema

The second group of analogs has a different active substance, but also has a diuretic effect and has a similar application. Among this group, the most famous and often used. It has a faster effect, but its effect lasts less than that of Torasemide.

Another disadvantage of Furosemide is that it has more side effects from electrolyte imbalance. The prescriptions for the appointment of Furosemide are chronic forms of edema in renal, heart and hepatic failure, as well as in arterial hypertension.

One or another type of funds should be selected by the attending physician based on the individual characteristics of the body and the characteristics of edema. Self-use or substitution of drugs is prohibited and may be harmful to health.

Torasemide is a diuretic drug. It has a wide range of applications for edema of various shapes and severity. The prescriptions for its appointment are arterial hypertension, or renal failure, which have severe edema.

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The drug is considered the most effective and safe among similar drugs in this group of action. With its use, the least manifestation of side effects is noted.

Torasemide has certain contraindications that should be taken into account when prescribing it. It is allowed to use the drug only with the appointment of the attending physician in compliance with all recommendations for dosage and course of treatment. Self-administration can lead to overdose and be harmful to health.

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 improper use of diuretic drugs can lead to severe complications.

short 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 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, seeking 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 harmful effect on metabolism. These drugs are actually much better tolerated than 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

Until today, there is no single system by which all diuretics would be divided, since all drugs have a different chemical structure and affect the body systems in different ways. 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", "Bumetanid".
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;
• "Pyrethanides";
• 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 for 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.

To stop a hypertensive crisis, powerful medications allow. 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";
• "Pyrethanides";
• 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 a 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 taking it for 20 minutes. The duration of exposure to the drug is about 4-5 hours.

This remedy is effective not only for the relief of hypertensive crisis. According to the instructions, the medicine helps with heart failure, edema of the brain and lungs, and chemical poisoning. 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. It should not be used by 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 the medicine to 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, Effectively the use of "Spironolactone" with edema 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.