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Torsemide

Torsemide
Torsemide is a loop diuretic that is used for the treatment of conditions in which the body retains excess water. Conditions include edema associated with heart, kidney or liver failure amongst others.

Brand: Torsemide

Availability: In Stock
Average Delivery Time: 9 Days
Exp. Date: June 2024
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Torsemide 20 mg
360 pills - 20 mg
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$242.57 $0.67 $163.15 Add to cart
270 pills - 20 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$186.93 $0.69 $117.36 Add to cart
180 pills - 20 mg
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$129.73 $0.72 $73.13 Add to cart
120 pills - 20 mg $90.99 $0.76 $44.25 Add to cart
90 pills - 20 mg $71.75 $0.80 $29.68 Add to cart
60 pills - 20 mg $52.99 $0.88 $14.63 Add to cart
30 pills - 20 mg $33.81 $1.13 No Add to cart
Torsemide 10 mg
360 pills - 10 mg
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$122.95 $0.34 $188.93 Add to cart
270 pills - 10 mg $96.91 $0.36 $137.00 Add to cart
180 pills - 10 mg $70.99 $0.39 $84.95 Add to cart
120 pills - 10 mg $53.93 $0.45 $50.03 Add to cart
90 pills - 10 mg $45.18 $0.50 $32.79 Add to cart
60 pills - 10 mg $36.53 $0.61 $15.45 Add to cart
30 pills - 10 mg $25.99 $0.87 No Add to cart

Product description

Drug Title

Torsemide

Pharmacological action

"Loop" diuretic. The main mechanism of action is due to the reversible binding of thoracemide to the sodium/chlorine/potassium transporter located in the apical membrane of the thick segment of the ascending loop of Genle, resulting in a reduction or complete inhibition of sodium ion reabsorption and reduction of intracellular fluid osmotic pressure and water reabsorption.


Torasemide causes hypokalemia to a lesser extent than furosemide, but it is more active and its effect is more prolonged.


Diuretic effect develops within about an hour after oral administration, reaching a maximum after 3-6 hours, and lasts for 8 to 10 hours.


It reduces systolic and diastolic BP in prone and standing position.


Pharmacokinetics

After oral administration, thoracemide is absorbed from the gastrointestinal tract with limited "first pass" effect through the liver. Cmax in plasma is reached within 1.5 hours after oral administration. Food intake has no significant effect on absorption. Renal and/or hepatic impairment do not affect absorption.


More than 99% of torasemide is bound to plasma proteins.


Vd in healthy volunteers and in patients with mild to moderate renal impairment or chronic heart failure is 12 to 15 L. In patients with liver cirrhosis Vd is doubled.


It is metabolized in the liver with the participation of CYP2C9 isoenzyme to form three metabolites.


The main metabolite is a carboxylic acid derivative and is pharmacologically inactive. The other two metabolites, which are formed in the body in small amounts, have some diuretic activity, but their concentration is too low to have any significant clinical effect.


T1/2 of thoracemide in healthy volunteers is 4 h. About 80% of the oral dose is excreted by the kidneys as metabolites and about 20% unchanged (in patients with normal renal function). Total clearance of thoracemide is 41 ml/min and renal clearance is about 10 ml/min, which corresponds to about 25% of the total.


Patients with chronic heart failure in decompensation stage have reduced hepatic and renal clearance of the drug. In such patients, total clearance of thoracemide is 50% lower than in healthy volunteers, and T1/2 and total bioavailability are correspondingly higher.


In patients with renal insufficiency, the renal clearance of thorasemide is markedly reduced, but this is not reflected in the total clearance. Diuretic effect in renal insufficiency can be achieved by using in high doses. Total clearance of thoracemide and T1/2 remain at the same level in case of reduced renal function, due to metabolism in the liver.


In patients with cirrhosis, Vd, T1/2 and renal clearance are increased, but total clearance remains unchanged.


The pharmacokinetic profile of thoracemide in elderly patients is similar to that in younger patients, with the exception that there is a decrease in renal clearance due to the characteristic age-related impairment of renal function in elderly patients. Total clearance and T1/2 are unchanged.

Contraindications to use

Anuria; hepatic coma and precoma; refractory hypokalemia; refractory hyponatremia; dehydration; severe urinary outflow disorders of any etiology (including unilateral urinary tract involvement); glycoside intoxication; acute glomerulonephritis; sinoatrial and AV-blockade of II and III degree; children and adolescents under 18 years of age; pregnancy; hypersensitivity to thorasemide; allergy to sulfonamides (sulfonamide antimicrobials or sulfonylurea preparations).


Administration during pregnancy and lactation

Administration during pregnancy is contraindicated. It should be used with caution during lactation (breast-feeding).

Special Directions

With caution: Arterial hypotension; hypovolemia (with or without arterial hypotension); urinary outflow disorders (benign prostatic hyperplasia, urethral narrowing or hydronephrosis); history of ventricular arrhythmia; acute myocardial infarction (increased risk of cardiogenic shock); diarrhea; pancreatitis; diabetes mellitus (decreased glucose tolerance); liver disease complicated by cirrhosis and ascites, renal failure, hepatorenal syndrome; gout, hyperuricemia; anemia; concurrent use of cardiac glycosides, amnoglycosides or cephalosporins, corticosteroids or ACTH; hypokalemia; hyponatremia; lactation period.


Patients with hypersensitivity to sulfonamides and sulfonylurea derivatives may have cross-sensitivity to thorasemide.


In patients, especially at the beginning of treatment with thorasemide and in elderly persons, it is recommended to monitor electrolyte balance, circulating blood volume and concentration.


During long-term treatment with torasemide it is recommended to perform regular monitoring of electrolyte balance (especially potassium levels), glucose, uric acid, creatinine, lipids and cellular blood components.


In patients receiving torasemide in high doses, it is not advisable to limit the intake of table salt in order to avoid the development of hyponatremia and metabolic alkalosis.


The risk of hypokalemia is highest in patients with cirrhosis, marked diuresis, with insufficient intake of electrolytes with food, as well as with concomitant treatment with corticosteroids or ACTH.


Increased risk of water-electrolyte balance disorders is noted in patients with renal insufficiency. During the course of treatment it is necessary to monitor the concentration of plasma electrolytes (including sodium, calcium, potassium, magnesium), acid-base status, residual nitrogen, creatinine, uric acid and conduct the appropriate corrective therapy if necessary (with greater frequency in patients with frequent vomiting and against parenteral administration of fluids).


In patients with developed water-electrolyte disorders, hypovolemia or prerenal azotemia the data of laboratory tests may include: hyper- or hyponatremia, hyper- or hypochloremia, hyper- or hypokalemia, acid-base balance disorders and increased blood urea level. If these disorders occur, thorasemide should be discontinued until normal values are restored, and then treatment with thorasemide should be resumed at a lower dose. If azotemia and oliguria appear or worsen in patients with severe progressive renal disease, it is recommended to suspend treatment.


Dosage regimen in patients with ascites against liver cirrhosis should be chosen under hospital conditions (disorders of water-electrolyte balance may lead to hepatic coma). Regular monitoring of plasma electrolytes is indicated for this category of patients.


To prevent hypokalemia, it is recommended to use potassium preparations and potassium-saving diuretics (especially spironolactone), as well as to follow a diet rich in potassium.


The use of thorasemide may cause exacerbation of gout.


In patients with diabetes mellitus or with reduced glucose tolerance, periodic monitoring of blood and urine glucose concentrations is required.


In patients with prostatic hyperplasia, ureteral narrowing, diuresis control is required due to the possibility of acute urinary retention.


In patients with cardiovascular diseases, especially those taking cardiac glycosides, hypokalemia caused by diuretics may cause arrhythmias.


Influence on the ability to drive vehicles and mechanisms


During treatment, patients should avoid potentially dangerous activities requiring high attention and rapid psychomotor reactions.

Indications of active substances of the drug Torasemide

Oedema syndrome of various genesis, including chronic heart failure, liver and kidney diseases.


Arterial hypertension.


Dosing regimen

The optimal dosing regimen is determined by the doctor. It should be strictly observed in accordance with the drug used dosage form of a particular drug indications for use and the dosing regimen.

It is taken orally. Depending on the indication, the dose is 5-20 mg once a day.


A single dose of more than 40 mg is not recommended because its effect has not been studied. It is used long term or until edema disappears.