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Britomar - instructions for use, analogs, reviews and release forms (tablets 5 mg and 10 mg prolonged action) of a diuretic drug for the treatment of edema and pressure reduction in adults, children and pregnancy. Composition

Britomar - instructions for use, analogs, reviews and release forms (tablets 5 mg and 10 mg prolonged action) of a diuretic drug for the treatment of edema and pressure reduction in adults, children and pregnancy. Composition

In this article, you can read the instructions for using the drug Britomar. Comments of visitors of the site - consumers of this diuretic medicine, as well as opinions of doctors of specialists on the use of Britomar in their practice are presented. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Britomar with available structural analogues.Use to treat edema and reduce pressure in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

 

Britomar - loop diuretic. The main mechanism of action of the drug due to the reversible binding of torasemide with sodium / chlorine / potassium cotransporter located in the apical membrane of the thick ascending loop of Henle segment, the resulting reduced or completely inhibited reabsorption of sodium ions and decreases the osmotic pressure of the intracellular fluid and water reabsorption.

 

Torasemide (active ingredient Britomar drug) to a lesser extent than furosemide, causes hypokalemia, wherein it exhibits higher activity and its action for a longer time.

 

The diuretic effect is about one hour after ingestion of the drug, peaking after 3-6 hours, and lasts for 8 to 10 hours.

 

Reduces systolic and diastolic blood pressure in a supine and standing position.

 

Composition

 

Torasemide + auxiliary substances.

 

Pharmacokinetics

 

The drug sustained-release tablets Britomar provides for gradual release torasemide, reducing fluctuations in the blood concentration, compared with preparations of torasemide in a dosage form of a tablet with a conventional release.

 

After taking several doses of the drug, the relative bioavailability of the prolonged form, compared to the usual dosage form, is about 102%. The active substance is absorbed from the digestive tract with a limited effect of "first passage" through the liver. Eating does not have a significant effect on the absorption of the drug. Impaired renal and / or liver function does not affect the absorption of the drug. More than 99% of torasemide binds to blood plasma proteins.

 

Metabolised in the liver with the participation of the isoenzyme CYP2C9 with the formation of three metabolites. The main metabolite is a carboxylic acid derivative, is pharmacologically inactive. Two other metabolites, which in the body are formed in a small amount, have some diuretic activity, but their concentration is too small to have any significant clinical effect.

 

About 80% of the ingested dose is excreted by the kidneys in the form of metabolites and about 20% unchanged (in patients with normal renal function).

 

The pharmacokinetic profile of torasemide in elderly patients is similar to that in young patients,that there is a decrease in renal clearance of the drug due to a characteristic age-related impairment of the decrease in renal function in elderly patients. The overall clearance and T1 / 2 do not change at the same time.

 

Indications

  • edematous syndrome of various genesis, incl. with chronic heart failure, liver and kidney diseases;
  • arterial hypertension.

 

Forms of release

 

Long-acting tablets 5 mg and 10 mg.

 

Instructions for use and dosage

 

Is taken internally. Tablets should be swallowed whole, not liquid, squeezed with liquid. Tablets can be taken at any convenient constant time, regardless of food intake.

 

Edema syndrome with chronic heart failure: the initial dose is usually 10-20 mg once a day. If necessary, the dose can be increased 2-fold to obtain the desired effect.

 

Edema syndrome with kidney disease: the initial dose is usually 20 mg once a day. If necessary, the dose can be increased 2-fold to obtain the desired effect.

 

Edema syndrome with liver disease: the initial dose is usually 5-10 mg once a day, together with aldosterone antagonists or potassium-sparing diuretics.If necessary, the dose of Britomar can be increased 2 times to obtain the desired effect. Not recommended single dose of more than 40 mg, t. its action has not been studied. The drug is prescribed for a long period or until the disappearance of edema.

 

Arterial hypertension: the initial dose is, as a rule, 5 mg once a day. In the absence of an adequate reduction in blood pressure within 4-6 weeks, the dose is increased to 10 mg once a day. If this dose does not give the desired effect, a hypotensive drug of another group should be added to the treatment regimen.

 

Older patients are not required to adjust the dose.

 

In case of missing the next dose, you can not take a double dose of the drug. Immediately take the forgotten dose. The next dose is taken at the usual time the next day.

 

Side effect

  • hypercholesterolemia (an increase in the level of cholesterol in the blood);
  • hypertriglyceridemia (an increase in the level of TG in the blood);
  • polydipsia (increased thirst);
  • dizziness;
  • headache;
  • drowsiness;
  • cramps in the muscles of the lower limbs;
  • confusion of consciousness;
  • fainting;
  • paresthesia in the extremities (sensation of numbness, "crawling crawling" and tingling);
  • extrasystole (heart rhythm disturbance);
  • tachycardia (increased heart rate);
  • increased heart rate;
  • redness of the face;
  • excessive arterial hypotension;
  • deep vein thrombosis (formation of blood clots);
  • thromboembolism;
  • nasal bleeding;
  • diarrhea;
  • abdominal pain;
  • flatulence;
  • nausea, vomiting;
  • loss of appetite;
  • pancreatitis;
  • dyspeptic phenomena;
  • increased frequency of urination;
  • polyuria (increased urine formation);
  • nocturia (frequency of urination at night);
  • increased urge to urinate;
  • urinary retention (in patients with obstruction of the urinary tract);
  • increase in the concentration of urea and creatinine in the blood;
  • an increase in the number of platelets;
  • decrease in the number of erythrocytes, leukocytes and platelets;
  • metabolic alkalosis;
  • visual impairment;
  • ringing in the ears and hearing loss (usually, reversible);
  • itching;
  • rash;
  • photosensitization;
  • asthenia (exhaustion);
  • weakness;
  • thirst;
  • hyperactivity;
  • nervousness;
  • increased fatigue.

 

Contraindications

  • anuria;
  • hepatic coma and precoma;
  • refractory hypokalemia; refractory hyponatremia;
  • dehydration;
  • marked abnormalities of urine outflow from any etiology (including unilateral urinary tract damage);
  • digitalis intoxication;
  • acute glomerulonephritis;
  • sinoatrial and AV-blockade of 2 and 3 degrees;
  • age under 18 years (safety and efficacy in children not studied);
  • pregnancy;
  • intolerance to galactose, deficiency of lactase or glucose-galactose malabsorption;
  • hypersensitivity to the components of the drug;
  • in patients with an allergy to sulfonamides (sulfanilamide antimicrobial agents or sulfonylureas), there may be a cross-allergy to torasemide.

 

Carefully:

  • arterial hypotension;
  • hypovolemia (with or without arterial hypotension);
  • disorders of urinary outflow (benign prostatic hyperplasia, narrowing of the urethra or hydronephrosis);
  • ventricular arrhythmia in the anamnesis;
  • acute myocardial infarction (increased risk of developing cardiogenic shock);
  • diarrhea;
  • pancreatitis;
  • diabetes mellitus (decreased glucose tolerance);
  • liver diseases complicated by cirrhosis and ascites, renal failure, hepatorenal syndrome;
  • gout, hyperuricemia;
  • anemia;
  • simultaneous use of cardiac glycosides, aminoglycosides or cephalosporins, corticosteroids or adrenocorticotropic hormone (ACTH);
  • hypokalemia;
  • hyponatremia;
  • lactation period.

 

Application in pregnancy and lactation

 

Britomar is not recommended for pregnancy.

 

Torasemide does not have a teratogenic effect and fetotoxicity, it penetrates the placental barrier, causing disturbances in water-electrolyte metabolism and thrombocytopenia in the fetus.

 

It is not known whether thorasemide penetrates breast milk. Caution should be given to Britomar during lactation (breastfeeding).

 

Use in children

 

Contraindicated in children and adolescents under the age of 18 years.

 

Application in elderly patients

 

Older patients are not required to adjust the dose.

 

special instructions

 

The drug should be used strictly according to the doctor's prescription.

 

Patients with hypersensitivity to sulfonamides and sulfonylureas may have cross-sensitivity to the Britomar preparation. In patients, especially at the beginning of treatment with the drug Britomar and the elderly, it is recommended to monitor the electrolyte balance, volume and concentration of circulating blood.

 

With long-term treatment with the drug Britomar, it is recommended to carry out regular monitoring of the electrolyte balance (especially the level of potassium), glucose, uric acid, creatinine, lipids and cellular components of the blood.

 

Patients receiving Britomar in high doses, in order to avoid the development of hyponatremia and metabolic alkalosis, it is inappropriate to limit the intake of table salt.

 

The risk of hypokalemia is greatest in patients with cirrhosis of the liver, expressed diuresis, inadequate intake of electrolytes with food, as well as with simultaneous treatment with corticosteroids or ACTH.

 

Increased risk of development of violations of water-electrolyte balance is observed in patients with renal insufficiency. During the course of treatment, it is necessary to periodically monitor the concentration of blood plasma electrolytes (including sodium, calcium, potassium, magnesium), acid-base state, residual nitrogen, creatinine, uric acid and, if necessary, appropriate corrective therapy (with higher multiplicity patients with frequent vomiting and against the background of parenterally injected fluids).

 

In patients with developed water-electrolyte disorders,hypovolemia, or prerenal azotemia, laboratory analysis data may include: hyper- or hyponatremia, hyper- or hypochloraemia, hyper- or hypokalemia, acid-base balance disorders, and increased urea levels. If these disorders occur, stop taking Britomar before restoring normal values, and then resume treatment with a smaller dose of Britomar. When azotemia and oliguria appear or increase in patients with severe progressive kidney disease, it is recommended to suspend treatment.

 

The choice of dosage regimen for patients with ascites against the background of liver cirrhosis should be carried out under in-patient conditions (violations of the water-electrolyte balance may lead to the development of hepatic coma). This category of patients shows regular monitoring of plasma electrolytes.

 

For the prevention of hypokalemia, the use of potassium and potassium-sparing diuretics (primarily spironolactone) is recommended, as well as a diet rich in potassium.

 

The use of the drug Britomar can cause an exacerbation of gout.

 

In patients with diabetes mellitus or with reduced glucose tolerance, periodic monitoring of glucose concentrations in the blood and urine is required.

 

In patients with prostatic hyperplasia, narrowing of the ureters, diuretic control is necessary in connection with the possibility of acute urinary retention.

 

In patients with diseases of the cardiovascular system, especially those taking cardiac glycosides, diuretic-induced hypokalemia can cause arrhythmias.

 

Impact on the ability to drive vehicles and manage mechanisms

 

During the treatment period, patients should avoid practicing potentially dangerous activities requiring increased attention and speed of psychomotor reactions.

 

Drug Interactions

 

Torasemide increases the toxicity of cardiac glycosides.

 

With simultaneous administration with mineral- and glucocorticoids, laxatives, an increase in the excretion of potassium is possible.

 

Britomar enhances the effect of antihypertensive drugs.

 

Torasemide, especially in high doses, can enhance the nephrotoxic and ototoxic effect of aminoglycosides, antibiotics, platinum preparations, cephalosporins.

 

Torasemide can enhance the action of curare-like muscle relaxants and theophylline.

 

With the simultaneous use of salicylates in high doses, it is possible to intensify their toxic effects.

 

Torasemide weakens the effect of hypoglycemic drugs.

 

Consecutive or simultaneous reception of Britomar with ACE inhibitors can lead to a short-term drop in blood pressure. This can be avoided by decreasing the initial dose of an ACE inhibitor or by lowering the dose of torasemide (or temporarily abolishing it).

 

Nonsteroidal anti-inflammatory drugs (NSAIDs) and probenecid can reduce the diuretic and hypotensive effect of torasemide.

 

Bioavailability and as a consequence, the effectiveness of torasemide can be reduced by joint therapy with colestyramine.

 

Torasemide may increase the toxicity of lithium preparations and the ethoxyrinic acid's ototoxicity.

 

Analogues of the drug Britomar

 

Structural analogs for the active substance:

  • Diver;
  • Torasemide;
  • Trigrim.

 

Analogues for the pharmacological group (diuretics or diuretics):

  • Acrypamide;
  • Aldactone;
  • Arindap;
  • Arifon;
  • Arifon retard;
  • Acetazolamide;
  • Brinaldiks;
  • Verospilactone;
  • Veroshpiron;
  • Hydrochlorothiazide;
  • Hydrochlorothiazide;
  • Hypothiazide;
  • Diakarb;
  • Diver;
  • Indap;
  • Indapamide;
  • Inder;
  • Inverse;
  • Kanefron H;
  • Clopamid;
  • Cristepin;
  • Lasix;
  • Lespenefril;
  • Lasersflain;
  • Lescopryl;
  • Lauras;
  • Mannitol;
  • Moderetik;
  • Urea;
  • Niebelong H;
  • Normatens;
  • Oxodoline;
  • Retapres;
  • Sinepres;
  • Spironolactone;
  • Torasemide;
  • Triamtel;
  • Urological (diuretic) collection;
  • Phytolysin;
  • Phytonefrol;
  • Furon;
  • Furosemide;
  • Tsimalon;
  • Espiro.

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