Generic name: Torsemide
Brand name: Demadex
How does it work?
Demadex belongs to Diuretics. The main mechanism of action is the reversible binding the torasemid with kontransporter Na +/2Cl-/K +, located in the apical membrane of the thick segment of loop of Henle, that results in reducing or completely inhibiting reabsorption of sodium ions, decreasing the osmotic pressure of intracellular fluid and reabsorption of water.
The composition and the form:
One tablet of the drug consist of torasemid 5 or 10 mg; excipients: lactose monohydrate, maize starch, sodium starch glycolate, colloidal anhydrous silicon, magnesium stearate; 20 or 60 tablets per pack.
Indications:
Edema caused by heart failure, liver disease, kidney and lung.
Contraindications:
- Hypersensitivity to torasemid and sulfonamides, anuria
- Hepatic coma and precomatose condition
- Renal failure with increasing azotemia
- Hypotension
- Arrhythmia
- Pregnancy
- Lactation (no data for taking Demadex during this period)
- The age under 18 years (the effectiveness and safety are not established)
Pregnancy and breastfeeding:
Don’t take it if you are pregnant. At the time of treatment breastfeeding should be stopped.
Dosing:
Demadex are taken orally after meal, once a day. Therapeutic dose – 5mg per day. If necessary, the dose is increased to 20mg per day, and in some cases – up to 40mg. Elderly patients do not need a special selection of doses.
Side effects:
From the blood side:
in different cases can be found some hematologic changes (reduction of the number of red blood cells, leukopenia, thrombocytopenia).
From the cardiovascular system part:
in some cases, because of thickening of blood, the circulation disorders and thromboembolism arise, reduce blood pressure.
From the part of the digestive tract:
the various dysfunctions of the digestive tract, loss of appetite, dry mouth, rarely – pancreatitis.
From the kidneys and urinary tract part:
patients with urinary tract obstruction may have the urine retention, sometimes – increased urea and creatinine.
From CNS:
headache, dizziness, weakness, drowsiness, confusion, convulsions, paresthesias of extremities.
The side of the liver:
can be observed the increasing of activity of liver enzymes.
Changes of laboratory parameters:
hypovolemia, disruption of water and electrolyte imbalance, hypokalemia, increased levels of uric acid in blood serum, hyperglycemia and hyperlipidemia.
Allergic reactions:
skin itching, rash, and photosensitivity. From the senses side: visual disturbances, tinnitus, deafness.
Interaction:
Torasemid increases the sensitivity of the myocardium to cardiac glycosides. Using simultaneously with the mineral-and glucocorticoids, laxative may increase excretion of potassium. Reinforces the effect of hypotensive drugs. Torasemid, especially in high doses, may exacerbate the nephrotoxicity and ototoksicheskie effects of aminoglycoside antibiotics, the toxicity of medicines of cisplatin, nephrotoxic effects of cephalosporins and cardio-and neurotoxic effects of lithium. In a joint application with large doses of salicylates, toxic effect of the latter may be intensified.
Torasemid may decrease the effectiveness of hypoglycemic (antidiabetic) agents. Consecutive or simultaneous taking of torasemid with ACE inhibitors may lead to a transient drop in blood pressure. This can be avoided by reducing the initial dose of ACE inhibitor and lowering the dose of torasemid (or temporarily lift it). NSAIDs and probenecid can decrease the diuretic effect torasemida. Kolestiramin may diminish the absorption of torasemid from the gastrointestinal tract (according to preclinical studies in animals).
Overdose:
Symptoms:
there is no typical picture of poisoning; there is forced urination, accompanied by hypovolemia, electrolyte derangement, with subsequent decrease of blood pressure, drowsiness, confusion, collapse. Can be observed gastro-intestinal disturbances.
Treatment:
there is no specific antidote. Symptomatic treatment surmises reducing the dose or elimination of the drug and simultaneous by filling the loss of fluid and electrolytes.
Cautions:
With long-term treatment with Demadex it is recommended to check electrolyte balance, glucose, uric acid, creatinine and lipids in the blood. Before prescribing Demadex correction of violations of electrolyte balance needs to be done. In the presence of diabetes mellitus type 1 or 2, you have to control the level of glucose in the blood. During treatment with this drug patients need to decline from driving and activities that require concentration.
Storage conditions:
Temperature is not above 30 °C.
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