Trigrim® (Trigrim®)

Composition Pharmacodynamics Indications Carefully Contraindications Dosing and Administration Side effects Form release / dosage
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Active substanceTorasemideTorasemide
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    • Dosage form: & nbsppills
    Composition:
    1 tablet contains the active substance torasemide 2.5 mg, 5 mg or 10 mg.
    Excipients: lactose, corn starch, silicon dioxide colloid, magnesium stearate.
    Description:

    For a dosage of 2.5 mg:

    Round biconvex tablets of white color.

    For a dosage of 5 mg and 10 mg:

    Round flat cylindrical tablets of white color; with a facet on both sides and a dividing risk on one side.

    Pharmacotherapeutic group:Diuretics
    ATX: & nbsp

    C.03.C.A   Sulfonamide diuretics

    C.03.C.A.04   Torasemide

    Pharmacodynamics:
    The main mechanism of action of the drug is due to the reversible binding of torasemide to the Na + / 2Cl- / K + transporter located in the apical membrane of the thick segment of the ascending loop of Henle, thereby reducing or completely inhibiting the reabsorption of sodium ions, thereby reducing the osmotic pressure of the intracellular fluid and reabsorption of water .
    At the same time, due to the anti-aldosterone action torasemide to a lesser extent than furosemide causes hypokalemia, with greater activity and duration of action.
    Pharmacokinetics:After oral administration torasemide quickly and almost completely absorbed in the gastrointestinal tract. The maximum concentration of torasemide in plasma is noted 1-2 hours after the administration. Bioavailability is about 80-91% or more with swelling. Connection with blood plasma proteins - 99%. The volume of distribution is 16 liters. Metabolized in the liver in the cytochrome P450 system with the formation of 3 metabolites Ml, M3 and M5.
    The half-life of torasemide and its metabolites in healthy volunteers is 3-4 hours. The total clearance of torasemide is 40 ml / min and the renal clearance is about 10 ml / min. On average, 80-83% of the accepted dose is excreted through the renal tubules: unchanged (24-25%) and in the form of metabolites (Ml-11-12%, M3 -3%, M5 41-44%).
    With renal failure, the half-life of torasemide does not change.
    Indications:
    - Edema caused by heart failure, liver, kidney and lung diseases.
    - Primary hypertension (used in monotherapy or in combination with other antihypertensive drugs).
    Contraindications:
    - hypersensitivity to torasemide and sulfonamides;
    - anuria;
    - hepatic coma and precomatosis;
    - chronic renal failure with increasing azotemia;
    - arrhythmia;
    - arterial hypotension;
    - pregnancy;
    - lactation period (no data on lactation use);
    - age to 18 years (efficacy and safety not established).
    Carefully:Diabetes mellitus, gout, abnormal water-electrolyte balance, impaired liver function, cirrhosis, predisposition to hyperuricemia.
    Dosing and Administration:

    Inside.

    Adults:

    Edema:

    5 mg once a day. If necessary, the dose can be gradually increased to 20 mg once a day. In some cases, up to 40 mg of Trigrim® is recommended per day.

    Congestive heart failure:

    5 - 20 mg once a day. If necessary, the daily dose can be gradually increased (doubling it), a maximum of 200 mg.

    Chronic kidney failure:

    The initial dose is 20 mg per day. If necessary, this dose can be gradually increased (doubling it), until an appropriate diuretic action is achieved. The maximum daily dose is 200 mg.

    Cirrhosis of the liver:

    5 - 10 mg once a day. If necessary, this dose can be gradually increased (doubling it), until an appropriate diuretic action is achieved.

    Appropriate studies were not conducted in patients with liver disease with doses greater than 40 mg per day.

    Primary arterial hypertension:

    2.5 mg orally once a day. If necessary, the dose can be gradually increased to 5 mg per day. According to studies, a dose of more than 5 mg per day does not lead to a further decrease in blood pressure. The maximum effect is achieved after about twelve weeks of continuous treatment.

    Older patients:

    Older patients do not require a special adaptation of the dose.

    Children:

    There is no data on the use of Trigrim in children.

    Food has no effect on the absorption of Trigrim®, so the drug can be taken regardless of food intake.

    Side effects:

    From the side of the blood: in some cases may experience changes in blood biochemical indices: reduction in the number of erythrocytes and leukocytes, and platelets, hypovolemia, electrolyte imbalance, hypokalemia, increased uric acid in blood serum lipids and glucose. An increase in the level of certain liver enzymes, for example gamma-GT.

    From the cardiovascular system: in some cases, because of the thickening of the blood, there are disorders of blood circulation and thromboembolism, a decrease in blood pressure (BP) of the blood.

    From the digestive tract: various dysfunctions of the gastrointestinal tract (GIT), loss of appetite, in some cases can develop pancreatitis.

    From the side of the kidneys and urinary tracts: acute urinary retention, increased levels of urea and creatinine in the plasma.

    From the central nervous system: headache, dizziness, weakness, drowsiness, confusion, convulsions, as well as paresthesia of the extremities.

    Allergic reactions: skin itching, rashes and photosensitivity.

    From the sense organs; visual disturbances, tinnitus, deafness.

    Other: dry mouth.

    Overdose:
    Symtomas - there is no typical pattern of poisoning.
    When an overdose - forced urination, accompanied by hypovolemia, a violation of the electrolyte balance, followed by a drop in blood pressure, drowsiness, confusion, collapse. Gastrointestinal disorders may occur.
    The specific antidote is unknown.Symptomatic treatment involves reducing the dose or canceling the drug and at the same time replenishment of fluid loss and electrolytes.
    Interaction:

    - Increases the sensitivity of the myocardium to cardiac glycosides in the presence of potassium or magnesium deficiency.

    - With simultaneous administration with mineral- and glucocorticoids, laxatives can increase the excretion of potassium.

    - Strengthens the effect of antihypertensive drugs.

    - In large doses can enhance the toxic effect of aminoglycosides, antibiotics, cisplatinum; nephrotoxic effect of cephalosporins, as well as cardio- and neurotoxic effects of lithium.

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

    - When using large doses of salicylates, their toxic effect can be increased, and the action of antidiabetics, on the contrary, is weakened.

    - Sequential or simultaneous administration of torasemide with angiotensin-converting enzyme (ACE) inhibitors can lead to a transient fall in blood pressure. This can be avoided by decreasing the initial dose of ACE, or by lowering the dose of torasemide (or temporarily abolishing it).

    - Torasemide reduces the effect of vasoconstrictor (epinephrine and norepinephrine)

    - Non-steroidal anti-inflammatory drugs and probenicides can reduce the diuretic and hypotensive effect of torasemide.

    - Kolestyramin can reduce the absorption of torasemide from the gastrointestinal tract (in animal experiments).

    Special instructions:
    - With prolonged treatment, it is recommended to monitor electrolyte balance, glucose, uric acid, creatinine and lipids in the blood.
    - With hypokalemia, hyponatremia, hypovolemia, or urinary disorders before the appointment of Trigrim®, all these conditions are eliminated before the administration of this drug.
    - Precautions for gout or tendencies to increase levels of uric acid
    - If you have diabetes, you need to monitor carbohydrate metabolism.
    - With thrombocytopenia or oppression of bone marrow function, as well as with skin rashes, the drug should be discontinued.
    Effect on the ability to drive transp. cf. and fur:
    At the initial stage of admission, it is not recommended to drive vehicles and maintain machinery due to the possibility of dizziness.
    Form release / dosage:
    Tablets of 2.5 mg, 5 mg and 10 mg.
    Packaging:
    For 10 tablets in a foil blister A1 / PVC.
    3 blisters (30 tablets) with instructions for use in a cardboard box.
    Storage conditions:In a dry, the dark place at a temperature of no higher than 25 ° C. Keep out of the reach of children.
    Shelf life:
    3 years. Do not use the drug after the expiration date.
    Terms of leave from pharmacies:On prescription
    Registration number:LSR-004423/09
    Date of registration:04.06.2009 / 12.09.2014
    Expiration Date:Unlimited
    The owner of the registration certificate:Pharmaceutical factory "POLFARMA" JSCPharmaceutical factory "POLFARMA" JSC Poland
    Manufacturer: & nbsp
    Representation: & nbspAKRIKHIN OJSC AKRIKHIN OJSC Russia
    Information update date: & nbsp27.02.2017
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