The question of creating a good diuretic has always been very acute. The vast majority of diuretics have a huge number of side effects, such as furosemide.

Experts from our catalog will be happy to help you

Trifas, which is classified as a long-acting loop diuretic, is the only drug to date with the original active ingredient Torasemide.

The drug is made from a branded substance (Swiss company Roche) and is currently recognized as the most successful development of pharmacologists.

Trifas is the optimal solution for a large list of pathologies associated with the need to take diuretics, including for patients with arterial hypertension.

On our website you can read scientific articles related to complete information about the drug, its pharmacological action, peculiarities of administration. This saves ordinary patients and cardiologists and therapists from searching the web and specialized literature for data. All articles have been prepared for you by pharmacologists.

Japanese Scientists' Research Results - Nippon Yakurigaku Zasshi Magazine

The results of studies carried out in a clinic have shown clear advantages of the drug Trifas in comparison with other diuretics, for example, with the popular furosemide.

Studies have revealed fundamental differences that allow cardiologists to make a choice in most cases in favor of Trifas.

The main advantage of Trifas was the stable bioavailability (not less than 80–90%), which did not decrease in patients with chronic coronary insufficiency. For example, furosemide shows a persistent decrease in bioavailability.

The next important factor is the long-term effect of the drug and the higher diuretic activity in comparison with most of the prescribed diuretics.

Cardiologists and therapists are obliged to proceed when prescribing medications of the two main indicators - the maximum possible therapeutic effect of the drug and the minimum of side effects.

Trifas has, in comparison with other diuretics (furosemide), a significantly lower potassium uretic effect, which is of great importance for patients with heart failure.

Diuretics should not have rebound syndrome. Torasemid developers managed to achieve this quality due to the combination of two factors - duration pharmacological action active substance and antialdosterone activity.

Many diuretics on the market and widely used in medicine for the treatment of hypertension are ototoxic, which makes it impossible to prescribe them to people at risk. Trifas has minimal ototoxicity.

The route of excretion from the body is predominantly hepatic. When using the drug, it is possible to obtain a smooth predictable diuretic effect, which is observed within 10-12 hours after administration.

Researchers' conclusion is unambiguous:

Trifas can be recommended for widespread use, since in terms of its high therapeutic effect and health safety, it has shown clear and undeniable advantages over other prescribed diuretics, in particular, over furosemide.

Trifas can be prescribed to patients with edematous syndromes (detailed information on clinical trials of the drug has been published by Japanese scientists, Nippon yakurigaku zasshi, 2001, August).

Over the years, data were obtained from various researchers, where it is confirmed:

In terms of the strength of the therapeutic effect, the drug Trifas exceeds other popular diuretics (including furosemide) by 2-3-5 times.

Some differences in the data depend on the types and characteristics of pathological processes in the body of a particular patient.

Arterial hypertension and diuretics. When is it worth making a choice in favor of Trifas?

The drug Trifas (Torasemid) is recommended for patients for the treatment of edematous syndrome of various origins, which also distinguishes this particular drug from others. The best result in patients with arterial hypertension was obtained with the use of Trifas.

Patients in Russia, Ukraine, Belarus and Kazakhstan are at risk

Reference. High blood pressure is a major risk factor for the development of a number of serious pathologies and severe coronary diseases, including atherosclerosis, left ventricular hypertrophy, heart failure, ischemia and myocardial infarction, cerebrovascular disease, and renal failure.

Excess blood pressure increases the risks of cerebral stroke and development to significant levels ischemic disease heart several times, and the factor of persistent increase over a long period of time plays a role.

Doctors call specific numbers: high rates blood pressure increase the risk of stroke and heart attack 3-4 times, and the risk of coronary heart disease increases seven (!) and even more times in comparison with those who have blood pressure in the normal range.

It is known that Russia, Belarus, Ukraine and Kazakhstan occupy the sad first places in the frequency of cerebral strokes, heart attacks and cardiovascular mortality in the world.

Experts say that such high numbers are explained by the fact that out of about 12 million Russians and Ukrainians who have been diagnosed with arterial hypertension, only about 15-17% receive adequate complex treatment... This figure refers to large settlements, in the provinces the indicator is even lower and is only about 5-6%.

Arterial hypertension Is the forerunner of all coronary diseases and vascular problems, and the appointment of a good modern diuretic in combination with individually selected drugs for the treatment of specific pathologies, in the overwhelming majority of cases, can preserve health, and even life.

The purpose of taking diuretics is to reduce the risk of complications in cardiovascular pathologies. "Target" level

The ultimate goal of therapeutic measures in the treatment of hypertension is to prevent the development of cardiovascular complications.

And this is an increase in the life expectancy of patients and the quality of their existence. To achieve this goal, the doctor is faced with the task of prescribing antihypertensive therapy to the patient, which will maintain blood pressure at the "target" level.

"Target" level- these are established as a result of randomized clinical research indicators.

reference... Blood pressure at a level not exceeding 140/90 mm Hg is relatively safe for the health of all people. Art. and even lower. With concomitant pathologies (diabetes mellitus, chronic kidney disease), it is recommended to maintain blood pressure values ​​below 130/85–80 mm Hg. For patients suffering from proteinuria (more than one g per day), as well as renal failure, this level should be even less than 125/75 mm Hg. Art.

Physicians and patients should be aware that monotherapy does not work well and cannot be used alone. Thus, the researchers note that a relatively positive result was obtained only in half of the patients who received monotherapy, and these patients were diagnosed with a very moderate increase in blood pressure (about 140-160 / 90-100 and not higher than 160-180 / 100-110 mm mercury column).

Important! The use of antihypertensive therapy alone does not give good indicators of blood pressure reduction. According to Japanese scientists, in about 60% of patients suffering from arterial hypertension and not having concomitant pathologies, for example, diabetes mellitus, and in 52-54% of patients with diabetes mellitus, there was a decrease in blood pressure when taking only one antihypertensive drug.

And this despite the fact that if you take all the existing pathologies of cardio-vascular system, then it is arterial hypertension that is most "provided" from the drug point of view. Despite this, it is precisely the same blood pressure that is the most difficult diagnosis from the point of view of prescribing a particular drug.

We need an individual selection of funds for a specific patient, which must include an effective and safe diuretic agent.

Diuretic tablets "Furosemide" are prescribed to eliminate edema different etiology... it medicine is aimed at removing excess fluid from the body and increasing the production of urine. To avoid undesirable negative consequences during treatment with "Furosemide", it is necessary to take a diuretic as prescribed by a doctor, in strictly prescribed dosages.

"Furosemide" is prescribed for edema of various nature.

"Loop" diuretic "Furosemide" contains the following elements:

furosemide - 40; milk sugar; food emulsifier E572; corn starch.

The diuretic "Furosemide" activates the renal function to excrete a large volume of fluid and salts with urine. This action of the drug allows patients to get rid of edema that has arisen for various reasons. But, unfortunately, together with the excreted urine, potassium and magnesium ions leave the body. That is why specialized experts recommend drinking potassium-saving drugs with "Furosemide". The severity of the diuretic effect of the described drug depends on the dosage that patients take, but in any case, this diuretic is more powerful than thiazide-like diuretics.

After the taken "Furosemide" pill, the diuretic effect appears in the first 60 minutes, and after the injection, the therapeutic effect is observed after 5 minutes. The disadvantage of this medication is the rapid cessation of the diuretic action. Prescribed "Furosemide" for edema of renal and cardiac origin, as well as for edema of hepatic etiology, but only in complex therapy, which includes a potassium-sparing diuretic. Specialists define potassium-sparing diuretics as drugs whose mechanism of action is aimed at preventing the excretion of potassium from the body. It should be borne in mind that the diuretic effect of "Furosemide" under the influence of theophylline decreases, while the effect of theophylline increases, which is dangerous by the development of negative consequences.

Back to the table of contents

You should not use "Furosemide" in patients who have the following pathologies:

oliguria; allergic reactions to the components of the described diuretic; dehydration; hypokalemia; hyponatremia; glomerulonephritis in the acute phase; gout; threat of renal coma; diabetes mellitus; low blood pressure; diarrhea; pancreatitis; impaired urine outflow.

In the course of treatment, data pharmaceutical product often such side effects:

Side effects of "Furosemide" will affect the patient's well-being and heart function. Heart palpitations; dry mouth; nausea; drowsiness; a sharp decrease in urination; dizziness; gagging; weakness; thirst.

Attached to the pharmaceutical product "Furosemide" instructions for use, which indicate the dosage depending on the indications, the severity of the disease, the patient's age and other factors that the doctor takes into account before prescribing the medicine to the patient. For adults, the dosage of the medication in tablet form is 20-80 mg, taken once or divided into several doses per day. The injection dose is 20-240 mg. If necessary, the dosage can be revised by the attending physician and increased.

Back to the table of contents

Drinking "Furosemide" should be in case of edema that has arisen against the background of dysfunction of the heart muscle, cirrhosis, high blood pressure, and renal failure... Taking the diuretic drug "Furosemide", the patient needs to eat properly. V therapeutic diet foods containing large amounts of potassium and magnesium should prevail. Based on this, it is recommended to include dried apricots in the menu, both whole and in the form of compotes. It is useful to combine the described diuretic with baked apples, which, like dried apricots, are able to saturate the body with potassium and magnesium.

Back to the table of contents

To normalize blood pressure, patients often require complex treatment, which includes not only antihypertensive medications, but also diuretics. Effective in the fight against hypertension is "Furosemide". In most cases, it is prescribed at 20-40 mg per day, but at the same time, the dose of other medications taken is reduced by 2 times.

Back to the table of contents

Many people use the described diuretic in the fight against obesity. However, specialized doctors say that it is inappropriate to use "Furosemide for weight loss." Its diuretic effect is aimed at removing excess fluid from the body, which has nothing to do with body fat. This drug with a diuretic effect, which many people mistakenly use to reduce body weight, with prolonged use leads to a loss of strength, low blood pressure, problems with urination and imbalance in water and electrolyte balance in the blood.

Back to the table of contents

Diuretics are used, in particular, "Furosemide" for edematous syndrome caused by renal and hepatic dysfunction. Patients with these pathologies require an individual selection of dosage with its subsequent increase. Such a treatment regimen is used to provide the patient with a gradual loss of fluid. In the first days of therapy for renal dysfunction, the dosage is 40-80 mg per day, which should be drunk once or divided into 2 doses.

In renal pathologies, "Furosemide" with a diuretic effect is used as an additional remedy for the ineffectiveness of aldosterone antagonists. The dosage of the medication is carefully selected for each patient individually to prevent sudden weight loss. On the first day of treatment, fluid loss of up to 0.5 kg of body weight is allowed. Initially, the daily dosage is 20-80 mg.

Back to the table of contents

The diuretic "Furosemide" is not prescribed in tablet form for children under 3 years of age. Starting from the 4th year of life, babies are prescribed 1-2 mg / day. for every kilogram of body weight. For the treatment of edema of various etiologies in children, this diuretic should not exceed the maximum permissible daily dose, which is 6 mg per 1 kg of the child's weight.

Back to the table of contents

During the period of bearing a child, medication is prescribed extremely rarely and only when severe course diseases, since its constituent components, overcoming the placental barrier, affect the fetus. Throughout the entire therapeutic course, doctors monitor the state of the intrauterine fetus. It is categorically contraindicated to self-medicate and take "Furosemide" without the knowledge of the doctor. As studies carried out on animals raised in laboratory conditions have shown, high doses of the drug have a negative effect on the course of pregnancy. You should not use a diuretic medication to eliminate edema during breastfeeding, as it passes through milk and affects the baby. In addition, "Furosemide" suppresses the production of breast milk.

Furosemide- a potent and fast-acting diuretic (diuretic). The most common form of use of the drug is tablets, although Furosemide is also available in the form of a solution for injection.

One tablet of Furosemide contains 40 mg of active ingredient. The daily dose for an adult usually ranges from 20 to 80 mg (half to 2 tablets) per day. In severe cases, the daily dose may be increased to 160 mg (4 tablets) per day.

Furosemide produces a very strong diuretic effect, but magnesium, calcium and, first of all, potassium are excreted from the body along with the liquid. Therefore, when taking Furosemide in a course (more than 1-3 days), it is recommended to take Asparkam or other drugs with it to restore the level of potassium and magnesium in the body.

Insofar as this drug refers to potent drugs, then it should be taken in the minimum dosage that gives desired effect... Furosemide is usually prescribed for edema associated with:

disturbances in the work of the heart; stagnation in the large and small circle of blood circulation; hypertensive crisis; impaired renal function (nephrotic syndrome); liver diseases.

Taking the drug in courses and its intravenous (less often intramuscular) administration should be monitored by a doctor, due to a significant number of side effects, as well as the danger of overdose, which can cause dehydration, impaired cardiac activity, a dangerous decrease in blood pressure and other dangerous consequences.

However, at the same time, Furosemide belongs to non-prescription drugs, is freely sold in pharmacies and is often taken without a doctor's prescription, to relieve puffiness, in the first place - with such a common problem as swelling of the legs.

Swelling of the extremities can be associated with both malfunction internal organs(varicose veins, heart failure, impaired renal function), and with various physical factors(sedentary work, prolonged exertion, temperature changes). In the second case, if the swelling causes discomfort, Furosemide can be used to relieve it if there are no side effects. You need to take the drug in the minimum dosage, no more than 1 tablet, 1-2 times. If the swelling does not disappear, then further taking Furosemide without medical advice may be unsafe.

The maximum effect after taking Furosemide is observed after 1.5-2 hours, and in general, the duration of one tablet is about 3 hours.

Furosemide is usually taken once a day on an empty stomach. If the indications require a large dosage of the drug, that is, more than 2 tablets, then it is taken in 2 or 3 doses.

With long-term treatment, how many days to take Furosemide is determined by the doctor, and you can take it on your own for 1, maximum - 2 days, and no more than once every 7-10 days.

Furosemide is a potent diuretic. It is taken to reduce edema caused by heart or kidney failure, cirrhosis of the liver, and other causes. It is also sometimes prescribed for high blood pressure. Below you will find instructions for use, written in clear language. Review the indications, contraindications and side effects. Find out how to take furosemide: how many times a day, in what dosage, before or after meals, for how many days in a row. The article describes in detail how to be treated with furosemide for edema and high blood pressure. Understand which is better: furosemide or torasemide, why sometimes furosemide is prescribed together with the drugs Veroshpiron and Diacarb. Read about the side effects of taking furosemide for weight loss, whether this drug is compatible with alcohol.

How to take furosemide

Take furosemide as directed by your doctor. He must select the dosage and indicate how many times a day you need to take this medicine. As a rule, with edema caused by various reasons, the diuretic should be drunk 1 or 2 times a day. For the daily treatment of hypertension, this drug is prescribed to be taken 2 times a day. For details on the use of furosemide for hypertension and edema, read below.

Many patients are interested in how many days in a row furosemide can be taken. This should only be decided by the attending physician. Do not prescribe or discontinue diuretics on your own. Many people, especially women, more or less often take furosemide for edema, instead of trying to eliminate its causes. You can easily find frightening descriptions of severe side effects on Russian-language sites that self-medication with diuretics for edema leads to.

The official instructions for use do not indicate whether furosemide should be taken before or after meals. An English-language article states that taking furosemide after meals significantly reduces its effectiveness. Typically, doctors prescribe this medication on an empty stomach, at least 20-30 minutes before a meal. Your doctor may prescribe you to take Furosemide after meals for some reason. In this case, follow its instructions.

Below are the answers to questions that often arise in patients about the use of the diuretic drug furosemide.

Can furosemide be drunk every day?

Furosemide is taken every day as prescribed by a doctor by people whose liver cirrhosis is complicated by ascites - the accumulation of fluid in abdominal cavity... Previously, this drug was prescribed for daily use in patients with heart failure and hypertension. Now new drug torasemide (Diuver) displaces furosemide in the treatment of heart failure. Why torasemide is better is described in detail below. If you are taking furosemide every day for heart failure, discuss with your doctor whether it is worth replacing it with torasemide.

For hypertension, daily furosemide is best avoided, like any other loop diuretics. These medications cause too many side effects. Use pressure pills that work more gently. See your doctor for a medication regimen that will keep your hypertension under control without compromising your well-being and test results. Some people occasionally drink furosemide when they have a hypertensive crisis. It is better, instead, to properly treat hypertension so that there are no pressure surges at all. Do not take furosemide daily for weight loss or edema! This can cause monstrous side effects. They are vividly described by many sites and forums in Russian.

Can I drink this medicine at night?

As a rule, doctors prescribe to drink furosemide in the morning or at lunchtime, and not at night, so that the patient does not have to go to the toilet too often at night. For some reason, your doctor may tell you to take furosemide at night. In this case, follow its instructions. Many people have voluntarily tried drinking this diuretic at night to avoid swelling and look good the next morning. Russian-language sites and forums are replete with eerie descriptions of the side effects that such self-medication leads to. The authors of numerous frightening stories about the side effects of furosemide are not exaggerating in the least.

Are furosemide and alcohol compatible?

Alcohol increases the frequency and severity of furosemide side effects. If you use a diuretic and alcohol at the same time, then blood pressure may drop too much. Symptoms of this: headache, dizziness, fainting, palpitations. Furosemide often causes orthostatic hypotension - dizziness when standing up suddenly from a sitting or lying position. Alcohol can increase this side effect. Alcohol dehydrates the body and removes useful minerals, just like diuretics. Furosemide should be taken only for severe illnesses in which the use of alcohol is completely prohibited. Even a small dose of alcohol will be harmful to you. For mild illnesses that allow moderate alcohol consumption, try replacing the loop diuretic with a more benign drug or no medication altogether.

How to take furosemide and Asparkam together?

Take furosemide and Asparkam together only as directed by your doctor, regularly having blood tests for potassium. Furosemide deprives the body of a valuable electrolyte - potassium. Asparkam and Panangin tablets replenish potassium reserves. Talk with your doctor if you need to take furosemide and Asparkam at the same time. Do not do this on your own initiative. Asparkam has contraindications. Study them before using this remedy. Take both drugs at the dosage your doctor tells you and as many times a day as he or she prescribes.

Why does furosemide not work? The patient's edema does not diminish.

No more shortness of breath, headaches, pressure surges and other symptoms of HYPERTENSION! Our readers are already using this method to treat pressure.

To learn more…

Furosemide is only a temporary solution to the problem of edema. It does not affect their cause, and sometimes even aggravates it. If it is not possible to eliminate the cause, then over time, even potent diuretics cease to work. Perhaps the patient's kidneys have become so bad that the body has stopped responding to the diuretic medication. In such situations, you cannot arbitrarily increase the dose of furosemide or change it to another diuretic. Talk to your doctor about what to do.

How to restore kidney function after treatment with furosemide?

To find out how furosemide affected the kidneys, ask what the glomerular filtration rate (creatinine clearance) is, and then take a blood test for creatinine. Learn and follow the rules of preparation for this analysis to get an accurate result. Creatinine clearance is the main indicator by which one can judge whether the kidneys are working well in a person.

It is rare that the unauthorized use of one or more furosemide tablets irreversibly damaged the kidneys. Chances are, your well-being and kidney function will return to normal soon after you stop taking the diuretic medication. If you have experienced unpleasant side effects, then this will serve as a lesson: you cannot take strong drugs on your own initiative.

Unfortunately, for people who develop kidney failure, there is no easy solution to this problem. Furosemide damages the kidneys. But if the swelling is so strong that it is impossible to endure them, then you have to use this remedy, despite the side effects. Follow your doctor's instructions on diet and medication to delay the moment your kidneys fail completely. No effective folk treatment renal failure does not exist. Diabetes patients should read the article "Diet for the kidneys in diabetes".

Torasemide or furosemide: which is better?

Torasemide is better than furosemide for treating heart failure. Both of these drugs are loop diuretics. Torasemide was invented 20 years later than furosemide, in 1988. In Russian-speaking countries, the first drug torasemide was registered in 2006.

Torasemide acts more smoothly and longer than furosemide and is considered a safer drug. A possible side effect of loop diuretics is a decrease in blood potassium levels in patients. Torasemide causes it less often. Sometimes torasemide is prescribed to patients in the late stages of renal failure, when furosemide can no longer be taken. After the accepted dose of furosemide has finished acting, the excretion of salt in the urine can be significantly reduced due to the "rebound effect". Torasemide does not have this problem.

If you are taking furosemide for edema in heart failure, talk to your doctor about torasemide (Diuver). The authors of articles in medical journals argue that in patients with hypertension, torasemide does not affect blood sugar and uric acid levels, unlike furosemide. Do not trust this information too much. People with high blood pressure may be better off taking safer medicines every day than the loop diuretics furosemide and torasemide.

Torasemide is probably as good as furosemide for treating fluid accumulation in the abdominal cavity (ascites) caused by liver cirrhosis. See, for example, the article "Torasemide versus furosemide in cirrhosis: a long-term, double-blind, randomized clinical study" by Fiaccadori F., Pedretti G., Pasetti G. et al in The Clinical Investigator, 1993. Nevertheless, until now, in severe liver diseases, furosemide is prescribed many times more often than torasemide. Usually, with cirrhosis of the liver, patients take simultaneously a loop diuretic and Veroshpiron (spironolactone).

Furosemide or Veroshpiron: which is better? Can I take it together?

Many patients are interested in which medicine is better: furosemide or Veroshpiron? You can't put the question like that, because these are completely different medicines. They are prescribed for different purposes. Therefore, it cannot be said that furosemide is better than Veroshpiron, or vice versa. Sometimes patients have to take both of these drugs at the same time. Furosemide is a powerful diuretic drug that belongs to loop diuretics. It stimulates the elimination of fluid and salt from the body. The effect is quick and strong, though not long lasting. While the kidneys of the patient can still react to diuretics, this medicine is good for edema. Veroshpiron has a weak diuretic effect. But it improves the results of treatment with furosemide and reduces the risk of a side effect - potassium deficiency in the body.

Diuver (torasemide) and its analogues have replaced furosemide in the treatment of heart failure. Because torasemide works better and has fewer side effects. However, furosemide remains a popular treatment for ascites (fluid accumulation in the abdomen) caused by cirrhosis. In severe liver diseases, patients are often prescribed furosemide and Veroshpiron together. Usually they start with a dosage of 100 mg of Veroshpiron and 40 mg of furosemide per day. If this dosage does not help enough, it is increased after 3-5 days. At the same time, the ratio of Veroshpiron and furosemide preparations is maintained at 100: 40 to maintain the optimal level of potassium in the blood.

Patients should avoid the use of furosemide at high blood pressure, except in the most severe cases. This medication has serious side effects when taken daily to treat high blood pressure. It removes potassium and magnesium from the body, which negatively affects the well-being of patients. Also, furosemide accelerates the development of diabetes and gout. If the patient with hypertension already has diabetes or gout, then taking a potent diuretic will worsen his condition.

Furosemide with increased pressure for daily administration is prescribed to severe patients who are no longer helped by thiazide and thiazide-like diuretics - Hypothiazide, Indapamide and their analogues. With hypertensive crises, this medicine can be taken occasionally, but only as directed by a doctor. Study the article "Hypertensive Crisis: Emergency Care". Furosemide and other diuretics are not the best choice when you need to quickly stop a hypertensive crisis. Use less harmful medicines for this. Talk to your doctor about which blood pressure pills you should take each day. The doctor will likely prescribe combination drugs that contain diuretics but not potent loop diuretics.

Furosemide helps with edema because it stimulates the kidneys to remove salt and fluid from the body. Unfortunately, this medicine does not eliminate the causes of edema, and sometimes even aggravates them. Typically, swelling is caused by heart failure, kidney or liver disease, and vascular problems in the legs. It is necessary to take measures to eliminate the cause of the edema, and not only to muffle their symptoms with furosemide. Taking diuretics for edema without permission can get you into trouble. Furosemide is a powerful drug that causes serious side effects. It is possible that it will permanently damage the kidneys.

If you regularly have swelling, then do not ignore them, but see your doctor as soon as possible. Get a medical examination to determine the cause. The diseases listed above respond well to treatment for early stages... Potent diuretic drugs are prescribed as symptomatic treatment in severe cases, when time is lost and it is no longer possible to act on the underlying disease. Furosemide for edema sometimes helps even patients who are already useless to take thiazide diuretics (Hypothiazide and its analogues).

• Category:

The main drugs are hypothiazide, furosemide, ethacrynic acid.

Individual therapeutic doses vary widely: for example, the dose of hypothiazide

ranges from 25 mg 1-2 times a week to 200 ml daily. The drugs are prescribed

in 1-2 doses, usually in the morning and afternoon. Thiazide diuretics (hypothiazide,

brinaldix) is prescribed in combination with veroshpiron, which provides

potassium-saving action. The action of veroshpiron appears on the 3-4th day

use, therefore it should be prescribed a few days before the start of treatment

the main diuretic. The average dose of hypothiazide is mg per day,

brinaldix-mg per day. With significant edema, furosemide is used in

tablets (40 mg per dose, on an empty stomach) or uregit (0.05 g) in the background

preliminary intake of veroshpiron (in tablets of 25 mg) - 150-250 mg per

day. A clear diuretic effect is achieved using combined

diuretics - triampura (a combination of the potassium-sparing drug triamterene and

hypothiazide), similar in action to brinerdine, cristepine. To receive

rapid diuretic effect (with acute left ventricular failure)

lasix (furosemide) is prescribed intravenously (20-60 mg).

All diuretics, and hypothiazide the most, cause loss

potassium. This negatively affects myocardial metabolism and contributes to

breaking heart rate... Therefore, when treated with diuretics

you need a diet enriched with potassium (dried apricots, raisins, baked potatoes,

peeled potatoes (in their skins), bananas). In addition, appoint

potassium preparations (panangin, asparkam, potassium chloride) after meals.

With insufficient therapeutic effect diuretic drugs

it is advisable to prescribe them in various combinations (hypothiazide with furosemide,

furosemide with uregite, furosemide with fonurite).

http://spbrentacar.ru/ car rental: a large selection of cars for rent.

Treatment with diuretic drugs is also used during the period

compensation, but in small, maintenance doses, under constant control with

The best diuretics according to customer reviews

Diuretics are widely used in medicine to treat many diseases. The main purpose of these drugs is to remove excess fluid, chemicals, salts that have accumulated in the walls of blood vessels or tissues from the body. The drugs are classified into several main groups, which differ in their mechanism, speed, strength and duration of action. This article discusses the best drugs in each group, their areas of application, the advantages and disadvantages of a single drug.

Which diuretic company to choose

As a rule, quality medicines are produced by the largest pharmaceutical companies. Leaders in the production of high-quality medical products have large-scale production, powerful scientific and technical potential and, of course, consumer confidence, which leads to high sales.

Be sure to check with the manufacturer to get a safe and effective diuretic.

Medicines from these brands are widespread and you can easily find them in almost every pharmacy.

The best diuretics of the saluretic group

Saluretics are thiazide derivatives. These synthetic diuretics have a long-term hypotensive effect. Main feature saluretics is an increase in the excretion of sodium ions from the body and, to a lesser extent, potassium ions.

Furosemide

It is a potent diuretic. It is used for the accelerated elimination of puffiness of various origins, to reduce pressure. The medicine is used as needed. The drug is not suitable for long-term use. Active ingredient, furosemide, reduces the tone of venous vessels, reduces the volume of intercellular fluid and circulating blood, which leads to a decrease in blood pressure. After intravenous administration, the effect occurs in a few minutes, after taking the pills - in an hour. Release form: granules for suspensions, tablets, solution.

• has a pronounced natriuretic, chloruretic action;
• reduces stress on the heart;
• low cost;
• the duration of the effect is up to 6 hours;
• helps to quickly get rid of excess fluid that causes puffiness.

• adverse reactions of the body after taking: allergies, disruption of the nervous system, cardiovascular, sensory organs, etc.;
• reduces the amount of potassium in the body;
• contraindications: diabetes, gout, renal failure, glomerulonephritis, pancreatitis, hypersensitivity, etc.

Bumetanide

It is a potent diuretic. It is used for edema of various origins, late toxicosis, liver cirrhosis, arterial hypertension. It is recommended for people for whom high doses of Furosemide do not bring the expected drug result. The active substance, bumetamide, interferes with the reabsorption of chloride and sodium ions; increases the excretion of magnesium, calcium, potassium ions. It is prescribed by injection or by mouth.

• unlike Furosemide, it is absorbed much faster and almost completely, this causes a more powerful effect of Bumetanide;
• the maximum effect of a diuretic develops after a quarter of an hour;
• effectively reduces puffiness.

• short action;
• the drug lowers blood pressure, therefore it is not recommended for people with hypotension;
• long-term use is prohibited;
• removes calcium, potassium, magnesium in the urine;
• adverse reactions: dizziness, loss of energy, hyponatremia, hypokalemia, dehydration, abdominal pain, nausea, etc.;
• contraindications: hypersensitivity, age after 60 years, renal coma, acute hepatitis, gout, etc.

Indapamide

It has an average strength of hypotensive and diuretic action. Main component, indapamide, is a sulfonylurea derivative. Acts in the vessels and tissues of the kidneys: changes the permeability of membranes for calcium, dilates arterioles, reduces the contractility of vascular smooth muscle cells. In the tissues of the kidneys, the drug reduces sodium reabsorption, increases the excretion of potassium, magnesium, chlorine with urine, which contributes to the formation of a larger volume of urine. Available in capsules and tablets.

• reduces the overall cardiac load;
• the duration of the effect is up to 24 hours;
• long-term admission is allowed;
• helps to reduce edema of various origins;
• low price.

• adverse reactions: dehydration, constipation, abdominal discomfort, blurred vision, cough, allergies;
• removes magnesium and potassium from the body;
• promotes a moderate decrease in blood pressure, therefore it is not recommended for people suffering from hypotension;
• contraindications: hypokalemia, decompensation of liver function, anuria, pregnancy, lactation.

Torasemid

It is a mild diuretic. Used for swelling caused by heart failure, high blood pressure. The active ingredient is torasemide. The duration of treatment depends on the course of the disease. The maximum diuretic effect occurs several hours after application. Dosage form: tablets.

• enhances diuresis;
• has a moderate anti-edema effect;
• duration of action up to 18 hours;
• the drug is allowed to be taken until the puffiness disappears completely;
• well absorbed in the digestive tract;
• gradually eliminates fluid retention in the body.

• the drug has some hypotensive effect, therefore it is not recommended for persons suffering from low blood pressure;
• reduces the amount of potassium in the blood, but to a lesser extent than Furosemide;
• side reactions: an increase in certain liver enzymes, urea, creatine in the blood; violation of the digestive tract; disorders of the nervous system;
• contraindications: hypersensitivity to the components of the diuretic, precoma or coma of the liver, arrhythmia.

The best diuretics of the potassium-sparing diuretic group

Medicines provoke an accelerated excretion of sodium, but at the same time block the excretion of potassium. Distinctive feature- there is practically no toxicity. This group of drugs is often prescribed for patients with edema caused by heart failure.

Triamteren

It is a mild diuretic. It is used for edema of various origins, high blood pressure, signs of liver cirrhosis. The active ingredient, triamterene, inhibits the secretion of potassium that forms in the distal tubules. The maximum effect of the intake occurs 2 hours after application. Dosage form: powder, capsules.

• admission to children is allowed, according to the dosage regimen;
• increases sodium excretion without affecting potassium content;
• long-term admission is allowed;
• if necessary, it is allowed to increase the dosage, but not exceed the daily rate of 30 g;
• increases the concentration of potassium in the blood;
• duration of action up to 12 hours;
• effectively removes excess fluid from the body, which helps to reduce edema.

• adverse reactions of the body: dehydration, hyponatremia, dyspeptic symptoms, etc.;
• contraindications: lactation, hypersensitivity, renal or hepatic failure;
• the drug is poorly soluble, sometimes sediment in the urine, this can lead to the appearance of kidney stones.

Amiloride

This drug is a diuretic with a weak but long-lasting effect. Used with high blood pressure as a diuretic; with swelling caused by heart failure or nephrotic pathology. The active ingredient, amiloride, acts on the distal region of the renal tubules, increases the excretion of sodium and chlorine. The effect of the application comes in a few hours. Dosage form: tablets.

• the effect of the drug can last up to 24 hours;
• in combination with other diuretics, reduces the risk of hypokalemia, hypomagnesemia;
• reduces the excretion of potassium;
• well absorbed by the liver and kidneys;
• a mild hypotensive effect helps to normalize blood pressure in people with hypertension;
• long-term admission is allowed.

• rarely, the following side reactions appear from the intake: disruption of the gastrointestinal tract, fatigue;
• the drug can lead to excessive accumulation of potassium, therefore, when long-term use it is necessary to periodically donate blood and check the amount of mineral in the body;
• contraindications: increased content of potassium in the body, hypersensitivity, impaired renal function.

The best diuretic in the group of osmotic diuretics

Medicines of this group increase the osmotic pressure in the blood plasma, increase its circulation and prevent the reabsorption of fluid. Osmotic diuretics are potent drugs and are prescribed as part of the complex therapy of acute conditions.

Mannitol

It has a strong diuretic effect. Applied for acute edematous conditions. The active ingredient, mannitol, increases plasma pressure, inhibits reabsorption, retains fluid, and increases the amount of urine. Water moves from tissues to the vascular bed, which leads to an enhanced diuretic effect. Dosage form: solution in ampoules.

• strong diuretic effect;
• low cost;
• reduces puffiness;
• removes a large volume of liquid with a high sodium content and a small amount of potassium;
• does not increase the levels of residual nitrogen in the blood.

• contraindications: hypochloremia, hypersensitivity, hyponatremia, hemorrhagic stroke, etc.;
• a doctor's prescription is required;
• adverse events at high dosages: dehydration, dyspeptic disorders, hallucinations.

What diuretic to buy

1. If you need a drug that will help you quickly get rid of edema and excess fluid in the body, it is better to purchase Furosemide.

2. If Furosemide did not give the expected result, then Bumetanide will do, the latter is almost 2 times more powerful, but it is worth remembering that the medicine washes out minerals from the bone tissue.

3. If you need a drug with a moderate diuretic effect, it is better to purchase Triamteren. In addition, the drug does not reduce the potassium content in the body.

4. In acute and critical conditions, accompanied by edema of various origins, an osmotic diuretic is required - Mannitol.

5. If available chronic diseases, as well as for the prevention of crises, diuretics of weak and moderate action are needed: Indapamide, Torasemide.

6. If you need a potassium-sparing diuretic with a mild, long-lasting effect, amiloride is the best choice.

/ URINE

URINE (DIURETIC) DRUGS

They enhance the excretion of salts and water by the kidneys, and thus eliminate edema or accelerate the excretion of chemicals from the body in case of poisoning.

They are used for hypertension, edema. It is impossible - in case of obstruction urinary tract(stones in the kidneys and ureters).

CLASSIFICATION BY POWER OF DIURETIC ACTION

1. "Powerful" or strong diuretics: mannitol (mannitol), furosemide (lasix), bumetanide (bufenox), ethacrynic acid (uregit).

2. Moderate to moderate strength: hydrochlorothiazide (hypothiazide), cyclomethiazide, chlorthalidone (oxodoline), clopamide (brinaldix), indapamide (arifone).

3. Weak diuretics: acetazolamide (diacarb), spironolactone (verospiron), triamterene, amiloride.

4. Vegetable diuretics: bearberry leaf, lingonberry, kidney tea, juniper fruits, field horsetail herb, blue cornflower flowers, birch buds.

CLASSIFICATION OF URINE PREFERREDLY

INFLUENCE ON THE DEPARTMENTS OF NEFRON

I. Diuretics with a predominant effect on the glomerulus are xanthine derivatives.

Euphillin - The diuretic effect is associated with improved renal blood flow and increased glomerular filtration rate when fluid is retained as a result of heart failure. For a diuretic effect, 1-2 ml of 24% solution or 5-10 ml of 2.4% solution is injected intramuscularly.

II. Diuretics with a predominant effect on the proximal tubules.

1. Osmotic diuretics (lures, urea) are metabolically inert substances. Mechanism of action: Introduce intravenous hypertonic solutions of these substances (solutions of urea 30%, mannitol - 10-20%). At the same time, the osmotic pressure of blood plasma increases and fluid from the tissues passes into the blood. Dehydration (dehydration) of tissues occurs. In the kidneys, urea and mannitol are not reabsorbed, and are almost completely excreted in the urine, entraining water and Na +. Contraindicated in violation of renal excretory function, urinary tract obstruction. Urea should not be prescribed for liver and cardiovascular insufficiency.

MANNIT (mannitol) - refers to a strong diuretic. It is used in emergency care:

Dehydration therapy for cerebral edema;

Acute renal failure

Forced diuresis in case of poisoning;

Relief of an acute attack of glaucoma.

The diuretic effect is manifested in a minute, the maximum - in a minute, the duration of action is 4-5 hours.

EF: vial 30.0 of the drug; amp 200 and 400 ml 15% solution.

UREA (UREA PURA) is a strong diuretic. Application: dehydration therapy for cerebral edema and reduction intraocular pressure... Better mannitol penetrates tissue, adduction can cause hydration of the brain and increase intracranial pressure. Duration of action is 12 hours.

EF: 90 g of a sterile preparation with the addition of 10% glucose solution (-225 ml) for the preparation of 30% solution.

2. Carbonic anhydrase inhibitors.

DIAKARB (fonurite) is a saluretic, an inhibitor of carbonic anhydrase, an enzyme involved in the hydration of carbonic acid. In the epithelium of the renal tubules, diacarb blocks carbonic anhydrase, therefore, the formation of carbonic acid is inhibited, followed by its dissociation and the release of hydrogen ions. The reabsorption of sodium ions decreases, because there is no exchange with Н + and НСО3-. The excretion of sodium and potassium ions is increased. Sodium is excreted with water in the form of bicarbonates. At the same time, inhibition of extrarenal carbonic anhydrase contained in various tissues occurs: in the ciliary body of the eye (as a result, the formation intraocular fluid); in the brain and its membranes (as a result, the production of cerebrospinal fluid, drowsiness may occur); in the gastric mucosa (as a result, the secretion of gastric juice decreases); in erythrocytes ( hemolytic anemia). Side effect:

After 1-2 days, it causes acidosis associated with the depletion of sodium ion reserves, therefore, it is prescribed with a break of 1-3 days or alternated with diuretics that cause alkalosis;

Application: glaucoma, epilepsy, barbiturate poisoning.

Contraindications: urinary tract obstruction, tendency to acidosis, Addison's disease, diabetes mellitus, liver damage.

III. Diuretics acting on the ascending part of Henle's loop (loop diuretics).

Powerful, strong diuretics, significantly remove salts, incl. ions of sodium, potassium, calcium, magnesium and chlorine, therefore saluretics are called.

The main side effect: alkalosis and hypokalemia, its prevention consists in the simultaneous administration of potassium preparations (potassium chloride, asparkam, panangin). Dyspepsia, hyponatremia, lack of calcium and magnesium ions, hyperglycemia, impaired renal function (irreversible changes in the epithelium of the renal tubules), and hearing impairment also occur.

A) emergency care in a hospital (i / v or i / m furosemide or bufenox) for acute renal failure, pulmonary edema, hypertensive crisis, acute heart failure, cerebral edema, glaucomatous crisis, acute poisoning with technical fluids, poisons, medicinal substances;

B) treatment of chronic patients: edema of various origins, hypertension, chronic heart failure, in contrast to hypothiazide - chronic renal failure.

Contraindications: urinary tract obstruction, hypokalemia, diabetes mellitus, Addison's disease, liver damage, torasemide is also contraindicated in case of hypersensitivity to sulfonamides, pregnancy, lactation, persons whose work requires an increased physical and mental reaction.

FUROSEMIDE (lasix) - one of the most active, fast and short active drugs... Unlike hypothiazide, it enhances the excretion of calcium from the body.

EF tab 0.04 and solution 1%, 2 ml each. When taken orally, the action occurs after a minute and lasts 3-4 hours, when administered intravenously, it acts after 3-4 minutes and within 1.5-2 hours.

Combined drug furesis (furosemide + triamterene).

TORASEMIDE (diuver) - less than furosemide causes potassium, but more active and lasting longer. F.V. tab 0.005 and 0.01 once, after meals.

BUMETANIDE (bufenox) - tab 0.001 and solution 0.025%, 2 ml each.

BRINALDIX (clopamide) - combination drug brinerdin.

K-TA ETAKRINOVA (uregit) - in the treatment of chronic patients with edema of various origins, one or more courses are prescribed for 3-5 days, with interruptions for normalization electrolyte balance, then switch to milder-acting diuretics. Tab 0.05 - taken in the morning, after meals.

IV.Diuretics. acting on the initial part of the distal tubule - this group includes most modern diuretics, saluretics.

Mechanism of action: enhance the excretion of potassium, sodium, chlorine, magnesium ions from the body. They reduce the excretion of calcium and uric acid ions in the urine, therefore, increase their content in the blood.

It is used orally for long-term treatment of various chronic diseases: hypertension, edema associated with kidney disease and cardiovascular failure, toxicosis of pregnant women, diabetes insipidus, glaucoma. Assign inside in the morning before meals.

DICHLOTHIAZIDE (hypothiazide) - a medium-strength thiazide diuretic, unlike furosemide, reduces the excretion of calcium in the urine and should not be prescribed for renal failure. The action develops in 1-2 hours and lasts an hour.

Hypokalemia (prevention: taking potassium supplements);

Exacerbation of gout (reduces the production of uric acid);

Exacerbation of diabetes mellitus (increases blood sugar);

Increases blood cholesterol levels;

Fatigue, weakness, hypotension;

EF tab 0.025 and 0.1.

trirezide-K (reserpine + dihydralazine + hydrochlorothiazide + potassium chloride), moduretic (amiloride + hypothiazide),

triampur-compositum (triamterene + hydrochlorothiazide),

INDAPAMID (arifon) - the main application - hypertension and edema in heart failure. PV tab and caps 0.0025; tab-retard 0.00125 (1.25 mg).

CYCLOMETHIAZIDE is a thiazide diuretic, chemical structure and properties close to hypothiazide, but 50 times more active. Tab 0.0005.

CHLORTALIDONE (oxodoline) - longer action than hypothiazide - up to a day or more, tab 0.05 and 0.1.

V. Diuretics with a predominant effect in the region of the distal tubules and collecting ducts (potassium-sparing).

1. Competitive antagonists aldosterone. Aldosterone is a hormone of the adrenal cortex. Reduces the release of sodium ions and increases the release of potassium ions in the renal tubules. An increase in the concentration of aldosterone leads to the development of edema. This occurs with congestion in the liver in chronic heart failure, when the inactivation of aldosterone in the liver is impaired.

SPIRONOLACTONE (veroshpiron) is an aldosterone antagonist. Eliminates the influence of aldosterone. Works only with aldosteronism. Promotes the elimination of sodium, chlorine and water ions. Reduces the excretion of potassium ions, their concentration in the blood increases (potassium-sparing diuretic). Acid-base balance does not violate. Does not cause the accumulation of uric acid in the body. The effect develops slowly: 1-2 days after the start of the drug, the duration of action is 2-3 days, after stopping the drug for 2-3 days, a weak diuretic effect remains.

Application: edema associated with the accumulation of aldosterone (GB, chronic heart failure). Because itself is inactive, it is prescribed with other diuretics to prevent hypokalemia. Contraindications: kidney disease, first trimester of pregnancy. Side effects: hyperkalemia (not possible with potassium preparations), hypernatremia, nausea, drowsiness, skin rash, gynecomastia (reversible). EF tab 0.025.

2. Blockers of sodium channels. They block sodium channels in the collecting ducts, impair the reabsorption of sodium and chlorine ions and are excreted in the urine. Retain potassium in the body, reduce the release of hydrogen and magnesium ions, like veroshpiron. The effect comes in 1-2 hours, it lasts an hour. Potassium-sparing diuretics reduce the toxicity of cardiac glycosides. Often used with other more potent diuretics to reduce dosages and side effects (see combination drugs). Independent use: GB, chronic heart failure, edema of pregnant women. Side effects: hyperkalemia, dyspepsia, azotemia.

TRIAMTERENE - caps 0.05; the combined preparation triampur-compositum.

AMILORIDE - tab 0.005; combined drug moduretic.

To continue downloading, you need to collect a picture:

Hypothiazide is a diuretic

Leave a comment 1,163

Quite often, specialists are prescribed diuretic tablets "Hypothiazid". This is because they not only help to remove excess fluid from the body, but also help prevent the development of stone disease. In addition, the drug eliminates edema caused by various malfunctions in the body.

Dosage form and packaging

"Hypothiazide" is available in the form of tablets. In color, they are either pure white or beige. On one side of the tablet there is always an engraving "H", and on the other there is a line in the form of a depression that goes through the center. There are two options for release - 0.025 and 0.1 grams of active ingredient. Sold by 20 tablets in a carton box.

The composition of the diuretic "Hypothiazide"

The main effect is exerted by the substance hydrochlorothiazide. Its content in 1 tablet is 25 or 1 milligram. Also, the preparation contains additional substances. First of all, it is magnesium stearate, which acts as a dietary supplement based on fatty acids... Talc and starch provide glide. Gelatin has a binding effect. Lactose monohydrate is used as a sweetener.

Pharmacology

This remedy has a diuretic effect. This effect is achieved due to the excretion of sodium and chlorine from the kidneys. The action of the tablets begins 1-2 hours after ingestion. In addition, it is prescribed to reduce blood pressure. Gynecologists sometimes ascribe the diuretic "Hypothiazide" to pregnant women with severe toxicosis. The diuretic effect on the body is not reduced by prolonged use.

Indications

The main indications include high blood pressure. Moreover, it can be used in combination with other drugs. Also, "Hypothiazide" is used for edema, which are the result of various diseases. It is effective with increased urination and as a prophylaxis urolithiasis... Less commonly, it is prescribed for cirrhosis of the liver and chronic kidney disease.

Contraindications

"Hypothiazide" diuretic has a number of contraindications. First of all, it is an individual sensitivity to the constituent components of the drug. Also, do not prescribe a remedy for violations of the flow of urine. Severe forms of renal and hepatic failure are the reason for the withdrawal of the diuretic. In addition, for high level potassium, sodium and magnesium in the body, the drug is contraindicated. The same applies to patients with Addison's disease.

Side effects

The wrong way of using "Hypothiazide" or the use with existing contraindications can provoke a number of side effects. So, from the side gastrointestinal tract it can be diarrhea, constipation, or the development of pancreatitis. From the side of the heart, arrhythmia is possible. Other side effects include dizziness, nausea that turns into vomiting, dry mouth, hives, and muscle cramps.

Overdose

An incorrectly selected dosage or regimen of administration leads to an abundant excretion of fluid from the body. This is fraught with a sharp drop in blood pressure and tachycardia; lack of urination or disturbances in this process; vomiting, which leads to thirst. There are no means for removing hydrochlorothiazide from the body. Therefore, gastric lavage in conjunction with the intake of activated charcoal or other sorbent can help.

Method of administration and dosage

You need to take the tablets after meals with a moderate amount of liquid. The following are the average dosages of the drug for adults:

1. In the case of increased pressure, 25-50 mg of the active substance is assigned at a time. The daily rate is no more than 100 mg. The duration of the course is 3 weeks.
2. In case of application for edema, the dose is 25-100 mg of the substance. Consume once a day or every 2 days.
3. For diabetes insipidus, take 50-150 mg per day.

When prescribing the drug to children, the pediatrician calculates the dose based on 1-2 mg per kilogram of the child's weight.

special instructions

When using "Hypothiazide" for a long time, the doctor must carefully monitor the water-electrolyte level in the body. Symptoms of imbalance are weakness, dry mouth, nausea, and others. There may also be violations of the parathyroid glands. It is necessary to take the remedy with caution for people sensitive to lactose. Otherwise, disturbances from the gastrointestinal tract are possible. At the beginning of the appointment, you need to drive the car with caution.

Interaction

Use with caution together with drugs to lower blood pressure and heart medications. Reception together with drugs for normalizing blood sugar levels is undesirable, since their effectiveness drops sharply. The same goes for barbiturates. Laboratory tests can show a decrease in iodine levels in the body or an increase in bilirubin in the blood. For the accuracy of studies, the drug should be canceled.

Storage and shelf life

Store the drug in a dark place out of the reach of children, at a temperature not exceeding 25 degrees. The expiration date is indicated on the packaging and is 5 years from the date of production. After the expiration date, taking the drug can be hazardous to health. The drug is dispensed in the pharmacy only with a prescription.

Copying site materials is possible without prior approval in the event of an active indexed link to our site.

N-s-d.ru - Forum about diabetes insipidus

International non-proprietary name

1 tablet contains 40 mg of furosemide

A fast-acting diuretic. Blocks the reabsorption of sodium and chlorine ions in the ascending part of the loop of Henle. The drug also acts on convoluted tubules, and this effect is not associated with inhibition of carbonic anhydrase. Furosemide has a pronounced diuretic, natriuretic and chloruretic effect. In addition, it increases the excretion of potassium, magnesium, calcium ions. The drug does not affect urine pH.

The diuretic effect of Furosemide develops within a minute after oral administration and lasts about 4 hours.

The bioavailability of the drug is about 60%.

The half-life is about 2 hours.

Plasma protein binding 91-99%.

It is metabolized in the body with the formation of glucuronide.

Indications for use

edematous syndrome of various origins (with chronic heart failure, liver cirrhosis, nephrotic syndrome);

chronic and acute renal failure;

some forms of hypertensive crisis;

The dose of the drug is set individually in each case. In the course of treatment, the dosage regimen is adjusted depending on the magnitude of the diuretic response and the dynamics of the patient's condition.

With mild edematous syndrome, it is prescribed orally in a single dose of mg (usually in the morning, on an empty stomach). With pronounced edematous syndrome - inside in a single dose of mg, if necessary, the dose of the drug can be increased to 500 mg.

The drug is prescribed at the rate of 1-2 mg / kg of body weight, the maximum daily dose is 3 mg / kg of body weight.

Possible: nausea, vomiting, diarrhea.

With prolonged use of the drug, hypovolemia, hypokalemia, hyponatremia, hypochloremia may develop and, as a consequence, the development of arterial hypotension; dizziness, dry mouth, thirst, arrhythmias, convulsions.

acute renal failure with anuria;

hypersensitivity to the drug.

During pregnancy, Furosemide is taken in exceptional cases and for a short time.

If the drug is prescribed during lactation, breastfeeding should be discontinued.

Caution should be exercised with the simultaneous appointment of Furosemide and hypoglycemic drugs, as this may require a dose adjustment of the latter.

With the simultaneous use of Furosemide with cardiac glycosides, the risk of developing glycosidic intoxication increases, and when combined with glucocorticosteroids, the risk of hypokalemia.

The drug potentiates the action of curariform agents.

With the simultaneous appointment of Furosemide with aminoglycosides or cephalosporins and cisplatin, their concentration in the blood plasma may increase, which can lead to the development of nephro- and ototoxic effects.

The simultaneous use of Furosemide with lithium preparations can lead to increased reabsorption of lithium ions in the renal tubules and the appearance of toxic effects.

NSAIDs can reduce the diuretic effect of furosemide.

With the simultaneous use of Furosemide and other antihypertensive drugs, the hypotensive effect is potentiated.

50 tablets of 400 mg

Group: Diuretics

Manufacturer: Chinoin Pharmac. and Chemical Works, Hungary

INN: HYDROCHLOROTHIAZIDE (HYDROCHLOROTHIAZIDE);

Medium strength thiazide diuretic. Reduces Na + reabsorption at the level of the cortical segment of Henle's loop, without affecting its section passing in the medulla of the kidney, which determines a weaker diuretic effect in comparison with furosemide. Blocks carbonic anhydrase in proximal convoluted tubules, increases urinary excretion of K + (in the distal tubules, Na + is exchanged for K +), hydrocarbons and phosphates. Virtually no effect on CBS (Na + is excreted either together with Cl- or with bicarbonate, therefore, with alkalosis, the excretion of bicarbonates increases, with acidosis - of chlorides). Increases the excretion of Mg2 +; retains Ca2 + ions in the body. The diuretic effect develops after 1-2 hours, reaches a maximum after 4 hours, lasts h. The effect decreases with a decrease in the glomerular filtration rate and stops when its value is less than 30 ml / min. In patients with diabetes insipidus, it has an antidiuretic effect (reduces the volume of urine and increases its concentration). It lowers blood pressure by reducing the BCC, changing the reactivity of the vascular wall, reducing the pressor effect of vasoconstrictor substances (epinephrine, norepinephrine) and increasing the depressor effect on the ganglia.

Absorption - 80%, fast. Communication with plasma proteins - 60-80%. Bioavailability - 70%, TCmax. In the therapeutic dose range, the average AUC increases in direct proportion to the dose increase; when administered 1 time per day, the cumulation is insignificant. Penetrates through the blood-placental barrier and into breast milk. T1 / h. Not metabolized by the liver. Excreted by the kidneys 95% unchanged and about 4% in the form of hydrolyzate-2-amino-4-chloro-m-benzenedisulfonamide (decreases with alkaline urine) by glomerular filtration and active tubular secretion in the proximal nephron.

Arterial hypertension; edematous syndrome of various origins (heart failure, portal hypertension, nephrotic syndrome, chronic renal failure, fluid retention in obesity), pregnancy toxicosis (nephropathy, edema, eclampsia); diabetes insipidus; subcompensated forms of glaucoma; prevention of the formation of stones in the urinary tract.

To lower blood pressure: by mouth, mg / day, with a slight diuresis and natriuresis observed only on the first day of admission (prescribed for a long time in combination with other antihypertensive drugs: vasodilators, ACE inhibitors, sympatholytics, beta-blockers). With an increase in the dose from 25 to 100 mg, a proportional increase in diuresis, natriuresis and a decrease in blood pressure is observed. In a single dose over 100 mg - an increase in diuresis and a further decrease in blood pressure are insignificant, there is a disproportionately increasing loss of electrolytes, especially K + and Mg2 +. Increasing the dose over 200 mg is inappropriate, because increased urine output does not occur. In case of edematous syndrome (depending on the condition and reaction of the patient), it is prescribed in a daily dose of mg, taken once (in the morning) or in two doses (in the morning). Elderly people - 12.5 mg 1-2 times a day. Children aged 2 months to 14 years old - 1 mg / kg / day. Maximum dose for children under the age of 6 months - 3.5 mg / kg / day, up to 2 years old - 12.5-37.5 mg / day, 3-12 years old - 100 mg / day, divided into 2-3 doses. After 3-5 days of treatment, it is recommended to take a break for 3-5 days. As a maintenance therapy at the indicated dose, it is prescribed 2 times a week. When using an intermittent course of treatment, taken after 1-3 days or within 2-3 days with a subsequent break, the decrease in effectiveness is less pronounced and side effects develop less frequently. To reduce intraocular pressure, 25 mg is prescribed 1 time in 1-6 days; the effect occurs within hours. With diabetes insipidus - 25 mg 1-2 times a day with a gradual increase in the dose (daily doses of mg) until reaching therapeutic effect(reduction of thirst and polyuria), further dose reduction is possible.

Dry mouth, nausea, vomiting, diarrhea; weakness, increased fatigue, dizziness, headache, palpitations, calf muscle cramps, hypokalemia, hypomagnesemia, hyponatremia, hyperuricemia, hypercalcemia, hyperglycemia; exacerbation of gout, thrombosis, embolism, hypercreatininemia, acute interstitial nephritis, vasculitis, progression of myopia, neutropenia, thrombocytopenia, hemorrhagic pancreatitis, acute cholecystitis (with gallstone disease), orthostatic hypotension, allergic dermatitis... Overdose. Symptoms: hypokalemia (weakness, paralysis, constipation, arrhythmias), drowsiness, decreased blood pressure. Treatment: infusion of electrolyte solutions; compensation for K + deficiency (prescribing K + drugs and potassium-sparing diuretics).

Hypersensitivity, gout, diabetes mellitus (severe forms), chronic renal failure (CC less / min, anuria), hypokalemia, hypercalcemia, hyponatremia; pregnancy (I trimester), lactation period. With caution - II-III trimester of pregnancy.

For the prevention of K + and Mg2 + deficiency, a diet with increased content these salts, potassium-sparing diuretics, K + and Mg2 + salts. During treatment, it is not recommended to engage in activities that require concentration of attention and speed of psychomotor reactions. Regular monitoring of plasma levels of K +, glucose, uric acid, fats and creatinine is necessary.

Drugs that intensively bind to proteins (indirect anticoagulants, clofibrate, NSAIDs) enhance the diuretic effect. The antihypertensive effect is enhanced by vasodilators, beta-blockers, barbiturates, phenothiazines, tricyclic antidepressants, ethanol. It enhances the neurotoxicity of salicylates, weakens the effect of oral hypoglycemic drugs, norepinephrine, epinephrine and anti-gout drugs, enhances the side effects of cardiac glycosides, cardiotoxic and neurotoxic effects of Li + drugs, the effect of peripheral muscle relaxants, and reduces the excretion of quinidine. With the simultaneous administration of methyldopa, hemolysis may develop. Cholestyramine reduces absorption. Reduces the effect of oral contraceptives.

Sometimes there is a need to take a diuretic if the pressure suddenly rises. But you have to be careful with the pills - I don't advise anyone with hypothiasis. I, for example, showed all the side effects.

Ordinary green tea helps as a diuretic - drink a cup, and then go to the toilet every half hour. And from the pills. Only Furosemide helps more or less.

That is, such a paradox - for us it is not a diuretic, but vice versa.

I also somehow accepted it, the effect was the opposite, then I just guessed to look into the instructions.

Here they recently prescribed carbamazepine for neuralgia, I think it's good luck, just there it says that the adiuritic action, so that the dose of the hormone can be reduced, it turned out that with this native carbamazepine (which I am now being given) it has completely ceased to be absorbed, I haven’t been absorbed for a long time from diabetes suffered.

But when such severe dehydration begins, it is clear that the whole body suffers, especially my heart problems begin with arrhythmia, tachycardia and blood pressure drops. In these cases, I always drink not just water, but Regidron's solution (for dehydration). Immediately I feel relatively better.

Furosemide is a potent diuretic. It is taken to reduce edema caused by heart or kidney failure, cirrhosis of the liver, and other causes. It is also sometimes prescribed for high blood pressure. Below you will find instructions for use, written in clear language. Review the indications, contraindications and side effects. Find out how to take furosemide: how many times a day, in what dosage, before or after meals, for how many days in a row. The article describes in detail how to be treated with furosemide for edema and high blood pressure. Understand which is better: furosemide or torasemide, why sometimes furosemide is prescribed together with drugs and Diacarb. Read about the side effects of taking furosemide for weight loss, whether this drug is compatible with alcohol.

Drug card

Instructions for use

Together with the drug Furosemide, they are looking for:

How to take furosemide

Take furosemide as directed by your doctor. He must select the dosage and indicate how many times a day you need to take this medicine. As a rule, with edema caused by various reasons, the diuretic should be drunk 1 or 2 times a day. For the daily treatment of hypertension, this drug is prescribed to be taken 2 times a day. For details on the use of furosemide for hypertension and edema, read below.

Many patients are interested in how many days in a row furosemide can be taken. This should only be decided by the attending physician. Do not prescribe or discontinue diuretics on your own. Many people, especially women, more or less often take furosemide for edema, instead of trying to eliminate its causes. You can easily find frightening descriptions of severe side effects on Russian-language sites that self-medication with diuretics for edema leads to.

The official instructions for use do not indicate whether furosemide should be taken before or after meals. claims that taking furosemide after meals significantly reduces its effectiveness. Typically, doctors prescribe this medication on an empty stomach, at least 20-30 minutes before a meal. Your doctor may prescribe you to take Furosemide after meals for some reason. In this case, follow its instructions.

Frequently asked questions and answers to them

Below are the answers to questions that often arise in patients about the use of the diuretic drug furosemide.

Can furosemide be drunk every day?

Furosemide is taken every day as prescribed by a doctor for people whose liver cirrhosis is complicated by ascites - the accumulation of fluid in the abdominal cavity. Previously, this drug was prescribed for daily use in patients with heart failure and hypertension. The new drug is now replacing furosemide in the treatment of heart failure. Why torasemide is better is described in detail below. If you are taking furosemide every day for heart failure, discuss with your doctor whether it is worth replacing it with torasemide.

For hypertension, daily furosemide is best avoided, like any other loop diuretics. These medications cause too many side effects. Use pressure pills that work more gently. See your doctor for a medication regimen that will keep your hypertension under control without compromising your well-being and test results. Some people occasionally drink furosemide when they have a hypertensive crisis. It is better, instead, to properly treat hypertension so that there are no pressure surges at all. Do not take furosemide daily for weight loss or edema! This can cause monstrous side effects. They are vividly described by many sites and forums in Russian.

Can I drink this medicine at night?

As a rule, doctors prescribe to drink furosemide in the morning or at lunchtime, and not at night, so that the patient does not have to go to the toilet too often at night. For some reason, your doctor may tell you to take furosemide at night. In this case, follow its instructions. Many people have voluntarily tried drinking this diuretic at night to avoid swelling and look good the next morning. Russian-language sites and forums are replete with eerie descriptions of the side effects that such self-medication leads to. The authors of numerous frightening stories about the side effects of furosemide are not exaggerating in the least.

Are furosemide and alcohol compatible?

Alcohol increases the frequency and severity of furosemide side effects. If you use a diuretic and alcohol at the same time, then blood pressure may drop too much. Symptoms of this: headache, dizziness, fainting, palpitations. Furosemide often causes orthostatic hypotension - dizziness when standing up suddenly from a sitting or lying position. Alcohol can increase this side effect. Alcohol dehydrates the body and removes useful minerals, just like diuretics. Furosemide should be taken only for severe illnesses in which the use of alcohol is completely prohibited. Even a small dose of alcohol will be harmful to you. For mild illnesses that allow moderate alcohol consumption, try replacing the loop diuretic with a more benign drug or no medication altogether.

How to take furosemide and Asparkam together?

Take furosemide and Asparkam together only as directed by your doctor, regularly having blood tests for potassium. Furosemide deprives the body of a valuable electrolyte - potassium. Asparkam and Panangin tablets replenish potassium reserves. Talk with your doctor if you need to take furosemide and Asparkam at the same time. Do not do this on your own initiative. Asparkam has contraindications. Study them before using this remedy. Take both drugs at the dosage your doctor tells you and as many times a day as he or she prescribes.

Why does furosemide not work? The patient's edema does not diminish.

Furosemide is only a temporary solution to the problem of edema. It does not affect their cause, and sometimes even aggravates it. If it is not possible to eliminate the cause, then over time, even potent diuretics cease to work. Perhaps the patient's kidneys have become so bad that the body has stopped responding to the diuretic medication. In such situations, you cannot arbitrarily increase the dose of furosemide or change it to another diuretic. Talk to your doctor about what to do.

How to restore kidney function after treatment with furosemide?

To find out how furosemide affected the kidneys, ask what the glomerular filtration rate (creatinine clearance) is, and then take a blood test for creatinine. Learn and follow the rules of preparation for this analysis to get an accurate result. Creatinine clearance is the main indicator by which one can judge whether the kidneys are working well in a person.

It is rare that the unauthorized use of one or more furosemide tablets irreversibly damaged the kidneys. Chances are, your well-being and kidney function will return to normal soon after you stop taking the diuretic medication. If you have experienced unpleasant side effects, then this will serve as a lesson: you cannot take strong drugs on your own initiative.

Torasemide or furosemide: which is better?

Torasemide is better than furosemide for treating heart failure. Both of these drugs are loop diuretics. Torasemide was invented 20 years later than furosemide, in 1988. In Russian-speaking countries, the first drug torasemide was registered in 2006.

Furosemide and torasemide: comparison

Torasemide acts more smoothly and longer than furosemide and is considered a safer drug. A possible side effect of loop diuretics is a decrease in blood potassium levels in patients. Torasemide causes it less often. Sometimes torasemide is prescribed to patients in the late stages of renal failure, when furosemide can no longer be taken. After the accepted dose of furosemide has finished acting, the excretion of salt in the urine can be significantly reduced due to the "rebound effect". Torasemide does not have this problem.

If you are taking furosemide for edema in heart failure, talk to your doctor about torasemide (Diuver). The authors of articles in medical journals argue that in patients with hypertension, torasemide does not affect blood sugar and uric acid levels, unlike furosemide. Do not trust this information too much. People with high blood pressure may be better off taking safer medicines every day than the loop diuretics furosemide and torasemide.

Medicines in which the active ingredient is Torasemide:

Torasemide is probably as good as furosemide for treating fluid accumulation in the abdominal cavity (ascites) caused by liver cirrhosis. See, for example, the article "Torasemide versus furosemide in cirrhosis: a long-term, double-blind, randomized clinical study" by Fiaccadori F., Pedretti G., Pasetti G. et al in The Clinical Investigator, 1993. Nevertheless, until now, in severe liver diseases, furosemide is prescribed many times more often than torasemide. Usually, with cirrhosis of the liver, patients take simultaneously a loop diuretic and Veroshpiron (spironolactone).

Furosemide or Veroshpiron: which is better? Can I take it together?

Many patients are interested in which medicine is better: furosemide or? You can't put the question like that, because these are completely different medicines. They are prescribed for different purposes. Therefore, it cannot be said that furosemide is better than Veroshpiron, or vice versa. Sometimes patients have to take both of these drugs at the same time. Furosemide is a powerful diuretic drug that belongs to loop diuretics. It stimulates the elimination of fluid and salt from the body. The effect is quick and strong, though not long lasting. While the kidneys of the patient can still react to diuretics, this medicine is good for edema. Veroshpiron has a weak diuretic effect. But it improves the results of treatment with furosemide and reduces the risk of a side effect - potassium deficiency in the body.

The drug and its analogues have supplanted furosemide in the treatment of heart failure. Because torasemide works better and has fewer side effects. However, furosemide remains a popular treatment for ascites (fluid accumulation in the abdomen) caused by cirrhosis. In severe liver diseases, patients are often prescribed furosemide and Veroshpiron together. Usually they start with a dosage of 100 mg of Veroshpiron and 40 mg of furosemide per day. If this dosage does not help enough, it is increased after 3-5 days. At the same time, the ratio of Veroshpiron and furosemide preparations is maintained at 100: 40 to maintain the optimal level of potassium in the blood.

Furosemide at elevated pressure

Patients should avoid the use of furosemide at high blood pressure, except in the most severe cases. This medication has serious side effects when taken daily to treat high blood pressure. It removes potassium and magnesium from the body, which negatively affects the well-being of patients. Also, furosemide accelerates the development of diabetes and gout. If the patient with hypertension already has diabetes or gout, then taking a potent diuretic will worsen his condition.

Furosemide at high blood pressure for daily administration is prescribed to seriously ill patients who are no longer helped by thiazide and thiazide-like diuretics, and their analogues. With hypertensive crises, this medicine can be taken occasionally, but only as directed by a doctor. Study the article "". Furosemide and other diuretics are not the best choice when you need to quickly stop a hypertensive crisis. Use less harmful medicines for this. Talk to your doctor about which blood pressure pills you should take each day. The doctor will likely prescribe combination drugs that contain diuretics but not potent loop diuretics.

Furosemide for edema

Furosemide helps with edema because it stimulates the kidneys to remove salt and fluid from the body. Unfortunately, this medicine does not eliminate the causes of edema, and sometimes even aggravates them. Typically, swelling is caused by heart failure, kidney or liver disease, and vascular problems in the legs. It is necessary to take measures to eliminate the cause of the edema, and not only to muffle their symptoms with furosemide. Taking diuretics for edema without permission can get you into trouble. Furosemide is a powerful drug that causes serious side effects. It is possible that it will permanently damage the kidneys.

If you regularly have swelling, then do not ignore them, but see your doctor as soon as possible. Get a medical examination to determine the cause. The diseases listed above respond well to early treatment. Potent diuretic drugs are prescribed as symptomatic treatment in severe cases, when time is lost and it is no longer possible to act on the underlying disease. Furosemide for edema sometimes helps even patients who are already useless to take thiazide diuretics (Hypothiazide and its analogues).

Furosemide for weight loss

Taking furosemide for weight loss is a bad idea. You can lose no more than 2-3 kg, and at the same time cause significant harm to your health. Furosemide reduces the amount of water in the body, but does not contribute to fat burning in the least. Being overweight is not an indication for the use of this drug. No doctor or nutritionist in their right mind would approve of the use of powerful diuretic drugs for weight loss. Because the side effects are frequent and severe.

Weight loss while taking furosemide is due to the fact that this drug quickly dehydrates. Lack of water in the body leads to diseases of the joints and internal organs. They develop over time. Also, dehydration worsens the appearance of the skin in women, and it becomes noticeable immediately. In addition to water, furosemide removes valuable minerals from the body - potassium and magnesium. An electrolyte deficiency will impair your well-being and attractiveness. Do not use strong diuretic medicines for weight loss. Pay attention to metformin (Siofor, Glucophage)

Didn't find the information you were looking for?
Ask your question here.

How to recover from hypertension on your own
in 3 weeks, without expensive harmful drugs,
"hungry" diet and hard physical education:
free step-by-step instructions.

In modern Ukrainian society, the illusion has developed that the most terrible disease is myocardial infarction. In fact, acute heart failure (AHF; acute decompensated heart failure (ADHF), acute left ventricular failure (ALVF)) is much more dangerous.

With almost the same incidence of acute heart failure and acute coronary syndrome (ACS), prehospital, nosocomial and 3-month mortality in AHF is much higher than in ACS (Table 1).

According to a number of cardiologists, the goals of therapy for ADHD are not as clear as for heart attack or unstable angina pectoris, the results of international clinical trials are minimal or conflicting, and the levels of evidence for major drug interventions, in contrast to acute forms coronary heart disease is based largely on expert opinion.

ADHF treatment in the first hours after hospitalization depends on regional characteristics (Table 2). Thus, in the USA, loop diuretics are used 13.5% significantly less often than in Eastern Europe, intravenous vasodilators - 8 times, and inotropes - 6 times less often than in Western Europe. (Collins S.P. et al., 2010).

A modern strategy for the treatment of AHF on prehospital stage and in the admission department of the hospital is shown in Fig. 1 .

As seen in Fig. 1, a diuretic is a first-line drug in the treatment of acute heart failure of any genesis. The decision on further drug strategy is made according to the current values ​​of blood pressure (BP).

A. Maggioni et al. (2011) analyzed the results of treatment of 5118 patients out of 136 medical centers Europe and the USA involved in the EUR Observational Research program. Of these, 1892 (37%) had acute heart failure, the rest had acute decompensated heart failure. 84.6% of patients received IV furosemide at an average dose of 60 mg, IV nitrates - 18.5%, inotropes - 10.5% (dobutamine - 4.6%, levosimendan - 2.4%, others - 3 ,5 %). As a result of the intensification of treatment, the overall mortality rate in such patients decreased from 6.7% in 2005 to 3.8% in 2009-2010. It is curious that mortality decreased in all etiological groups of AHF: with cardiogenic shock - from 39.5 to 22.0%, pulmonary edema - from 9.1 to 5.6%, hypertensive ALVF - from 1.5 to 1.2% , right ventricular ALVH - from 8.0 to 6.1%.

The frequency of diuretic use in all forms of AHF both at the prehospital stage and in the hospital is the highest and amounts to 78-100% (Fig. 2).

The need for the use of loop diuretics in the treatment of emergency conditions is not in doubt today. The type of diuretic and the modes of use are important.

The purpose of our article was comparative assessment the effectiveness and tolerability of modern intravenous diuretic therapy with torasemide in the treatment of acute left ventricular failure caused by hypertensive crises in patients with arterial hypertension (AH).

Materials and research methods

We analyzed the therapy of 96 patients with ALVO (class III according to Killip) against the background of ADF, who were treated in cardiology department for patients with myocardial infarction with the cardiac intensive care unit of the KGKB No. 5 from January 2011 to March 2013. Among those included in the study were only patients with chronic heart failure, whose pulmonary edema developed against the background of decompensation of previously existing disorders of systolic and / or diastolic function of the left ventricle (LV). At the same time, persons with pulmonary edema on the background of acute myocardial infarction, mitral stenosis, hypoproteinemia (of various origins), pneumothorax, acute obstruction of the airways, pneumonia, and the effects of toxic substances were excluded.

All patients received the following therapy: beta-blockers, ACE inhibitors, adequate anticoagulant therapy. All patients were randomly assigned into two groups. The differences between the groups were in the choice of the loop diuretic.

Group I included 42 patients who received torasemide (Trifas®, Berlin-Chemi AG) 10-20 mg intravenously bolus followed by drug infusion (up to a maximum of 100 mg per day) if necessary. Group II (comparison group) consisted of 54 patients who received furosemide 40-80 mg intravenously bolus, if necessary, followed by infusion of the drug (up to a maximum of 400 mg per day).

Therapy with ALVO (pulmonary edema) in our study was carried out according to the following scheme (Fig. 3).

Research results

As a result of treatment with loop diuretics in both groups, there was a change in general condition sick.

A more rapid decrease in the symptoms of shortness of breath, palpitations, wheezing in the lungs, the disappearance of peripheral edema in combination with effective control of blood pressure was observed among patients from the torasemide group (Table 3). They showed a more complete restoration of oxygenation of peripheral tissues, increased urine output, and a reduction in the time spent in the intensive care unit.

The general condition according to the Likert scale improved in 73.8% of patients in group I and in 61.1% in group II (relative risk (RR) 0.63; p = 0.03). The number of patients with no improvement or worsening was significantly greater in group II - in 33.3% of patients versus 21.4% of patients in group I (RR 0.71; p = 0.04).

During the first month, 1 patient died in the furosemide group and none in the torasemide group.

According to our observation, the composite endpoint (death plus re-hospitalization within 6 months after discharge from the hospital) reached 3 (7.2%) patients in group I and 6 (11.2%) patients in group II (p = 0.23) ...

The duration of the diuretic action of furosemide averaged 2.2 hours from the moment of injection, and of torasemide - about 6 hours. To achieve stabilization of the state, titration of the dose was significantly more often required in patients of group II. The diuretic dose was adjusted in 27 (50.0%) patients in the furosemide group and in 14 (33.4%) patients in the torasemide group. According to A.E. Bagriya, A.I. Dyadyka (2008), the use of torasemide instead of furosemide in the treatment of pulmonary edema in the setting of hypertensive crisis in addition to opiates, oxygen and digoxin reduces by 36.5% (p< 0,05) частоту кумулятивной конечной точки (документированная смерть от всех причин плюс повторный отек легких) .

The daily urine output in our study was 2.84 and 2.66 l / day, respectively, for the torasemide and furosemide groups (the differences are not significant). Hypokalemia (K + less than 3.5 mmol / l) every other day was noted more than 2 times less often in group I - in 3 (7.2%) patients, while in the furosemide group - in 9 (16.7%) patients ...

In earlier studies (Stringer K.A., Watson W., 1994) in patients with cardiogenic pulmonary edema, the efficacy and safety of intravenous torasemide has also been proven. So, against the background of intravenous administration of torasemide at a dose of 20-40 mg (if necessary, followed by titration within 24 hours), the average fractional sodium excretion increased 2.35 times, the average urine volume increased from 134 to 375 ml per hour (p = 0.0034). The introduction of torasemide was accompanied by a significant decrease in the number of wheezing in the lungs and a pronounced decrease in dyspnea. It is important that none of the patients had serious adverse reactions who demanded exclusion from the study. The authors concluded that intravenous administration torasemide is effective and well tolerated in patients with acute cardiogenic pulmonary edema.

Against the background of intensive diuretic therapy, we observed cardiac arrhythmias in the form of extrasystolic arrhythmias. In the torasemide group, ventricular premature beats occurred in 1 (2.4%) patient and in 4 (7.4%) patients in the furosemide group. The average length of hospital stay in Group I patients was 14.3% less - 9.4 ± 2.6 days versus 10.1 ± 2.8 days in the furosemide group.

Discussion

Furosemide and torasemide have a strong natriuretic and, accordingly, diuretic effect, which gives reason to consider this class of diuretics as the most effective in the treatment of edema syndrome. In addition, loop diuretics have a direct antihypertensive effect, which is associated with the stimulation of the synthesis of renal vasodilating prostanoids (primarily prostaglandin E2).

Torasemide is not inferior in diuretic effect to furosemide and has an additional pronounced antialdosterone effect (Table 4). It has a longer lasting diuretic effect and is less likely to cause hypokalemia. It is important that, unlike other loop diuretics - furosemide and bumetanide, torasemide does not affect excretion in the proximal tubules and therefore causes less loss of phosphates and bicarbonates. In addition, torasemide differs from furosemide in its lower affinity for albumin, which ensures the preservation of the diuretic effect in hypoalbuminemia. This property of the drug is important for patients with manifestations of acute left ventricular failure associated with chronic use of loop diuretics, especially in situations requiring emergency care in the absence of data on the level of serum albumin.

The ability of torasemide to prevent the growth of impaired contractility of the left ventricular myocardium is manifested during chronic use of the drug and can hardly be of significant importance in the treatment of emergency conditions. As shown by the DUEL study, the incidence of adverse reactions during the use of torasemide is 14 times significantly less than with the use of furosemide.

Interesting results from a publication on the use of loop diuretics in ADHD in the United States. (Vats V., DiDomenico R.J., 2007)... For example, an analysis of care in 107 hospitals in Illinois showed that when prescribing loop diuretics, torasemide was used in 69.2% of cases.

IV injection of loop diuretics in general and torasemide in particular has both a vasodilating effect, manifested by a rapid (after 5-30 min) decrease in right atrial pressure and wedge pressure pulmonary artery as well as a decrease in pulmonary vascular resistance. With bolus administration of high doses of furosemide> 1 mg / kg, there is a risk of reflex vasoconstriction. This risk is significantly lower in torasemide, since the drug has vasodilating properties due to partial blockade of angiotensin II receptors and a decrease in the calcium content in the smooth muscle cells of the vascular wall. This should be considered primarily in patients with acute coronary syndrome when vasodilating properties are of particular importance. In severe HF decompensation, diuretics help to normalize the filling pressure of the heart chambers and can quickly reduce neurohormonal activity. If in furosemide this is due exclusively to hemodynamic effects, then torasemide, due to its antialdosterone and antiangiotensin properties, has clear advantages in relation to the normalization of neurohormonal parameters.

Treatment of ALVN usually begins with a bolus of torasemide at a dose of 10–20 mg. In the future, the dose should be titrated until a clinical effect is achieved and the symptoms of acute fluid retention are reduced. The administration of a loading dose of the drug followed by infusion is more effective than repeated bolus administration. The maximum daily dose of torasemide for parenteral use is 100 mg per day. The drug Trifas 20 ampoules, according to the instructions, cannot be mixed with other drugs for intravenous injections and / or infusions.

Based on the above features pharmacological effects furosemide and torasemide, such practical conclusions should be drawn:

1. The strength of the diuretic effect of loop diuretics depends on the dose of drugs: the larger the dose, the stronger the diuretic effect.

2. The diuretic furosemide has advantages over torasemide only in the speed of development of the diuretic effect.

3. The loop diuretic torasemide has significant and fundamental advantages over furosemide:

By the effect on the metabolic-electrolyte profile (does not cause significant loss of K +, Mg 2+, phosphates and bicarbonates, to a lesser extent contributes to the retention of urates), which leads to a more favorable profile of the pharmacological safety of torasemide and greater adherence to treatment. Proven absence negative influence torasemide on the indicators of glucose tolerance test, fasting glucose level, glycosylated hemoglobin, insulin, C-peptide. Special attention should be paid to research data proving the complete absence of a negative effect of torasemide on indicators carbohydrate metabolism in patients with type 2 diabetes mellitus and indicators of lipid metabolism with prolonged use;

In terms of bioavailability, the nature of absorption and connection with food (it has a significantly higher lipophilicity and bioavailability, complete absorption and no dependence on food intake), torasemide is more effective in severe patients who have impaired absorption processes. The drug can be prescribed regardless of food intake (both before and after), which also leads to a greater adherence of patients to treatment;

By the nature of the diuretic action and, to a certain extent, its reliability (unlike furosemide, torasemide has a more predictable and stable diuretic effect, which is primarily associated with a significantly better bioavailability of the drug);

By the duration of the diuretic effect (unlike furosemide, torasemide has a significantly longer half-life). The drug should be prescribed once a day, in the morning (whereas furosemide should be prescribed at least 2 times a day). The use of furosemide once a day may be accompanied by the development of the rebound phenomenon (the phenomenon of postdiuretic Na + retention), when a significant increase in urine output in the first half of the day is replaced by Na + and fluid retention in the second half. As a result, the daily excretion of fluid may change slightly, which does not make it possible to obtain a satisfactory clinical effect (reduction of shortness of breath and edema syndrome);

By the presence of two ways of excretion of torasemide (renal and hepatic), which reduces the risk of drug accumulation in cases of dysfunction of one of the organs. The pharmacokinetics of furosemide is more dependent on renal function than liver function, and renal dysfunction may lead to drug accumulation. It should be noted that some studies prove the fact of a decrease in the elimination of torasemide in women compared to men. The latter is considered as the reason for the greater number of adverse reactions of torasemide in female patients;

According to the significantly better tolerability of the drug (a rather important point in practical terms is that, unlike furosemide, torasemide does not cause intense diuresis) and high adherence of patients to treatment, as evidenced by other important advantages of the drug.

The benefits of torasemide over furosemide based on evidence-based medicine:

1. Improving the prognosis and reducing the overall and cardiovascular mortality of patients with AHF.

2. A significant decrease in the severity of shortness of breath and functional class, an increase in tolerance to physical activity and improving the quality of life of patients with ADHD.

3. Reducing the frequency and duration of hospitalizations for AHF.

4. Improvement of the functional state of the left ventricle, anti-remodeling effect (decrease in end-diastolic size, LV myocardial mass).

5. Decrease in the frequency of registration of hypokalemia.

6. Improvement of neurohumoral status (decrease in the concentration of sodium-uretic peptide, activity of renin and aldosterone in blood plasma).

7. Increase in vasodilation due to activation of NO release, secretion of prostaglandin I 2 and lack of stimulation of thromboxane release, suppression of the activity of angiotensin II and endothelin-1.

conclusions

Based on literature data and our own clinical experience-use, it can be concluded that the parenteral form of torasemide (Trifas®) should be used more widely than that of furosemide in therapy different forms acute heart failure due to greater efficiency. Torasemide is significantly superior in safety profile to furosemide, which gives the right to use it in severe decompensated patients when prescribing the parenteral form in emergency cardiology.

Bibliography

1. Bonow R.O., Ganiats T.G., Beam C.T. et al. ACCF / AHA / AMA-PCPI 2011 Performance Measures for Adults With Heart Failure. Report of the American College of Cardiology Foundation / American Heart Association Task Force on Performance Measures and the American Medical Association - Physician Consortium for Performance Improvement // J. Am. Coll. Cardiol. 2012; 59 (20): 1812-1832.

2. Smith W.R., Poses R.M., McClish D.K. et al. Prognostic judgments and triage decisions for patients with acute congestive heart failure // Chest 2002; 121 (5): 1610-7.

3. Weintraub N.L., Collins S.P., Pang P.S. et al. Acute heart failure syndromes: emergency department presentation, treatment, and disposition: current approaches and future aims: a scientific statement from the American Heart Association // Circulation 2010; 122 (19): 1975-96.

4. Peacock W. F., Costanzo M. R., De Marco T. et al. Impact of intravenous loop diuretics on outcomes of patients hospitalized with acute decompensated heart failure: insights from the ADHERE registry // Cardiology 2009; 113 (1): 12-9.

5. Maisel A. S., Peacock W. F., McMullin N. et al. Timing of immunoreactive B-type natriuretic peptide levels and treatment delay in acute decompensated heart failure: an ADHERE (Acute Decompensated Heart Failure National Registry) analysis // J. Am. Coll. Cardiol. 2008; 52 (7): 534-40.

6. Peacock W.F., Fonarow G.C., Emerman C.L. et al. Impact of early initiation of intravenous therapy for acute decompensated heart failure on outcomes in ADHERE // Cardiology 2007; 107 (1): 44-51.

7. Cosin J., Diez J .; TORIC investigators. Torasemide in chronic heart failure: results of the TORIC study // Eur. J. Heart Fail. 2002; 4: 507-13.

8. Murray M., Deer M., Ferguson J. et al. Open-label randomized trial of torsemide compared with furosemide therapy for patients with heart failure // Am. J. Med. 2001; 111 (7): 513-520.

9. Spannheimer A., ​​Muller K., Falkenstem P. et al. Long-term diuretic treatment in heart failure: are there differences between furosemide and torasemide? // Schweiz. Rundsch. Med. Prax. 2002; 91 (37): 1467-1475.

10. Muller K., Gamba G., Jaquet F., Hess B. Torasemide vs. furosemide in primary care patients with chronic heart failure NYHA II to IV - efficacy and quality of life // Eur. J. Heart Fail. 2003; 5 (6): 793-801.

11. Yamato M., Sasaki T., Honda K. et al. Effects of torasemide on left ventricular function and neurohumoral factors m patients with chronic heart failure // Circ J. 2003; 67 (5): 384-390.

12. Veeraveedu P. T., Watanabe K., Ma M. et al. Torasemide, a long-actingloop diuretic, reduces the progression of myocarditis to dilated cardiomyopathy // Eur. J. Pharmacol. 2008; 581: 121-31.

13. Tanaka H., Watanabe K., Harima M. et al. Effects of various diuretics on cardiac function in rats with heart failure // Yakugaku Zasshi. 2009; 129: 871-9.

14. Negishi K., Kasama S., Araki Y. et al. Torasemide treatment improves cardiac sympathetic nerve activity as well as combined furosemide and spironolactone treatment in patients with heart failure // Circ. J. 2008; 72: Abst PJ-155.

15. De Berrazueta J.R., Gonzalez J.P., de Mier I., Poveda J.J., Garcia-Unzueta M.T. Vasodilatory action of loop diure-tics: A plethysmo-graphy study of endothelial function in forearm arteries and dorsal hand veins in hypertensive patients and controls // J. Cardiovasc. Pharmacol. 2007; 49: 90-5.

16. Liguori A., Casini A., Di Loreto M., Andreini I., Napoli C. Loop diuretics enhance the secretion of prostacyclin in vitro, in healthy persons, and in patients with chronic heart failure // Eur. J. Clin. Pharmacol. 1999; 55: 117-24.

17. Fortuno A., Muniz P., Ravassa S. Torasemi-de inhibits angiotensin II-induced vasoconstriction and intracellular calcium increase in the aorta of spontaneously hypertensive rats // Hypertension. 1999; 34: 138-43.

18. Fortuno A., Muniz P., Zalba G., Fortu-no M.A., Diez J. The loop diuretic torasemide interferes with endothelin-1 actions in the aorta of hypertensive rats // Nephrol. Dial. Transplant. 2001; 16: 18-21.

19. Muniz P., Fortuno A., Zalba G., Fortu-no M.A., Diez J. Effects of loop diuretics on angiotensin II-stimulated vascular smooth muscle cell growth // Nephrol. Dial. Transplant. 2001; 16: 14-17.

20. Lyseng-Williamson K.A. Torasemide prolonged release // Drugs. 2009; 69: 1363-72.

21. Ivanov V.P. Diuretics: aspects of the clinical use of diuretics for family and general practitioners // Cardiology: from science to practice. - 2012. - No. 4. - S. 108-122.

22. Baumgart P. Torasemide in comparison with thiazides in the treatment of hypertension // Cardiovasc. Drugs Ther. 1993; 7 (suppl. 1): 63-68.

23. Spannbrucker N., Achhammer I., Metz P., Glocke M. Comparative study on the hypertensive efficacy of torasemide and indapamide in patiehts with essential hypertension // Drug Res. 1988; 38 (1): 190-193.

24. Porcellati C., Verdecchia P., Schillaci G. et al. La torasemide, nuovo diuretico del'ansa, nell trattamento dell'ipertensione arteriosa: Studio con trolla to in doppla cecita // BasRazion Terapia 1990; 20: 407-10.

25. Baumgart P., Walger P., von Eiff M., Achhammer I. Long-term efficacy and tolerance of torasemide in hypertension // Progress in pharmacology and Clinical Pharmacology. Gustav-Fischer-Verlag: Stuttgart 1990; 8: 169-81.

26. Reyes A.J., Chiesa P.D., Santucci M.R. et al. Hydrochlorothiazide versus a nondiuretic dose of torasemide as once daily antihyper-tensive monopharmacotherapy in elderly patients; randomized and double-blind study // Progress in Pharmacology and Clinical Pharmacology. Gustav-Fischer-Verlag: Stuttgart 1990; 8: 183-209.

27. Boelke T., Piesche L. Influence of 2.5-5 mg torasemide o.d. versus 25-50 mg HCTZ / 50-100 triamterene o.d. on serum parameters in elderly patients with mild to moderate hypertension // Diuretics IV: Chemistry, Pharmacology and clinical Applications. Excerta Medica: Amsterdam 1993; 279-82.

28. Voelke T., Achhammer I., Meyer-Sabel-lek W.A. Blutdrucksenkung und meta-bolische Veranderungen bei essentiellen Hypertoni-kem nach Langzeitgabe unterschiedlicher Diuretika // Hochdruck 1990; 9: 40-1.

29. Achhammer I., Metz P. Low dose loop diuretics in essential hypertension: Expe-rience with torasemide // Drugs 1991; 41 (Suppl. 3): 80-91.

30. Achhammer I., Eberhard R. Comparison of serum potassium levels during long-term treatment of hypertension patients with 2.5 mg torasemide o.d. or 50 mg triamterene / 25 mg hydrochlorothi-azide o.d. // Progress in Pharmacology and Clinical Pharmacology. Gustav-Fischer-Verlag: Stuttgart 1990; 8: 211-20.

31. Roca-Cusachs A., Aracil-Vilar J., Calvo-Gomez C. et al. Clinical effects of torasemide prolonged release in mild-tomo-derate hypertension: a randomized non-inferiority trial versus torasemide immediate release // Cardiovasc. Ther. 2008; 26: 91-100.

32. Kult J., Hacker J., Glocke M. Comparison of efficacy and tolerance of different oral doses of torasemide and furosemide in patients with advanced chronic renal failure // Arzneimittel-Forschung / Drug Research. 1998; 38: 212-214.

33. Clasen W., Khartabil T., Imm S., Kindler J. Torasemid for diuretic treatment of advanced chronic renal failure // Arzneimittel-Forschung / Drug Research. 1988; 38: 209-211.

34. Mourad G., Haecker W., Mion C. Dose-dependent efficacy of torasemide in comparison with furosemide and placebo in advanced renal failure // Arzneimittel-Forschung / Drug Research. 1988; 308: 205-208.

35. Vasavada N., Saha C., Agarwal R. A double-blind randomized crossover trial of two loop diuretics in chronic kidney disease // Kidney Int. 2003; 64 (2): 632-640.