Diuver tabs 10mg #60

Instruction for Diuver

You can buy Diuver tablets on this page

Composition

In addition to the biologically active component of torasemide, which may be in a dosage of 5 or 10 mg, depending on the form of release, the following excipients are present in the medicinal product (the mass part is indicated according to the amount of the active ingredient):
    lactose monohydrate - 58.44 / 116.88 mg;
    corn starch - 14.56 / 29.12 mg;
    sodium carboxymethyl starch - 0.8 / 1.6 mg;
    anhydrous silicon dioxide - 0.6 / 1, »mg;
    magnesium stearate - 0.6 / 1.2 mg.

Form of issue

The tablets are milky white, round in shape, biconvex with a facet on one side and digital engraving on the other, which differs depending on the dosage of the main active ingredient. The mass fraction in 5 mg of torasemide corresponds to the figure 915, and 10 mg to 916 on the back of the tablet.
The pharmaceutical preparation is sold in blister packs of polymer film and aluminum foil, each of which has 10 tablets. In a cardboard box there are two plates (20 pieces in a box).

Pharmacological action

Diuver is a diuretic drug, a group of loop urinary stimulating substances, that is, the main action of the drug is directed to the Henle loop (one of the main components of the kidney nephron structural unit). The predominant pharmacological effect is the inhibition of the reverse absorption of sodium and chlorine ions in the ascending knee of the loop, which is manifested in a decrease in the osmotic parameters of the intracellular fluid. As a result, renal reabsorption of water is inhibited, daily diuresis increases and excess fluid is excreted from the body.
The mechanism of action of the pharmaceutical preparation is carried out by blocking the ion carriers in the apical part of the ascending (another segment name - thick) part of the nephron loop. Also, aldosterone receptors located in the cardiac muscle are blocked. This makes it possible to further increase the excretion of water, since the adrenal hormone does not act in a stimulating manner to reverse the absorption of the fluid.
Cardiac effects allow to normalize the diastolic function of the myocardium, since excessive volume overload is prevented (the main pathophysiological cause of insufficiency of the heart valves and subsequent hypertrophy of the heart divisions). Due to an extended cycle of myocardial work and a longer diastole, fibrosis and sclerosis of the muscle tissue of the internal pump decreases.
Also, Dyuver can act as an antihypertensive agent, since the action of Torasemide, the main active ingredient, is realized by decreasing the peripheral resistance of blood vessels (a reloading component leading to increased heart function and, as a result, increased blood pressure). The mechanism of this action is to stimulate the activity of potassium ions in smooth cells of the muscle layer of the vascular bed, thereby reducing the response of the wall to the effects of biological presses (endogenous substances, for example, catecholamines or vasopressin, the hormone of the posterior lobe of the pituitary gland).
It should be noted that torasemide, as a thiazide diuretic, has several advantages over the main pharmaceutical preparation of this action - Furosemide:
    To a lesser extent, a pathological condition develops, such as hypokalemia;
    the activity of the drug based on torasemide is higher;
    the effect provided by Diuver is more prolonged, which allows long-term conservative treatment with this drug.

Pharmacodynamics and pharmacokinetics

Diuver is taken orally, quickly and relatively fully (the bioavailability of the drug is 80-90 percent, depending on the individual characteristics of the body) is adsorbed from the gastrointestinal tract. The maximum plasma concentration of active ingredients is noted after 1-2 hours, after taking the tablets. In the blood, torasemide binds to plasma proteins, which provides a diuretic effect for the next eighteen hours. The frequency of urination increases steadily over the entire duration of the drug, which is undoubtedly a positive feature of the drug (unlike Furosemide, does not force the patient to restrict the activity immediately after taking the tablets).
The drug is metabolized in the liver under the action of enzymes of the cytochrome P450 system. As a result of chemical reactions, hydroxylated metabolites are formed which bind to blood plasma proteins by 86-97 percent (the accessibility of the bond depends on the biological transformation of the components and the sequence of the oxidation reaction and ring hydroxylation).
Diuver is excreted mainly by the kidneys (renal clearance of torasemide is 10 ml / min, against the background of the general - 40 ml / min) in the form of inactive metabolites, about eighty percent of the dose once taken. The half-life of the pharmaceutical preparation is about 3-4 hours (in case of renal insufficiency the indicator does not change in any way). An insignificant part of metabolites of torasemide is excreted by hemodialysis and hemofiltration.

Indications for use Diuver

Absolute indications for the use of a diuretic drug based on torasemide is edematous syndrome on a background of various pathologies. So in diseases of the kidneys, liver, lungs in complex therapy, it is worth including a drug of this kind.
Chronic heart failure is also much more effective to treat if loop diuretics are used to reduce the accumulation of fluid in the cavities and tissues.
Indications for the use of Diuver in arterial hypertension are not absolute, however, most clinicians use this drug in a conservative treatment regimen, since it has a strong and long-lasting effect compared to the rest of diuretics. A positive feature of the use of Diuver is also its pharmacokinetic ability and dose-dependent effect, allowing to precisely regulate the desired therapeutic effect.

Contraindications

    hypersensitivity or intolerance of the constituent components of the pharmaceutical preparation;
    renal failure in the anuria stage;
    deficiency of lactase (and lactose intolerance, as its consequence) or insufficiency of absorption of glucose and galactose;
    dehydration, exsicosis, hypovolemic conditions;
    hepatic coma;
    lactation period;
    intoxication with cardiac glycosides;
    severe hypokalemia or hyponatremia;
    acute glomerulonephritis;
    Decompensated heart valve defects (in particular stenosis of the aortic and mitral orifices);
    increased central venous pressure above 10 mm Hg;
    age category up to 18 years.
There are also a number of pathological conditions when the drug should be taken only under the supervision of qualified specialists in inpatient treatment (so that, if the adverse effects of conservative therapy develop, help is given as soon as possible). Such states include:
    arterial hypotension;
    atherosclerosis (especially the arteries of cerebral circulation);
    predisposition to increase the plasma concentration of urate;
    disturbances of urine outflow from the urethra (the most common cause is benign prostatic hyperplasia in men or stenosing inflammatory processes in women);
    acute stage of myocardial infarction (there is a growing risk of cardiogenic shock and progression of the pathological process);
    diabetes mellitus (reduces the tolerance of cells to glucose and reduces the hypoglycemic effect of drugs);
    anemia;
    hepatorenal syndrome.

Side effects

The drug can cause the following undesirable reactions during the complex treatment of edematous syndrome:
    On the part of the cardiovascular system: acute circulatory failure, excessive reduction in blood pressure until collapse, arrhythmia (mainly tachycardia), a decrease in the volume of circulating blood.
    From the urinary system: acute retention of urine, increased concentration of uric acid salts in blood plasma, hematuria (blood in the urine), interstitial nephritis, hydronephrosis.
    From VEB and KSBB: decrease in the plasma content of sodium, potassium, chlorine, magnesium, calcium, metabolic alkalosis, hypovolemia, dehydration, exsicosis, hemoconcentration and increase in blood viscosity.
    On the part of the metabolism: hypercholesterolemia, hypertriglyceridemia and atherosclerosis, as a result, an increase in the concentration of creatinine and urea in the blood, gouty diseases, a decrease in glucose tolerance (it is possible to provoke manifestations of diabetes mellitus).
    The digestive tract: dyspeptic phenomena (nausea, vomiting, epigastric pain, diarrhea), impaired hepatic enzyme activity, pancreatitis (mainly acute).
    From the side of the central nervous system and hearing organs: reversible hearing disorders, tinnitus, headaches, dizziness, paresthesia.
    Skin covers: urticaria, skin itch, foci, dermatitis, photosensitivity, vasculitis, anaphylactic and anaphylactoid reactions (up to the development of an allergic shock).
    From the peripheral blood: a decrease in the number of platelets and leukocytes (the latter manifests itself in the form of agranulocytosis), aplastic or hemolytic anemia.

Diuver, instructions for use (Method and dosage)

Tablets are taken orally, washed down with a small amount of water. It is recommended to use the medicine immediately after breakfast, when the adsorption in the gastrointestinal tract is stimulated by a food lump.
The scheme of taking the drug is the attending physician taking into account the individual characteristics of the organism and indications for conservative sanation, usually with edematous syndrome of various origins the therapeutic dose is 5 mg of torasemide once a day. Gradually, the daily dose can be increased to 20 and even 40 mg per dose, if the pathological condition of the patient demands. Stop treatment only after the disappearance of edema (to confirm the positive effect is used control weighing and McClure-Aldrich test for latent edema).
Instructions for use Diuver in the arterial hypertension is slightly different. The initial dose is 2.5 mg, that is, half the tablet with a mass portion of torasemide 5 mg (or quarter at 10 mg of active ingredient). If necessary, to increase the therapeutic effect, the daily dose may increase to 5 mg.

Overdose

Increased plasma concentration with uncontrolled administration of the drug causes the following symptoms of intoxication:
    frequent urination with a small specific gravity of urine;
    excessive circulatory deficiency;
    marked reduction in blood pressure, right up to orthostatic hypotension;
    violation of electrolyte and acid-base balance of the body;
    gastrointestinal disorders;
    drowsiness;
    confusion of consciousness;
    collapse - acute circulatory failure.
Specific antidote, which would help with intoxication Dioverom in the pharmaceutical market there, but there are methods of conservative treatment that compensate for the pathological state of the body. So, abundant intravenous infusions with isotonic and crystalline solutions are used to compensate for the loss of bcc. Under the control of serum concentrations of electrolytes and gemotokrita regulators KOS and VIB are poured. In especially difficult situations blood substitutes and blood components can be used.
If the drug poisoning occurred against the background of a recently accepted increased dose of the drug, then effectively washing the stomach, provoking vomiting, evacuation of the contents of the stomach in all possible ways (used as conservative, drug therapy, and methods of physiotherapy).

Interaction

Torasemide is an extremely active pharmaceutical component that can actively interact with a large list of medications. Thus, the diuretic increases the concentration, and accordingly the risk of the development of side effects and undesirable reactions (especially oto and nephrotoxicity) of such drugs as antibiotics of cephalosporin and aminoglycoside, chloramphenicol, cisplatin, ethacrynic acid, amphotericin B (interact as a competitive renal excretion).
Separately it is worth noting that Diuver reduces the effectiveness of hypoglycemic agents, which requires appropriate correction of conservative treatment of diabetes mellitus. Otherwise, it is possible to develop hyperglycemic or ketoacidotic coma and irreversible changes in the microcirculatory vascular bed. Also, the pharmaceutical effect of allopurinol is reduced if complex therapy combines this drug with diuretics based on Torasemide.
Diuver significantly reduces the renal clearance of lithium preparations, since a large amount of poorly concentrated urine is released (with increased amounts of secreted fluid, the glomerular apparatus works much less). This action threatens the development of lithium intoxication, which can manifest as follows:
    dyspeptic disorder (nausea, vomiting, and so on);
    increased neuromuscular excitability;
    epileptic seizures and stupor;
    ataxia;
    a large tremor;
    confusion, delirium;
    renal insufficiency.
Nonsteroidal anti-inflammatory drugs significantly reduce the diuretic effect of torasemide, since they inhibit the synthesis of prostaglandins, which is manifested in the disruption of the activity of a biologically active component, such as renin in blood plasma. As a result, the renal blood flow and urination is less active. The same mechanism of action of NSAIDs strengthens the hypotensive effect of diuretic drugs (renin is the main component of renal regulation of arterial pressure, which has a pressor effect on the vascular bed).
Do not combine in combination therapy and drugs that inhibit the angiotensin converting enzyme or angiotensin receptor agonists together with loop diuretics, such treatment can lead to excessive lowering of blood pressure and the development of acute circulatory insufficiency up to collapse. At absolute indications, it is recommended to reduce or temporarily stop the conservative treatment with torasemide in this case.
In patients with a high risk of developing kidney pathology (nephropathy of different etiologies), simultaneous administration of cyclosporine and torasemide should be avoided, since this can serve as a triggering factor for a very serious disease. The side effect of cyclosporine is a disruption of excretion of uric acid salts by the kidneys, and torasemide, in turn, causes an increase in their concentration in the bloodstream. Such a mutual action will inevitably lead to the deposition of urates or the development of gouty arthritis.

Terms of sale

You can buy Diuver without prescription forms in pharmacies.

Storage conditions

The drug should be stored away from children, in dry rooms with a constant temperature regime from 15 to 30 degrees Celsius.
Shelf life - 3 years.

In pregnancy and lactation

Biologically active components of the Diuver do not have a teratogenic or mutagenic effect, do not have a fetotoxic effect, but are able to penetrate the barrier between the placenta and the fetus. Due to this, torasemide can cause a decrease in the number of blood platelets or disturbances in the water-electrolyte balance, which will have a destructive effect on the laying of the organs and tissues of the unborn child. Therefore, a pharmaceutical preparation can only be used if the beneficial therapeutic effect for the mother is significantly greater than the potential risk to the fetus. At absolute indications for the use of Diuver, it is recommended to carry out treatment under the supervision of qualified medical personnel and regular additional studies.

Reviews of Diuver

Reviews of the Diuver confirm its high effectiveness in the treatment of edematous syndrome with a variety of different pathologies. So a positive opinion about the drug was made by patients with chronic heart diseases, kidney damage and diseases, accompanied by a violation of the regulation of the release of fluid from the body.
Actively applied pharmaceutical preparation for inpatient treatment as part of a conservative complex therapy, which testifies to the positive opinion of practicing qualified doctors, since the diuretic loop diuretic has a stronger and longer action than analog drugs.