Diver - instructions for use, reviews, analogs and forms of release (5 mg and 10 mg tablets) diuretic for the treatment of hypertension and edema in adults, children and in pregnancy

In this article, you can read the instructions for using a diuretic medicine Diver. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of Diver in their practice. 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 Diver in the presence of existing structural analogs. Use for the treatment of hypertension and edema in adults, children, as well as during pregnancy and lactation.

Diver - loop diuretic. The main mechanism of action of the drug is due to the reversible binding of torasemide (the active substance of the drug Dyuver) to the Na / Cl / K transporter located in the apical membrane of the thick segment of the ascending section of the Henle loop. As a result, the reabsorption of sodium ions decreases and completely inhibits and the osmotic pressure of the intracellular fluid decreases and the water reabsorption decreases. It blocks aldosterone receptors in the myocardium, reduces fibrosis and improves diastolic function of the myocardium.

Torasemide, to a lesser degree than furosemide, causes hypokalemia, while it shows great activity and its effect is more prolonged.

The maximum diuretic effect develops 2-3 hours after ingestion. Diuretic effect persists up to 18 hours, this facilitates the tolerability of therapy due to the lack of very frequent urination during the first hours after ingestion, which limits the activity of patients.

Diver can be used for a long time.

Composition

Torasemide + auxiliary substances.

Pharmacokinetics

After oral administration, Dyuver quickly and almost completely absorbed from the digestive tract.Bioavailability is about 80% with minor individual variations. Metabolized in the liver with the participation of cytochrome P450 isoenzymes. As a result of successive oxidation, hydroxylation or ring hydroxylation reactions, 3 metabolites are formed (M1, M3 and M5), binding to plasma proteins is 86%, 95% and 97%, respectively. On average, about 83% of the dose is given by the kidneys: unchanged (24%) and mostly inactive metabolites (M1 - 12%, M3 - 3%, M5 - 41%).

Indications

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

Forms of release

Tablets 5 mg and 10 mg.

Instructions for use and dosing regimen

The drug is taken orally once a day after breakfast, washed down with a small amount of water.

Ocular syndrome of various genesis, incl. with chronic heart failure, liver, lung and kidney diseases

The therapeutic dose is 5 mg once a day. If necessary, the dose should be gradually increased to 20-40 mg once a day, in some cases - up to 200 mg per day.The drug is prescribed for a long period or until the disappearance of edema.

Arterial hypertension

The initial dose is 2.5 mg (1/2 tablet 5 mg) once a day. If necessary, the dose can be increased to 5 mg once a day.

Older patients do not need a dose adjustment.

Side effect

• hyponatremia, chloropenia, hypokalemia, hypomagnesemia, hypocalcemia;
• headache;
• confusion of consciousness;
• convulsions;
• tetany;
• muscle weakness;
• heart rhythm disturbances;
• dyspeptic disorders;
• hypovolemia;
• dehydration (usually in elderly patients);
• thrombosis;
• excessive decrease in blood pressure;
• orthostatic hypotension;
• collapse;
• tachycardia;
• arrhythmias;
• increasing the concentration of creatinine and urea in the blood;
• increasing the concentration of uric acid in the blood, which can cause or intensify the manifestations of gout;
• a decrease in glucose tolerance (a manifestation of latent diabetes mellitus is possible);
• oliguria;
• acute urinary retention (e.g., prostatic hyperplasia, urethral constriction, hydronephrosis);
• interstitial nephritis;
• hematuria;
• decreased potency;
• nausea, vomiting;
• diarrhea;
• acute pancreatitis;
• hearing impairment;
• tinnitus, especially in patients with renal insufficiency or hypoproteinemia (nephrotic syndrome);
• paresthesia;
• itching;
• hives;
• erythema multiforme;
• exfoliative dermatitis;
• purpura;
• fever;
• vasculitis;
• eosinophilia;
• photosensitization;
• severe anaphylactic or anaphylactoid reactions up to shock;
• Thrombocytopenia, leukopenia, agranulocytosis, aplastic or hemolytic anemia.

Contraindications

• renal failure with anuria;
• hepatic coma and precoma;
• pronounced hypokalemia;
• severe hyponatremia;
• hypovolemia (with or without arterial hypotension) or dehydration;
• marked abnormalities of urine outflow from any etiology (including unilateral urinary tract damage);
• intoxication with cardiac glycosides;
• acute glomerulonephritis;
• decompensated aortic and mitral stenosis;
• hypertrophic obstructive cardiomyopathy;
• increased central venous pressure (more than 10 mm Hg);
• hyperuricemia;
• age to 18 years;
• lactation period (breastfeeding);
• lactose intolerance, lactase deficiency, glucose-galactose malabsorption;
• hypersensitivity to the components of the drug;
• hypersensitivity to sulfonamides (sulfanilamide antimicrobial agents or sulfonylureas).

Application in pregnancy and lactation

In pregnancy, Diower can be used only if the potential benefit to the mother exceeds the possible risk to the fetus, only under the supervision of the doctor and only in minimum doses.

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 is excreted in breast milk. If you need the drug Diver during lactation should stop breastfeeding.

Application in elderly patients

Older patients are not required to select a specific dose.

Use in children

Contraindicated in children and adolescents under the age of 18 years (efficacy and safety not established).

special instructions

Apply strictly according to the doctor's prescription.

Patients with hypersensitivity to sulfonamides and sulfonylureas may have cross-sensitivity to the Diver.

Patients receiving high doses of Diver for a prolonged period, in order to avoid the development of hyponatremia, metabolic alkalosis and hypokalemia, a diet with a sufficient content of table salt and the use of potassium preparations is recommended.

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 electrolytes in the blood plasma (including sodium, calcium, potassium, magnesium), acid-base state, residual nitrogen, creatinine, uric acid and, if necessary, appropriate corrective therapy (with higher multiplicity in patients with frequent vomiting and against the background of parenterally injected fluids).

When azotemia and oliguria occur in patients with severe progressive kidney disease, it is recommended to suspend treatment.

Selection of the dosing regimen in patients with ascites against the background of liver cirrhosis should be carried out in a hospital (violations of water-electrolyte balance may lead to the development of hepatic coma). This category of patients shows regular monitoring of plasma electrolytes.

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

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

Impact on the ability to drive vehicles and manage mechanisms

During the treatment period, patients should refrain from driving vehicles and practicing other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Drug Interactions

Diver increases the concentration and risk of developing nephro- and ototoxic effects of cephalosporins, aminoglycosides, chloramphenicol, ethacrynic acid, cisplatinum, amphotericin B (due to competitive kidney excretion).

Torasemide increases the effectiveness of diazoxide and theophylline, reduces the effectiveness of hypoglycemic agents, allopurinol.

Pressor amines and torasemide mutually reduce efficiency.

Drugs that block tubular secretion, increase the concentration of torasemide in blood plasma.

With the simultaneous use of glucocorticosteroids (GCS), amphotericin B increases the risk of hypokalemia, with cardiac glycosides - the risk of developing glycosidic intoxication due to hypokalemia (for high and low polarity) and T1 / 2 prolongation (for low-polarity) increases.

Diver reduces the renal clearance of lithium preparations and increases the likelihood of intoxication.

Non-steroidal anti-inflammatory drugs (NSAIDs), sucralfate reduce the diuretic effect due to inhibition of prostaglandin synthesis, disturbance of renin activity in blood plasma and aldosterone elimination.

Torasemide enhances the hypotensive effect of antihypertensive drugs, neuromuscular blockade of depolarizing muscle relaxants (suxamethonium), and weakens the effect of nondepolarizing muscle relaxants (tubocurarine).

With the simultaneous administration of salicylates in high doses against the background of torasemide therapy, the risk of their toxicity increases (due to competitive excretion by the kidneys).

Sequential or simultaneous use of torasemide with ACE inhibitors or angiotensin 2 receptor antagonists can lead to a strong reduction in blood pressure.This can be avoided by lowering the dose of torasemide or temporarily abolishing it.

When used simultaneously with probenecid or methotrexate, the effectiveness of Diver may be reduced (the same way of secretion). On the other hand, torasemide may lead to a reduction in the excretion of these drugs by the kidneys.

With the simultaneous use of cyclosporine and torasemide, the risk of gouty arthritis increases due to the fact that cyclosporine can cause impairment of urate excretion by the kidneys, and torasemide is hyperuricemia.

It has been reported that patients with a high risk of developing nephropathy receiving torasemide inside, with the introduction of radiopaque agents, impaired renal function were observed more often than in patients with a high risk of developing nephropathy, who received intravenous hydration prior to administration of radiocontrast agents.

Analogues of the drug Diver

Structural analogs for the active substance:

• Britomar;
• Torasemide;
• Torasemide Canon;
• Trigrim.

Analogues for the pharmacological group (diuretics):

• Aquaphor;
• Acrypamide;
• Aldactone;
• Arifon;
• Arifon retard;
• Acetazolamide;
• Brinaldiks;
• Brinerdin;
• Brusniver;
• Bufenox;
• Verospilactone;
• Veroshpiron;
• Hygroton;
• Hydrochlorothiazide;
• Hydrochlorothiazide;
• Hypothiazide;
• Diakarb;
• Zokardis plus;
• Isobar;
• Indap;
• Indapamide;
• Inder;
• Ionik;
• Kanefron H;
• Clopamid;
• Cristepin;
• Lasix;
• Lespenefril;
• Lasersflain;
• Lescopryl;
• Lauras;
• Mannitol;
• Mannitol;
• Niebelong H;
• Normatens;
• Retapres;
• Sinepres;
• Spironolactone;
• Torasemide;
• Triamtel;
• Urological (diuretic) collection;
• Phytolysin;
• Furosemide;
• Fursemide;
• Cimalon.

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