Фармакологическое действие — диуретическое. Инструкция
Показания к применению
отечный синдром различного генеза, в т.ч. при хронической сердечной недостаточности, заболеваниях печени, легких и почек;артериальная гипертензия.
Противопоказания
повышенная чувствительность к торасемиду или любому из компонентов препарата;аллергия на сульфаниламиды (сульфаниламидные противомикробные средства или препараты сульфонилмочевины);почечная недостаточность с анурией;печеночная кома и прекома;рефрактерная гипокалиемия;рефрактерная гипонатриемия;гиповолемия (с артериальной гипотензией или без нее) или ...
Круглые плоскоцилиндрические таблетки белого или почти белого цвета с фаской и риской.
Фармакологические свойства
Фармакологическое действие — диуретическое.
Показания к применению
отечный синдром различного генеза, в т.ч. при хронической сердечной недостаточности, заболеваниях печени, легких и почек;артериальная гипертензия.
Противопоказания
повышенная чувствительность к торасемиду или любому из компонентов препарата;аллергия на сульфаниламиды (сульфаниламидные противомикробные средства или препараты сульфонилмочевины);почечная недостаточность с анурией;печеночная кома и прекома;рефрактерная гипокалиемия;рефрактерная гипонатриемия;гиповолемия (с артериальной гипотензией или без нее) или дегидратация;резко выраженные нарушения оттока мочи любой этиологии (включая одностороннее поражение мочевыводящих путей);гликозидная интоксикация;острый гломерулонефрит;синоатриальная и AV-блокада II–III степени;декомпенсированный аортальный и митральный стеноз;гипертрофическая обструктивная кардиомиопатия;повышение центрального венозного давления (свыше 10 мм рт. ст.);аритмия;хроническая почечная недостаточность с нарастающей азотемией;гиперурикемия;одновременное применение аминогликозидов и цефалоспоринов;непереносимость лактозы, дефицит лактазы или глюкозо-галактозная мальабсорбция;беременность;период грудного вскармливания;возраст до 18 лет (безопасность и эффективность не установлены).С осторожностью: артериальная гипотензия; стенозирующий атеросклероз церебральных артерий; гипопротеинемия; нарушения оттока мочи (доброкачественная гиперплазия предстательной железы, сужение мочеиспускательного канала или гидронефроз); желудочковая аритмия в анамнезе; острый инфаркт миокарда (увеличение риска развития кардиогенного шока); диарея; панкреатит; гипокалиемия; гипонатриемия; нарушение функции печени, цирроз печени, почечная недостаточность, гепаторенальный синдром; сахарный диабет (снижение толерантности к глюкозе); подагра, предрасположенность к гиперурикемии; анемия; одновременное применение сердечных гликозидов, кортикостероидов и АКТГ.
Применение при беременности и в период грудного вскармливания
Торасемид не обладает тератогенным эффектом и фетотоксичностью, проникает через плацентарный барьер, вызывая нарушения водно-электролитного обмена и тромбоцитопению у плода.Контролируемых исследований по применению торасемида у беременных не проводилось, препарат противопоказан во время беременности.Данных о выделении торасемида в грудное молоко нет, поэтому при необходимости применения торасемида в период лактации необходимо прекратить грудное вскармливание.
Способ применения и дозы
Внутрь, один раз в день, не разжевывая, запивая достаточным количеством воды. Таблетки можно принимать в любое удобное постоянное время, независимо от приема пищи.Отечный синдром при ХСН. Обычная начальная доза составляет 10–20 мг один раз в день. При необходимости доза может быть увеличена вдвое до получения требуемого эффекта.Отечный синдром при заболеваниях почек. Обычная начальная доза составляет 20 мг один раз в день. При необходимости доза может быть увеличена вдвое до получения требуемого эффекта.Отечный синдром при заболеваниях печени. Обычная начальная доза составляет 5–10 мг один раз в день. При необходимости доза может быть увеличена вдвое до получения требуемого эффекта. Максимальная разовая доза составляет 40 мг, ее превышать не рекомендуется (отсутствует опыт применения). Препарат применяют в течение длительного периода или до исчезновения отеков.Артериальная гипертензия. Начальная доза составляет 2,5 мг (1/2 табл. по 5 мг) один раз в день. При отсутствии терапевтического эффекта в течение 4 нед дозу увеличивают до 5 мг один раз в день. При отсутствии адекватного снижения АД при приеме в дозе 5 мг один раз в день в течение 4–6 нед дозу увеличивают до 10 мг один раз в день. Если доза 10 мг не дает требуемого эффекта, в лечебную схему нужно добавить гипотензивный препарат другой группы.Пациентам пожилого возраста коррекция дозы не требуется.
Побочное действие
Частота развития побочных эффектов классифицирована согласно рекомендациям ВОЗ: очень часто— ≥1/10 (≥10%); часто— от ≥1/100 до <1/10 (≥1 и <10%); нечасто— от ≥1/1000 до <1/100 (≥0,1 и <1%); редко— от ≥1/10000 до <1/1000 (≥0,01 и <0,1%); очень редко— <1/10000 (<0,01 %); частота неизвестна— частота не может быть оценена на основании имеющихся данных.Со стороны нервной системы: часто— головная боль, головокружение, сонливость; нечасто— судороги мышц нижних конечностей; частота неизвестна— спутанность сознания, обморок, парестезии в конечностях (ощущение онемения, ползания мурашек и покалывания).Со стороны органов чувств: частота неизвестна— нарушение зрения, нарушение слуха, шум в ушах и потеря слуха (носит, как правило, обратимый характер), обычно у пациентов с почечной недостаточностью или гипопротеинемией (нефротический синдром).Со стороны ССС: нечасто— экстрасистолия, аритмия, тахикардия; частота неизвестна— чрезмерное снижение АД, ортостатическая гипотензия, коллапс, тромбоз глубоких вен, тромбоэмболия, снижение ОЦК.Со стороны дыхательной системы: нечасто— носовое кровотечение.Со стороны пищеварительной системы: часто— диарея; нечасто— боль в животе, метеоризм, полидипсия; частота неизвестна— сухость во рту, тошнота, рвота, потеря аппетита, панкреатит, диспепсические расстройства, внутрипеченочный холестаз.Со стороны кожи и подкожных тканей: частота неизвестна— кожный зуд, сыпь, крапивница, полиморфная эритема, эксфолиативный дерматит, пурпура, васкулит, фотосенсибилизация.Со стороны опорно-двигательного аппарата: частота неизвестна— мышечная слабость.Со стороны мочевыделительной системы: часто— увеличение частоты мочеиспускания, полиурия, никтурия; нечасто— учащенные позывы к мочеиспусканию; частота неизвестна— олигурия, задержка мочи (у пациентов с обструкцией мочевыводящих путей), интерстициальный нефрит, гематурия.Со стороны репродуктивной системы: частота неизвестна— снижение потенции.Со стороны обмена веществ: частота неизвестна— гипокалиемия, гипонатриемия, гипомагниемия, гипокальциемия, гипохлоремия, метаболический алкалоз, гиповолемия, дегидратация (чаще у пациентов пожилого возраста).Со стороны лабораторных показателей: нечасто— гиперхолестеринемия, гипертриглицеридемия; частота неизвестна— гиперурикемия, небольшое повышение активности ЩФ в плазме крови, повышение концентрации креатинина и мочевины в плазме крови, повышение активности некоторых печеночных ферментов в плазме крови (например ГГТ), тромбоцитопения, лейкопения, агранулоцитоз, гипергликемия, снижение толерантности к глюкозе (возможна манифестация латентно протекающего сахарного диабета).Прочие: частота неизвестна— апластическая или гемолитическая анемия.
Передозировка
Симптомы: усиленный диурез, сопровождающийся снижением ОЦК и нарушением водно-электролитного баланса крови, с последующим выраженным снижением АД, сонливостью и спутанностью сознания, коллапсом. Могут наблюдаться желудочно-кишечные расстройства.Лечение: индукция рвоты, промывание желудка, назначение активированного угля. Лечение симптоматическое, снижение дозы или отмена препарата и одновременно восполнение ОЦК и коррекция показателей водно-электролитного баланса и кислотно-основного состояния под контролем содержания электролитов в плазме крови и уровня гематокрита. Гемодиализ неэффективен, т.к. выведение торасемида и его метаболитов не ускоряется. Специфического антидота нет.
Взаимодействие с другими лекарственными средствами
При одновременном применении торасемида с минералокортикостероидами и ГКС, амфотерицином В повышается риск развития гипокалиемии; с сердечными гликозидами— возрастает риск развития гликозидной интоксикации вследствие гипокалиемии (для высоко- и низкополярных сердечных гликозидов) и удлинения T1/2 (для низкополярных сердечных гликозидов).Прием торасемида повышает концентрацию и риск развития нефро- и ототоксического действия цефалоспоринов, аминогликозидов, хлорамфеникола, этакриновой кислоты, антибиотиков, салицилатов, цисплатина, препаратов платины, амфотерицина В (вследствие конкурентного почечного выведения).Последовательное или одновременное применение торасемида с ингибиторами АПФ или АРА II может привести к резкому снижению АД. Этого можно избежать, уменьшив начальную дозу ингибитора АПФ или снизив дозу торасемида (или временно отменив его).НПВС, сукральфат снижают диуретический эффект торасемида вследствие ингибирования синтеза ПГ, нарушения активности ренина в плазме крови и выведения альдостерона.Торасемид усиливает антигипертензивное действие гипотензивных средств, нервно-мышечную блокаду деполяризующих миорелаксантов (суксаметоний) и ослабляет действие недеполяризующих миорелаксантов (тубокурарин).Торасемид снижает почечный клиренс препаратов лития и повышает вероятность развития интоксикации.Торасемид повышает эффективность диазоксида и теофиллина, снижает эффективность гипогликемических средств, аллопуринола.Прессорные амины и торасемид взаимно снижают эффективность друг друга.ЛС, блокирующие канальцевую секрецию, повышают концентрацию торасемида в плазме крови.При одновременном применении циклоспорина и торасемида увеличивается риск развития подагрического артрита вследствие того, что циклоспорин может вызвать нарушение экскреции уратов почками, а торасемид— гиперурикемию.Одновременное применение пробенецида или метотрексата может уменьшать эффективность торасемида (одинаковый путь секреции). С другой стороны, торасемид может приводить к снижению почечной элиминации этих ЛС.Сообщалось, что у пациентов с высоким риском развития нефропатии, принимающих торасемид внутрь, при введении рентгеноконтрастных средств нарушения функций почек наблюдались чаще, чем у пациентов с высоким риском развития нефропатии, которым перед введением рентгеноконтрастных средств проводили в/в гидратацию.Биодоступность и, как следствие, эффективность торасемида может быть снижена при совместной терапии с колестирамином.
Условия хранения
В защищенном от света месте, при температуре не выше 25°C. Хранить в недоступном для детей месте.
Срок годности
3 года. Не применять по истечении срока годности, указанного на упаковке.2000-2017. Регистр лекарственных средств России
Условия отпуска
По рецепту.
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При отсутствии адекватного снижения АД при приеме в дозе 5 мг один раз в день в течение 4–6 нед дозу увеличивают до 10 мг один раз в день. Если доза 10 мг не дает требуемого эффекта, в лечебную схему нужно добавить гипотензивный препарат другой группы.Пациентам пожилого возраста коррекция дозы не требуется."}}]},{"id":8,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Частота развития побочных эффектов классифицирована согласно рекомендациям ВОЗ: очень часто— ≥1/10 (≥10%); часто— от ≥1/100 до \u003c1/10 (≥1 и \u003c10%); нечасто— от ≥1/1000 до \u003c1/100 (≥0,1 и \u003c1%); редко— от ≥1/10000 до \u003c1/1000 (≥0,01 и \u003c0,1%); очень редко— \u003c1/10000 (\u003c0,01 %); частота неизвестна— частота не может быть оценена на основании имеющихся данных.Со стороны нервной системы: часто— головная боль, головокружение, сонливость; нечасто— судороги мышц нижних конечностей; частота неизвестна— спутанность сознания, обморок, парестезии в конечностях (ощущение онемения, ползания мурашек и покалывания).Со стороны органов чувств: частота неизвестна— нарушение зрения, нарушение слуха, шум в ушах и потеря слуха (носит, как правило, обратимый характер), обычно у пациентов с почечной недостаточностью или гипопротеинемией (нефротический синдром).Со стороны ССС: нечасто— экстрасистолия, аритмия, тахикардия; частота неизвестна— чрезмерное снижение АД, ортостатическая гипотензия, коллапс, тромбоз глубоких вен, тромбоэмболия, снижение ОЦК.Со стороны дыхательной системы: нечасто— носовое кровотечение.Со стороны пищеварительной системы: часто— диарея; нечасто— боль в животе, метеоризм, полидипсия; частота неизвестна— сухость во рту, тошнота, рвота, потеря аппетита, панкреатит, диспепсические расстройства, внутрипеченочный холестаз.Со стороны кожи и подкожных тканей: частота неизвестна— кожный зуд, сыпь, крапивница, полиморфная эритема, эксфолиативный дерматит, пурпура, васкулит, фотосенсибилизация.Со стороны опорно-двигательного аппарата: частота неизвестна— мышечная слабость.Со стороны мочевыделительной системы: часто— увеличение частоты мочеиспускания, полиурия, никтурия; нечасто— учащенные позывы к мочеиспусканию; частота неизвестна— олигурия, задержка мочи (у пациентов с обструкцией мочевыводящих путей), интерстициальный нефрит, гематурия.Со стороны репродуктивной системы: частота неизвестна— снижение потенции.Со стороны обмена веществ: частота неизвестна— гипокалиемия, гипонатриемия, гипомагниемия, гипокальциемия, гипохлоремия, метаболический алкалоз, гиповолемия, дегидратация (чаще у пациентов пожилого возраста).Со стороны лабораторных показателей: нечасто— гиперхолестеринемия, гипертриглицеридемия; частота неизвестна— гиперурикемия, небольшое повышение активности ЩФ в плазме крови, повышение концентрации креатинина и мочевины в плазме крови, повышение активности некоторых печеночных ферментов в плазме крови (например ГГТ), тромбоцитопения, лейкопения, агранулоцитоз, гипергликемия, снижение толерантности к глюкозе (возможна манифестация латентно протекающего сахарного диабета).Прочие: частота неизвестна— апластическая или гемолитическая анемия."}}]},{"id":9,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Симптомы: усиленный диурез, сопровождающийся снижением ОЦК и нарушением водно-электролитного баланса крови, с последующим выраженным снижением АД, сонливостью и спутанностью сознания, коллапсом. Могут наблюдаться желудочно-кишечные расстройства.Лечение: индукция рвоты, промывание желудка, назначение активированного угля. Лечение симптоматическое, снижение дозы или отмена препарата и одновременно восполнение ОЦК и коррекция показателей водно-электролитного баланса и кислотно-основного состояния под контролем содержания электролитов в плазме крови и уровня гематокрита. Гемодиализ неэффективен, т.к. выведение торасемида и его метаболитов не ускоряется. Специфического антидота нет."}}]},{"id":10,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"При одновременном применении торасемида с минералокортикостероидами и ГКС, амфотерицином В повышается риск развития гипокалиемии; с сердечными гликозидами— возрастает риск развития гликозидной интоксикации вследствие гипокалиемии (для высоко- и низкополярных сердечных гликозидов) и удлинения T1/2 (для низкополярных сердечных гликозидов).Прием торасемида повышает концентрацию и риск развития нефро- и ототоксического действия цефалоспоринов, аминогликозидов, хлорамфеникола, этакриновой кислоты, антибиотиков, салицилатов, цисплатина, препаратов платины, амфотерицина В (вследствие конкурентного почечного выведения).Последовательное или одновременное применение торасемида с ингибиторами АПФ или АРА II может привести к резкому снижению АД. Этого можно избежать, уменьшив начальную дозу ингибитора АПФ или снизив дозу торасемида (или временно отменив его).НПВС, сукральфат снижают диуретический эффект торасемида вследствие ингибирования синтеза ПГ, нарушения активности ренина в плазме крови и выведения альдостерона.Торасемид усиливает антигипертензивное действие гипотензивных средств, нервно-мышечную блокаду деполяризующих миорелаксантов (суксаметоний) и ослабляет действие недеполяризующих миорелаксантов (тубокурарин).Торасемид снижает почечный клиренс препаратов лития и повышает вероятность развития интоксикации.Торасемид повышает эффективность диазоксида и теофиллина, снижает эффективность гипогликемических средств, аллопуринола.Прессорные амины и торасемид взаимно снижают эффективность друг друга.ЛС, блокирующие канальцевую секрецию, повышают концентрацию торасемида в плазме крови.При одновременном применении циклоспорина и торасемида увеличивается риск развития подагрического артрита вследствие того, что циклоспорин может вызвать нарушение экскреции уратов почками, а торасемид— гиперурикемию.Одновременное применение пробенецида или метотрексата может уменьшать эффективность торасемида (одинаковый путь секреции). С другой стороны, торасемид может приводить к снижению почечной элиминации этих ЛС.Сообщалось, что у пациентов с высоким риском развития нефропатии, принимающих торасемид внутрь, при введении рентгеноконтрастных средств нарушения функций почек наблюдались чаще, чем у пациентов с высоким риском развития нефропатии, которым перед введением рентгеноконтрастных средств проводили в/в гидратацию.Биодоступность и, как следствие, эффективность торасемида может быть снижена при совместной терапии с колестирамином."}}]},{"id":11,"name":"Условия хранения","slug":"storage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"В защищенном от света месте, при температуре не выше 25°C. Хранить в недоступном для детей месте."}}]},{"id":12,"name":"Срок годности","slug":"expiry_date","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"3 года. Не применять по истечении срока годности, указанного на упаковке.2000-2017. Регистр лекарственных средств России"}}]},{"id":13,"name":"Условия отпуска","slug":"release_condition","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"По рецепту."}}]}],"source":{"title":"ЭркаФарм","url":"https://erkapharm.com"}},"description_toggle":false,"short_description":"Фармакологическое действие — диуретическое.","substance":[{"id":435,"title":"Торасемид","title_latin":"Torasemidum","slug":"torasemid_435"}],"branding":null,"valid_for_quick_buy":true,"is_available_to_delivery":false,"comments":null,"image_alt":"Лотонел - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/22287/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/22287/share_default/"}},"diseases":[{"id":"717","title":"Эссенциальная [первичная] гипертензия","slug":"717-essentsialnaya_pervichnaya_gipertenziya"},{"id":"718","title":"Вторичная 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