BRITOMAR PILLS PROLONGED 5MG
BRITOMAR PILLS PROLONGED 5MG - 30 tabs
Security policy (edit with Customer reassurance module)
Delivery policy (edit with Customer reassurance module)
Return policy (edit with Customer reassurance module)
Mechanism of action
Torsemide is a “loopback” diuretic. The main mechanism of action of Britomar is due to the reversible binding of Torsemide to the sodium / chlorine / potassium counter-transporter,
located in the apical membrane of the thick segment of the ascending loop of Geste, as a result of which the reabsorption of sodium ions is reduced or completely inhibited and the osmotic pressure of the intracellular fluid and the reabsorption of water decrease. Torsemide to a lesser extent than Furosemide, causes hypokalemia, while it exhibits greater activity and its action is longer. The diuretic effect develops about an hour after taking the drug inside, reaching a maximum after 3-6 hours, and lasts from 8 to 10 hours. Reduces systolic and diastolic blood pressure (BP) in the "lying" and "standing."
Indications and usage
- Edematous syndrome of various genesis, incl. in chronic heart failure, liver disease, and kidney disease;
- arterial hypertension.
- hypersensitivity to Torsemide or to any of the components of Britomar; in patients with allergies to sulfonamides(sulfanilamide antimicrobial agents or sulfonylurea drugs) cross allergy to Torsemide may occur;
- hepatic coma and precoma;
- refractory hypokalemia; refractory hyponatremia;
- pronounced violations of urine outflow of any etiology (including unilateral damage to the urinary tract);
- digitalis intoxication;
- acute glomerulonephritis;
- sinoatrial and AV blockade of the P-Sh degree;
- age up to 18 years (safety and efficacy in children have not been studied);
- galactose intolerance, lactase deficiency or glucose-galactose malabsorption.
Dosage and administration
Britomar is prescribed by mouth once a day, regardless of the meal, without chewing, washed down with a small amount of liquid.
The usual initial dose is 5 mg 1 time per day. In the absence of the necessary diuretic effect, the dose is increased approximately twice to obtain an adequate diuretic response.
Determination of the frequency of adverse reactions: very often (> 1/10), often (> 1/100, <1/10), infrequently (> 1/1000, <1/100), rarely (> 1/10 000, <1 / 1000), very rarely (1/10 000, including individual messages); frequency unknown (cannot be estimated based on available data).
Metabolism:infrequently, hypercholesterolemia (increase in blood cholesterol level), hypertriglyceridemia (increase in blood TG level), polydipsia (increased thirst).
Nervous system:often dizzinessheadache, drowsiness; infrequently - muscle cramps of the lower limbs; the frequency is unknown - confusion, fainting, paresthesia in the limbs (feeling of numbness, "crawling goosebumps" and tingling).
Cardiovascular:infrequently - extrasystole (heart rhythm disturbance), tachycardia (increase in heart rate), increased heartbeat, redness of the face; frequency not known - excessive arterial hypotension, deep vein thrombosis (formation of blood clots), thromboembolism, hypovolemia (decrease in BCC).
Respiratory:infrequently - nosebleeds.
Gastrointestinal:often - diarrhea; infrequently - abdominal pain, flatulence; frequency is unknown - nausea, vomiting, loss of appetite, pancreatitis, dyspeptic symptoms.
From the kidneys and urinary tract:often - an increase in the frequency of urination, polyuria (increased urine formation), nocturia (increased urination at night); infrequently - increased urge to urinate; frequency is unknown - urinary retention (in patients with obstruction of the urinary tract), increasing the concentration of urea and creatinine in the blood.
Laboratory values:infrequently - an increase in the number of platelets; frequency is unknown - hyperglycemia, hyperuricemia, hypokalemia, decrease in the number of erythrocytes, leukocytes and platelets, a slight increase in ALP activity in the blood, increased activity of some liver enzymes (for example, GGT), hyponatremia, hypochloremia, metabolic alkalosis.
Special senses: the frequency is unknown - visual impairment, tinnitus and hearing loss (usually reversible).
From the skin:frequency is unknown - pruritus, rash, photosensitization.
Other: infrequently - asthenia (exhaustion), weakness, thirst, hyperactivity, nervousness, fatigue.
If any of the side effects indicated in the instructions are aggravated or any other side effects have been noticed, the patient should inform the physician.
The drug should be used strictly as prescribed by a doctor.
Patients with hypersensitivity to sulfonamides and sulfonylurea derivatives may have a cross-sensitivity to Britomar. In patients, especially at the beginning of treatment with Britomar and the elderly, it is recommended to monitor electrolyte balance, volume and concentration of circulating blood.
With long-term treatment with Britomar, it is recommended to regularly monitor the electrolyte balance (especially potassium levels), glucose, uric acid, creatinine, lipids, and cellular blood components.
Patients receiving Britomar in high doses, in order to avoid the development of hyponatremia and metabolic alkalosis, it is impractical to limit the intake of salt.
The risk of hypokalemia is greatest in patients with cirrhosis of the liver, severe diuresis, with insufficient consumption of electrolytes from food, as well as with simultaneous treatment with corticosteroids or ACTH.
An increased risk of developing disorders of water and electrolyte balance is observed in patients with renal insufficiency.During the course of treatment, it is necessary to periodically monitor the concentration of electrolytes in the blood plasma (including sodium, Calcium, potassium, magnesium), acid-base state, residual nitrogen, creatinine, uric acid and, if necessary, carry out appropriate corrective therapy (with greater frequency in patients with frequent vomiting and parenterally administered fluids).
In patients with advanced water electrolyte disorders, hypovolemia, or prerenal azotemia, laboratory test data may include: hyper or hyponatremia, hyper or hypochloraemia, hyper or hypokalemia, acid-base imbalance, and increased blood urea levels. If these disorders occur, you must stop taking Britomar until normal levels are restored, and then resume treatment with Britomar at a lower dose. When the onset or increase of azotemia and oliguria in patients with severe progressive kidney disease, it is recommended to stop treatment.
The selection of the dosing regimen in patients with ascites on the background of cirrhosis should be carried out in stationary conditions (violations of water and electrolyte balance may lead to the development of hepatic coma). This category of patients shows regular monitoring of plasma electrolytes.
For the prevention of hypokalemia, the use of potassium and potassium-sparing diuretics (primarily spironolactone) is recommended, as well as a diet rich in potassium.
Use of Britomar may cause aggravation of gout.
Patients with diabetes mellitus or with reduced glucose tolerance require periodic monitoring of the concentration of glucose in the blood and urine.
In patients with prostatic hyperplasia, narrowing of the ureters, it is necessary to control diuresis due to the possibility of acute urinary retention.
In patients with diseases of the cardiovascular system, especially those receiving cardiac glycosides, hypokalemia caused by diuretics may cause arrhythmias.
Torsemide increases the toxicity of cardiac glycosides.
When taken simultaneously with mineral and glucocorticoids, laxatives, an increase in potassium excretion is possible.
Torsemide enhances the action of antihypertensive drugs.
Torasemide, especially in high doses, can enhance the nephrotoxic and ototoxic effects of aminoglycosides, antibiotics, platinum drugs (Pt), cephalosporins. Torsemide may enhance the action of curare-like muscle relaxants and theophylline. When using salicylates in high doses, their toxic effects may be enhanced.
Torsemide reduces the effects of hypoglycemic drugs.
Consistent or simultaneous administration of Torsemide with angiotensin-converting enzyme (ACE) inhibitors can lead to a short-term drop in blood pressure. This can be avoided by reducing the initial dose of an ACE inhibitor or by lowering the dose of Torsemide (or temporarily canceling it).
Non-steroidal anti-inflammatory drugs (NSAIDs) and probenecid may decrease the diuretic and hypotensive effects of Torsemide.
Bioavailability and as a result, the effectiveness of Torsemide can be reduced with co-therapy with colestyramine.
Torsemide may increase the toxicity of lithium preparations (Li+) and ototoxicity of ethacripic acid.
In the dark place at a temperature of no higher than 30 ° C. Keep out of the reach of children.