Translation of the instruction Mose

TORADIV of a tablet of 10 mg

Instruction

On medical use of medicine

Toradiv

(toradiv)

Ingredients:

Active ingredient: torasemide;

1 tablet supports a torasemid of 10 mg;

excipients: lactoses monohydrate, starch prezhelatinizirovanny, silicon dioxide colloidal anhydrous, magnesium stearate.

Dosage form.

Tablet.

Main physical and chemical properties: white color round tablets with a unilateral notch for division.

Pharmacotherapeutic group.

Diuretic drugs. highly active diuretics.

ATX C03C A04 Code.

Pharmacological properties.

Pharmacodynamics.

Torasemid acts with

as saluretic, action is connected with oppression of renal absorption of ions of sodium and chlorine in the ascending part of a Henle's loop. At the person the diuretic effect quickly reaches the maximum within the first 2–3 hours after intravenous and oral administration respectively and remains to constants within nearly 12 hours. At healthy volunteers in the range of doses of 5-100 mg the increase in a diuresis in proportion to a dose logarithm was observed. Increase in a diuresis was observed even when other diuretics, for example distally the operating effective diuretics of a tiazidovy row, did not render the necessary effect, for example, in a renal failure any more. Thanks to such mechanism of action torasemid leads to reduction of hypostases. In case of heart failure torasemid reduces manifestations of a disease and improves functioning of a myocardium due to reduction before - and afterloads. After oral administration the antihypertensive action of a torasemid develops gradually, since first week after an initiation of treatment. The maximum of antihypertensive action is reached not later than in 12 weeks. Torasemid reduces arterial blood pressure due to decrease in the general peripheric resistance of vessels. This influence is explained by normalization of the broken electrolytic balance, mainly due to reduction of superactivity of free calcium ions in cells of muscles of arterial vessels that was revealed at the patients having arterial hypertension. Possibly, this influence reduces the increased susceptibility of vessels to endogenous angiotonic substances, for example catecholamines.

Pharmacokinetics.

by

After oral administration torasemid it is quickly and completely soaked up within 1–2 hours. The bioavailability is about 80-90%; on condition of full absorption the maximum value of effect of the first passing is 10–20%. Meal does not influence absorption of a torasemid. Linking of a torasemid with proteins of plasma makes more than 99%, metabolites of M ₁ , M ₃ , and M ₅ — 86%, 95% and 97% respectively. At the person torasemid it is metabolized with formation of three metabolites — M ₁ , M ₂ and M ₅ . There are no proofs of existence of other metabolites. Metabolites of M ₁ and M ₅ are formed as a result of oxidation of the metalny group which is on a phenolic ring to carboxylic acid. The metabolite of M ₃ is formed as a result of hydroxylation of a ring. The kinetics of a torasemid and its metabolites is characterized by linear dependence, it means that the maximum concentration in blood serum and the area under a curve of content in serum increases in proportion to a dosage. Final time of semi-removal (t _1/2 ) a torasemid and its metabolites at healthy volunteers is 3–4 hours. The general clearance of a torasemid is 40 ml/min., renal clearance — about 10 ml/min. The main metabolite of M ₅ has no diuretic effect, and and the M ₃ taken together is the share of a share of the operating metabolites of M _{1 about 10% of pharmakodinamichesky action. In a renal failure the general clearance and elimination half-life of a torasemid do not change, and elimination half-life of M 3 and M 5 is extended. However pharmakodinamichesky characteristics remain invariable, and the severity of a renal failure does not influence duration of action. At patients with an abnormal liver function or heart failure the elimination half-life of a torasemid and metabolite of M 5 is slightly extended, and the amount of the substance removed with urine corresponds to quantity which is removed at healthy people therefore cumulation of a torasemid and its metabolites should not be expected. Torasemid and his metabolites are practically not removed at a hemodialysis and haemo filtration.}

Clinical characteristics.

Indication.

Treatment and prevention of a recurrence of the hypostases and/or exudates caused by heart failure.

Contraindication.

Hypersensitivity to active ingredient, other medicaments of sulphonylurea or to excipients. a renal failure with an anury. hepatic coma or prekoma. arterial hypotension. hypovolemia. hyponatremia. hypopotassemia. considerable disturbances of urination, for example, owing to a prostatauxe.

Interaction with other medicines and other types of interactions.

Torasemid strengthens effect of other antihypertensive drugs, in particular inhibitors of angiotensin-converting enzyme that can lead to an excessive lowering of arterial pressure at their combined use. at simultaneous use of a torasemid with digitalis medicaments the deficiency of potassium caused by diuretic use can lead to increase or strengthening of side effect of both drugs. torasemid can reduce efficiency of antidiabetic means. probenetsid and non-steroidal anti-inflammatory medicaments can slow down diuretic and antihypertensive action of a torasemid. at treatment by salicylates in high doses torasemid can increase their toxic action on the central nervous system. torasemid, especially in high doses, can strengthen ototoksichesky and nephrotoxic action of aminoglikozidny antibiotics, for example Kanamycinum, gentamycin, Tobramycinum and cytostatic means — platinum derivatives and also nephrotoxic effect of cephalosporins. torasemid can strengthen effect of theophylline and also influence of kurarepodobny medicines on a relaxation of muscles. depletive and also mineralo- and glucocorticoids can strengthen the potassium loss caused torasemidy. at simultaneous use of a torasemid and medicaments of lithium the increase in concentration of lithium in plasma is possible that can cause strengthening of influence and side effects of lithium. torasemid can reduce vasoconstrictive action of catecholamines, for example epinephrine and Norepinephrinum. at simultaneous use with holesteraminy the absorption of a torasemid and according to its expected efficiency can decrease.

Feature of use.

needs to eliminate with

before use of medicament the existing hypopotassemia, a hyponatremia or a hypovolemia. at prolonged use of a torasemid the regular control of electrolytic balance, in particular potassium in blood serum, especially at the patients who are at the same time accepting foxglove glycosides, glucocorticosteroids, mineralokortikosteroida or depletive is necessary. besides, it is regularly necessary to control the content of glucose, uric acid, creatinine and lipids in blood.

Torasemid with extra care should be applied to the patients having liver diseases, followed cirrhosis and ascites as sudden changes of water and electrolytic balance can lead to a hepatic coma. Patients of this group need to carry out therapy using a torasemid (as well as other diuretics) in the conditions of a hospital. For prevention of a hypopotassemia and a metabolic acidosis it is necessary to appoint medicament with the medicaments antagonists of Aldosteronum or medicaments promoting a potassium delay in an organism. After use of drug, ototoxicity cases (sonitus and a hearing loss) which had reversible character were observed, however direct link with use of medicament is not established.

When prescribing diuretics needs to control carefully clinical symptoms of disturbance of electrolytic balance, a hypovolemia, an extrarenal azotemia and other disturbances which can be shown in the form of dryness in a mouth, thirst, weakness, slackness, drowsiness, excitement, muscular pain or sudorg, myasthenias, hypotonias, oligurias, tachycardias, nausea, vomitings. The excessive diuresis can become the cause of dehydration of an organism, lead to decrease in volume of the circulating blood, a thrombogenesis and an embolism, especially at patients of advanced age.

to Patients with disturbances of water and electrolytic balance should stop use of medicament and after elimination of undesirable effects to restore therapy, since lower doses.

Because at treatment torasemidy increase in content of glucose in blood can be observed, at patients with latent and obvious diabetes the careful check of metabolism of carbohydrates is necessary for

. Regular control of a picture of blood (erythrocytes, leukocytes, thrombocytes) is also necessary. Especially in an initiation of treatment of patients of advanced age it is necessary to pay special attention to emergence of symptoms of loss of electrolytes and a pachemia.

As does not have

sufficient clinical experience of use, it is not necessary to appoint torasemid in diseases stated below and states: gout; arrhythmia, for example sinuatrial blockade, atrioventricular block of II and III degrees; pathological changes of acid-base metabolism; the accompanying therapy with use of medicaments of lithium, aminoglycosides or cephalosporins; pathological changes of a picture of blood, for example thrombocytopenia or anemia at patients without renal failure; a renal failure, caused by nefrotoksichny substances. Drug contains lactose therefore patients with such rare hereditary diseases as intolerance of a galactose, deficiency of Lappa lactase or disturbance of malabsorption of glucose galactose it is not necessary to use this drug.

Use of tablets of a torasemid can be the cause of obtaining positive take at implementation of doping test. It is impossible to predict influence on the state of health if tablets of a torasemid are applied incorrectly, that is for the purpose of doping, in this case it is impossible to exclude possible harm for health.

Use during pregnancy and feeding by a breast.

Pregnancy.

is not present

Reliable data concerning influence of a torasemid on an embryo and a fruit of the person. In experiments on animals the toxic action of a torasemid on reproductive function was shown. Torasemid gets through a placental barrier. Due to the aforesaid torasemid it is possible to apply during pregnancy only on vital indicators and in a minimal effective dose. Diuretics are unsuitable for the standard scheme of treatment of hypostases at pregnant women as they are capable to reduce perfusion of a placental barrier and to have toxic impact on pre-natal fetation. If torasemid to apply to treatment of pregnant women with heart failure, then careful control of level of electrolytes and a hematocrit and also fetation is required.

feeding Period breast.

Use is contraindicated to

. If use of a torasemid during this period, feeding by a breast is necessary it is necessary to stop.

Ability to influence speed of response at control of motor transport or other mechanisms.

Even at appropriate use torasemid can result

in considerable negative impact on ability to run motor transport or works with other mechanisms. it in many respects concerns such cases as an initiation of treatment, increase in a dose of drug, replacement of medicament or purpose of the accompanying therapy. therefore during use of medicament it is necessary to be very careful at control of motor transport or other mechanisms.

Route of administration and doses.

Adult. to begin treatment with use of a daily dose 5 mg of a torasemid that there correspond ½ tablets of medicament toradiv. usually this dose is considered supporting. if the daily dose of 5 mg is insufficient, it is necessary to apply a daily dose of 10 mg of a torasemid which is appointed by the doctor daily. depending on weight a daily dose it is possible to increase the patient's fortunes to 20 mg of a torasemid. the maximum daily dose — 40 mg. to take a pill on an empty stomach, not to chew and wash down with a small amount of liquid. duration of treatment depends on the course of the disease.

Patients with a liver failure. Treatment of such patients should be carried out with care as increase in concentration of a torasemid in blood plasma is possible.

Patients of advanced age. Special selection of a dose is not required.

Children.

should not be Applied torasemid to children as there is no sufficient clinical experience.

Overdose.

Typical symptomatology is unknown to

. the overdose can cause a severe diuresis, including risk of excessive loss of water and electrolytes, drowsiness, an amental syndrome (one of consciousness disturbance forms), symptomatic arterial hypotension, cardiovascular insufficiency and disturbances from a digestive tract.

overdose Treatment. Specific antidote is unknown. Symptoms of intoxication disappear, as a rule, at a dose decline and cancellation of medicine and also at the corresponding substitution of liquid and electrolytes (it is necessary to carry out control). Torasemid is not brought from blood by means of a hemodialysis. Treatment in case of a hypovolemia — substitution of volume of liquid. Treatment in case of a hypopotassemia — prescribing of medicaments of potassium. Treatment of cardiovascular insufficiency — to give to the patient a sitting position and, if necessary, to appoint symptomatic therapy.

Acute anaphylaxis (urgent measures). At the first emergence of skin reactions (such as small tortoiseshell or erubescence), the excited condition of the patient, a headache, perspiration, nausea, cyanosis to carry out vein catheterization; to give to the patient horizontal position, to provide free intake of air, to appoint oxygen. If necessary to enter epinephrine, solutions substituting the liquid volume, glucocorticoid hormones.

Side reactions.

by

For assessment of by-effects used such classification of frequency of their manifestations: very often – ≥10%; often — ≥ 1% —

Metabolisms/electrolytes. Often: intensification of a metabolic alkalosis; spasms of muscles (especially in an initiation of treatment); not digestion of food, a meteorism, desires to urination, rash; increase in concentration of uric acid and glucose in blood and also a lipidemia (including increase in cholesterol and triglycerides); a hypopotassemia at the accompanying low-calorie diet, in vomiting, diarrhea, after excessive use of depletive and also at patients with chronic dysfunction of a liver. Depending on dosing and duration of treatment disturbances of water and electrolytic balances, for example a hypovolemia, a hypopotassemia and/or a hyponatremia are possible. At considerable losses of liquid and electrolytes as a result of the strengthened urination the arterial hypotension, a headache, fatigue, thirst, drowsiness, especially in an initiation of treatment and at patients of advanced age can be observed.

from a cardiovascular system. Very seldom: because of a possible pachemia there can be tromboembolic episodes, confusion of consciousness, arterial hypotension and also disturbances of blood circulation and warm activity, including ischemia of heart and brain that can lead, for example, to arrhythmia, stenocardia, an acute myocardial infarction, a syncope.

from a digestive tract. Often: disturbances of a digestive tract (especially in an initiation of treatment), including lack of appetite, a stomach ache, nausea, vomiting, diarrhea, a constipation. Very seldom: pancreatitis.

from kidneys and urinary tract. Sometimes: increase in concentration of creatinine and urea of blood. At patients with urination disturbances the increased formation of urine can lead to its delay and a recystectasia.

from a liver and biliary tract. Often: increase in concentration of some liver enzymes (gamma glutamiltranspeptidazy) in blood.

from skin and the immune system. Very seldom: allergic reactions, for example itching, dieback, photosensitization, heavy skin reactions.

from blood. Very seldom: reduction of quantity of thrombocytes, erythrocytes and/or leukocytes as result of haemo concentration.

General manifestations. Often: a headache, dizziness, increased fatigue, the general weakness (especially in an initiation of treatment). Sometimes: dryness in a mouth, unpleasant feelings in extremities (paresthesia). Very seldom: disorders of vision, a ring in ears, a hearing loss.

Expiration date.

2 years.

Storage conditions.

to Store

in original packing at a temperature not above 25 °C. to store out of children's reach.

Packing.

On 10 tablets in the blister, on 3 or 9 blisters in a pack.

Category of release.

According to the prescription.

Producer.

Ltd company "pharmex groups".

Location of the producer and its address of the place of implementation of activity.

Ukraine, 08301, Kiev Region, Boryspil, st. of Shevchenko, house 100.

needs to inform the producer On all cases of side reactions:

LLC PHARMEX GRUP, Ukraine, 08301, Kiev region, Boryspil, Shevchenko St., 100, ph.: +38 (044) 391-19-19, fax: +38 (044) 391-19-18, or through a form on the website: http://www.pharmex.com.ua/kontakty/farmakonadzor

TORADIV solution for injections of 5 mg/ml

Instruction

On medical use of medicine

Toradiv

(toradiv)

Ingredients:

Active ingredient: torasemide;

for injections the torasemida of 5 mg contains

1 ml of solution;

excipients: polyethyleneglycol 400, trometamin, sodium hydroxide, water for injections.

Dosage form.

Solution for injections.

Main physical and chemical properties: transparent, colourless solution.

Pharmacotherapeutic group.

Diuretic drugs. highly active diuretics.

ATX C03C A04 Code.

Pharmacological properties.

Pharmacodynamics.

Torasemid acts with

as saluretic, its action is connected with oppression of renal absorption of ions of sodium and chlorine in the ascending part of a Henle's loop. At the person the diuretic effect quickly reaches the maximum for the first 2–3 hours after intravenous and oral administration respectively and remains to constants for nearly 12 hours. At healthy volunteers in the range of doses of 5-100 mg the increase in a diuresis proportional to a dose logarithm (loopback activity of diuretic) was observed. Increase in a diuresis was observed even when other diuretics, for example distally the operating diuretics of a tiazidovy row, did not render the necessary effect, for example, in a renal failure any more. Thanks to such mechanism of action torasemid leads to reduction of hypostases. In case of heart failure torasemid reduces manifestations of a disease and improves functioning of a myocardium due to reduction before - and afterloads.

Pharmacokinetics.

Linking of a torasemid with proteins of blood plasma makes more than 99%, metabolites of M ₁ , M ₃ and M ₅ — 86%, 95% and 97% respectively. The visible volume of distribution (Vz) is 16 l. In a human body torasemid it is metabolized with formation of three metabolites — M ₁ , M ₃ and M ₅ . There are no proofs of existence of other metabolites. Metabolites of M ₁ , and M ₅ are formed by M ₃ as a result of stupenchasty oxidation of the methyl group attached to a phenolic ring to carboxylic acid, the metabolite of M ₃ is formed as a result of hydroxylation of a ring. At the person it did not turn out to viyavit metabolites of M ₂ and M ₄ found in experiments on animals.

Pharmacokinetics of a torasemid and its metabolites is characterized by linear dependence. It means that its maximum concentration in blood serum and the area under a curve of content in blood serum increases in proportion to a dosage. Final elimination half-life (t _1/2 ) a torasemid and its metabolites in healthy volunteers makes 3–4 hours. The general clearance of a torasemid is

40 ml/min., renal clearance — about 10 ml/min. At healthy volunteers about 80% of the entered dose it is removed in the form of a torasemid and its metabolites with urine with such average percentage: torasemid — about 24%, a metabolite of M ₁ – about 12%, a metabolite of M ₃ — about 3%, a metabolite of M ₅ — about 41%. The main metabolite of M ₅ has no diuretic effect, and and the M ₃ taken together is the share of the operating metabolites of M _{1 about 10% of all pharmakodinamichesky action. In a renal failure the general clearance and t 1/2 a torasemida do not change, and t 1/2 and M 5 is extended with M 3 . However pharmakodinamichesky characteristics remain not changed, and the severity of a renal failure does not influence duration of action. In patients with abnormal liver functions or heart failure the period of t 1/2 a torasemid and a metabolite of M 5 slightly increases, and the amount of the substance removed with urine almost completely corresponds to quantity which is removed at healthy volunteers therefore accumulation of a torasemid and its metabolites does not happen. Torasemid and his metabolites are practically not removed at a hemodialysis and haemo filtration.}

Clinical characteristics.

Indication.

Treatment of the hypostases and/or exudates caused by heart failure if intravenous use of medicine, for example, in case of a fluid lungs owing to an acute heart failure is necessary.

Contraindication.

Hypersensitivity to active ingredient, medicaments of sulphonylurea and to one of medicament excipients. a renal failure with an anury. hepatic coma or prekoma. arterial hypotension. hypovolemia. hyponatremia. hypopotassemia. an acute disorder of urination, for example, owing to a prostatauxe. feeding period breast.

Interaction with other medicines and other types of interactions.

Torasemid strengthens effect of other antihypertensive drugs, in particular inhibitors of angiotensin-converting enzyme that can lead to an excessive lowering of arterial pressure at their combined use. at simultaneous use of a torasemid with digitalis medicaments the deficiency of potassium caused by use of diuretics can lead to increase and strengthening of side effect of both drugs. torasemid can reduce efficiency of anti-diabetic means. probenetsid and non-steroidal anti-inflammatory medicaments (for example, indometacin, acetylsalicylic acid) can slow down diuretic and antihypertensive action of a torasemid. at treatment by salicylates in high doses torasemid can increase their toxic action on the central nervous system. torasemid, especially in high doses, can strengthen ototoksichesky and nephrotoxic action of aminoglikozidny antibiotics, for example Kanamycinum, gentamycin, Tobramycinum and cytostatic means — active derivatives of platinum and also nephrotoxic effect of cephalosporins. torasemid can strengthen effect of theophylline and also influence of kurarepodobny medicines. depletive and also mineralo- and glucocorticoids can strengthen the potassium loss caused torasemidy. at simultaneous use of a torasemid and medicaments of lithium the increase in concentration of lithium in blood plasma is possible that can cause strengthening of influence and strengthening of side effects of lithium. torasemid can reduce vasoconstrictive action of catecholamines, for example epinephrine and Norepinephrinum. at simultaneous use with holestiraminy the absorption of a torasemid and according to its expected efficiency can decrease.

Feature of use.

needs to eliminate with

before use of medicament the existing hypopotassemia, a hyponatremia or a hypovolemia.

At long use of a torasemid is recommended to exercise regular control of electrolytic balance, in particular potassium in blood serum, especially in patients who at the same time apply foxglove glycosides, glucocorticoids, mineralokortikoida or depletive. Besides, it is regularly necessary to control the level of glucose, uric acid, creatinine and lipids in blood. Torasemid patients who have the liver diseases which are followed by cirrhosis and ascites as sudden changes of water and electrolytic balance can lead to a hepatic coma need to apply with extra care. Patients of this group need to carry out therapy using a torasemid (as well as other diuretics) in the conditions of a hospital. For prevention of a hypopotassemia and a metabolic acidosis it is necessary to appoint medicament together with the medicaments antagonists of Aldosteronum or medicaments promoting a potassium delay in an organism. After use of a torasemid, ototoxicity cases (sonitus and a hearing loss) which had reverse character were observed, however direct link with use of medicament is not established. At use of diuretics it is necessary to control carefully clinical symptoms of disturbance of electrolytic balance, a hypovolemia, an extrarenal azotemia and other disturbances which can be shown in the form of dryness in a mouth, thirst, weakness, slackness, drowsiness, excitement, muscular pain or spasms, a myasthenia, hypotonia, an oliguria, tachycardia, nausea, vomiting. The excessive diuresis can become the cause of dehydration of an organism, lead to decrease in volume of the circulating blood, a thrombogenesis and an embolism, especially in patients of advanced age.

to Patients with disturbances of water and electrolytic balance needs to stop use of medicament and after elimination of undesirable effects to restore therapy, since other doses.

Because at treatment torasemidy increase in content of glucose in blood can be observed, in patients with latent or obvious diabetes it is necessary to carry out a continuous careful inspection of metabolism of carbohydrates. Regular control of a picture of blood (erythrocytes, leukocytes, thrombocytes) is also necessary. Especially in an initiation of treatment the patients of advanced age need to pay special attention to emergence of symptoms of loss of electrolytes and a pachemia.

should not appoint

in case of lack of sufficient clinical experience of use torasemid in the presence of the following diseases and states: gout; arrhythmia, for example sinuatrial blockade, atrioventricular block ІІ and ІІІ degrees; pathological changes of acid-base metabolism; the accompanying therapy using medicaments of lithium, aminoglycosides or cephalosporins; pathological changes of a picture of blood, for example thrombocytopenia or anemia in patients without renal failure; the renal failures caused by nephrotoxic substances.

Use of the medicament Toradiv can be the cause of obtaining positive take at test for doping. In this case it is impossible to exclude negative impact of medicament on health if to apply it out of indications, that is for the purpose of doping.

Use during pregnancy or feeding by a breast.

Pregnancy.

is not present

Reliable data concerning influence of a torasemid on an embryo and a fruit in the person. Torasemid gets through a placental barrier. Therefore medicament is used during pregnancy only according to vital indications and in minimum possible effective dose. Diuretics are unsuitable for the standard scheme of treatment of arterial hypertension or hypostases in pregnant women as they are capable to reduce perfusion of a placental barrier and to have toxic impact on pre-natal fetation. If torasemid it is applied to treatment of pregnant women with a heart or renal failure, then it is required to carry out careful monitoring of electrolytes and a hematocrit and also to watch carefully fetation.

feeding Period breast.

to

it is not established Now whether gets torasemid into breast milk at animals or the person. It is impossible to exclude risk of use of medicament in newborns/babies. Therefore use of a torasemid in the period of a lactation is contraindicated. If it is necessary to apply torasemid during this period, then feeding by a breast it is necessary to stop.

Fertility.

Researches of influence of a torasemid on fertility at people were not conducted by

.

Ability to influence speed of response at control of motor transport or other mechanisms.

Even on condition of appropriate use torasemid can have negative effect on ability to run motor transport or to work with other mechanisms. it in many respects concerns such cases as an initiation of treatment, increase in a dose of drug, replacement of medicine or purpose of the accompanying therapy. therefore at use of a torasemid it is necessary to be very careful at control of motor transport or other mechanisms.

Route of administration and doses.

Adult. treatment it is necessary to begin with reception of a single dose 2 ml of medicament toradiv that is equivalent to 10 mg of a torasemid a day. if the effect is insufficient, then it is possible to increase a single dose to 4 ml of medicament toradiv that is equivalent to 20 mg of a torasemid. if the effect also in this case is insufficient, it is possible to perform short-term (within no more than 3 days) therapy with introduction of a daily dose of 8 ml of medicament toradiv that is equivalent to 40 mg of a torasemid.

Acute fluid lungs. Treatment it is necessary to begin 4 ml of the medicament Toradiv with intravenous administration of a single dose that is equivalent to 20 mg of a torasemid. Depending on effect, this dose can be repeated at an interval of 30 minutes. It is forbidden to exceed the maximum daily dose of 20 ml of the medicament Toradiv that is equivalent to 100 mg of a torasemid.

Solution for injections to enter

intravenously, slowly. It is forbidden to enter solution vnutriarterialno. To enter only pure solution. At prolonged use the intravenous administration needs to be replaced with oral administration as intravenous use of a torasemid is not recommended to spend more than 7 days as soon as possible.

Patients with a liver failure. Treatment of this category of patients should be carried out with care as increase in concentration of a torasemid in blood plasma is possible.

Patients of advanced age. Treatment of this category of patients does not demand special selection of a dose. However the corresponding researches concerning people of advanced age in comparison with young patients were not conducted.

Children.

should not be applied torasemid to children and teenagers due to the lack of sufficient clinical experience.

Overdose.

Typical symptomatology is unknown to

. the overdose can cause a severe diuresis, including risk of excessive loss of water and electrolytes, drowsiness, an amental syndrome (one of consciousness disturbance forms), symptomatic arterial hypotension, cardiovascular insufficiency and disorders from digestive system.

overdose Treatment. Specific antidote is unknown. Symptoms of intoxication disappear, as a rule, at decrease in a dosage and cancellation of medicine and at the corresponding substitution of liquid and electrolytes (it is necessary to carry out control). Torasemid is not brought from blood by means of a hemodialysis.