Diuver

Diuver, also known by its international generic name torasemide, is a diuretic medicine used to treat edema associated with heart failure, kidney disease, or liver disease. It belongs to a class of medications called loop diuretics, which help the body get rid of excess water and salts through urine.

Torasemide works by blocking the reabsorption of sodium and chloride in the loop of Henle in the kidneys, resulting in increased urine output. This may help reduce symptoms associated with excess fluid load, such as swelling, shortness of breath, and fatigue.

Diuver is often used when other diuretics, such as furosemide, are ineffective or when a more stable diuretic effect is required. It is important to take this medication under a doctor's supervision because it may affect electrolyte levels and other aspects of health.

Indications Diuvera

1. Heart failure: Diuver is used to reduce symptoms and prevent complications of chronic heart failure by helping to reduce swelling and improve breathing.
2. Edema: It is effective in treating edema associated with cardiac, renal or liver failure by reducing excess accumulated fluid in tissues.
3. Hypertension: Diuver is sometimes used to treat high blood pressure, although this is not the primary indication. It helps control blood pressure by reducing the volume of circulating fluid.

Release form

Diuver is usually available in the form of tablets for oral administration.

Pharmacodynamics

1. Inhibits sodium and chloride reabsorption: Diuver is a potent inhibitor of potassium channels in the apical membrane of the glomerulus, as well as type 2 potassium channels in the vascular epithelium. This leads to an increase in the excretion of sodium and chloride in the urine, which helps to reduce the volume of circulating blood and reduce edema.
2. Reduces calcium reabsorption: Diuver may also reduce calcium reabsorption in the kidneys, which may be useful in treating certain conditions such as calcium oxalate stones.
3. Improves cardiac function: In addition to its diuretic effects, torasemide may also have beneficial effects on cardiac function. This is due to a decrease in the volume of blood that the heart has to pump, which can reduce its workload.
4. Antihypertensive effects: Diuver may also lower blood pressure by reducing blood volume and improving diuresis.

Pharmacokinetics

1. Absorption: It has good and predictable absorption after oral administration. Maximum plasma concentration is usually reached 1-2 hours after administration.
2. Metabolism: metabolized in the liver, mainly with the involvement of cytochrome P450. The main metabolite is torasemide dehydrochloride.
3. Elimination: excreted from the body mainly by the kidneys (about 80-90% as unchanged drug). Its half-life is approximately 3-5 hours, making it longer than some other diuretics.
4. Protein binding: About 95% bound to plasma proteins.
5. Interactions: May interact with other drugs, especially antiarrhythmics, lithium, drugs that affect electrolyte balance such as digoxin or aminoglycosides, and some nonsteroidal anti-inflammatory drugs.

Dosing and administration

1. Dosage: The usual starting dose of Diuver is 5 to 10 mg once daily. In some cases, the dose may be increased to 20 mg per day. However, the recommended dose may vary depending on the patient's condition, severity of the disease and other factors.
2. Dosage: Diuver is usually taken orally, with or without food, depending on your doctor's recommendations. The tablets are swallowed whole and washed down with water.
3. Regularity of use: It is important to follow your doctor’s instructions regarding the regularity of use and dosage of the drug. Do not change the dosage or stop taking it without consulting your doctor.
4. Monitoring: During treatment, it is important to regularly monitor the patient's condition, including blood pressure, kidney function, and blood electrolyte levels.
5. Following other recommendations: Your doctor may also make additional recommendations regarding diet, physical activity, and other aspects of treatment that you should follow for best results.

Use Diuvera during pregnancy

The use of Diuver during pregnancy is not recommended, especially in the first trimester, due to the lack of data on its safety for the fetus and the possibility of negative effects on its development. Torsemide belongs to the class of loop diuretics, which can depress plasma volume and reduce placental blood flow, potentially leading to fetal hypoxia and other adverse effects.

Research has shown that many loop diuretics, including torsemide, should not be used during pregnancy unless there are strict medical indications that outweigh the potential risks to the fetus. A review of the literature did not find an increased risk of adverse effects such as birth defects or fetal growth restriction with diuretic use in utero, but these data did not include specific information for torsemide (Albalas et al., 2009).

Therefore, before using torasemide or other diuretics during pregnancy, you should discuss all potential risks and benefits with your doctor.

Contraindications

1. Anuria is a complete absence of urination, which may indicate severe kidney damage.
2. Severe renal failure (especially if urine production does not occur).
3. Severe disturbances of water-electrolyte balance - torasemide can aggravate the condition associated with a deficiency of substances such as potassium, sodium.
4. Severe hepatic coma or precomatose state.
5. Hypersensitivity to torsemide or other sulfonamides - in case of allergy to sulfonamides, the risk of allergic reactions to torsemide increases.
6. Pregnancy and lactation - the drug may have undesirable effects on the fetus or newborn.

Side effects Diuvera

1. Electrolyte disturbances: Decreased levels of potassium, sodium, magnesium and calcium in the blood, which can lead to muscle cramps, weakness, irregular heartbeat and other serious conditions.
2. Dehydration: Losing too much fluid can lead to dehydration, which can cause dry mouth, fatigue, weakness and dizziness.
3. Kidney problems: In rare cases, torasemide may cause kidney failure or worsening kidney function, especially in patients with pre-existing kidney disease.
4. Hypotension: A drop in blood pressure, especially when standing up (orthostatic hypotension), which can cause dizziness or fainting.
5. Hyperuricemia: Increased levels of uric acid in the blood, which can contribute to the development of gout.
6. Gastrointestinal symptoms: Such as nausea, diarrhea, or constipation.
7. Metabolic changes: Including elevated blood glucose levels, which can be a problem for people with diabetes.
8. Allergic reactions: Rash, itching, or more serious reactions such as angioedema.

Overdose

1. Electrolyte disturbances: Overdose of torasemide can cause significant losses of potassium, sodium and other electrolytes, which can lead to the development of hypokalemia, hyponatremia and other electrolyte disturbances.
2. Dehydration: Excessive diuretic effect of torasemide in overdose can lead to severe dehydration and loss of fluid from the body.
3. Hypotension: Loss of fluid and electrolytes can lead to low blood pressure and hypotension.
4. Kidney failure: With significant overdose, acute kidney failure may occur due to decreased blood flow to the kidneys and tissue damage.

Interactions with other drugs

1. Drugs that affect the cardiovascular system: Torasemide may enhance the effects of other drugs that affect the cardiovascular system, such as antihypertensives or drugs to treat arrhythmia. This may increase the effectiveness of the treatment or may increase side effects.
2. Medicines affecting electrolyte balance: Since torasemide is a diuretic that promotes the excretion of sodium and water from the body, its combination with other drugs affecting electrolyte balance, such as antihypertensives, anticoagulants or drugs affecting potassium, may lead to additional changes in the level of electrolytes in the body.
3. Non-steroidal anti-inflammatory drugs (NSAIDs): Torasemide may increase the toxic effect of non-steroidal anti-inflammatory drugs on the kidneys, especially in patients with pre-existing renal insufficiency.
4. Medicines affecting the endocrine system: Torasemide may interact with drugs affecting the endocrine system, such as glucocorticoids or drugs containing aldosterone, which may lead to additional changes in electrolytes and kidney function.
5. CNS-Acting Drugs: Combining torasemide with drugs that affect the central nervous system (CNS), such as barbiturates or hypnotics, may result in increased sedation.