Diver

Diuver, also known by its generic name torasemide, is a diuretic medication used to treat swelling associated with heart failure, kidney disease, or liver disease. It belongs to a class of drugs called loop diuretics, which help the body get rid of excess water and salts through urine.

Torasemide works by blocking the reabsorption of sodium and chloride in the loop of Henle in the kidneys, which leads to increased urine output. This can help reduce symptoms associated with excess fluid load, such as swelling, shortness of breath, and fatigue.

Diuver is often used when other diuretics, such as furosemide, are ineffective or when a more consistent diuretic effect is needed. It is important to take this medication under the supervision of a doctor, as it can affect electrolyte levels and other aspects of health.

Indications Diouvera

1. Heart Failure: Diuver is used to reduce symptoms and prevent complications of chronic heart failure by helping to reduce swelling and improve breathing.
2. Edema: It is effective in treating edema associated with cardiac, renal or hepatic failure by reducing excess fluid accumulation in the tissues.
3. Arterial hypertension: Diuver is sometimes used to treat high blood pressure, although this is not the main indication. It helps control blood pressure by reducing the volume of circulating fluid.

Release form

Diuver is usually available in tablet form for oral administration.

Pharmacodynamics

1. Inhibits sodium and chloride reabsorption: Diuver is a strong inhibitor of potassium channels in the glomerular apical membrane, as well as type 2 potassium channels in the vascular epithelium. This leads to increased excretion of sodium and chloride in the urine, which helps reduce circulating blood volume and reduce edema.
2. Reduces Calcium Reabsorption: Diuver may also reduce calcium reabsorption in the kidneys, which may be useful in treating certain conditions such as calcium oxalate stone.
3. Improves Heart Function: In addition to its diuretic effect, torasemide may also have a beneficial effect on heart function. This is due to the reduction in the amount of blood the heart must pump, which may reduce its workload.
4. Antihypertensive action: Diuver can also lower blood pressure by reducing blood volume and improving diuresis.

Pharmacokinetics

1. Absorption: It has good and predictable absorption after oral administration. Peak plasma concentrations are usually reached 1-2 hours after administration.
2. Metabolism: Metabolized in the liver, mainly with the involvement of cytochrome P450. The main metabolite is torasemide dehydrochloride.
3. Elimination: It is eliminated from the body mainly by the kidneys (about 80-90% as unchanged drug). Its half-life is about 3-5 hours, making it longer than some other diuretics.
4. Protein binding: binds to plasma proteins at a level of approximately 95%.
5. Interactions: May interact with other drugs, especially antiarrhythmic drugs, lithium, drugs that affect electrolyte balance such as digoxin or aminoglycosides, and some nonsteroidal anti-inflammatory drugs.

Dosing and administration

1. Dosage: The usual starting dose of Diuver is 5 to 10 mg once daily. In some cases, the dose may be increased to 20 mg daily. However, the recommended dose may vary depending on the patient’s condition, the severity of the disease, and other factors.
2. Directions for use: Diuver is usually taken orally, with or without food, depending on your doctor's recommendations. The tablets are swallowed whole with water.
3. Regularity of administration: It is important to follow your doctor's instructions regarding the regularity of administration and dosage of the drug. Do not change the dosage or stop taking it without consulting your doctor.
4. Monitoring: During treatment, it is important to regularly monitor the patient's condition, including blood pressure, kidney function, and blood electrolyte levels.
5. Following other recommendations: Your doctor may also give you additional recommendations regarding diet, physical activity, and other aspects of treatment that you should follow to achieve the best results.

Use Diouvera during pregnancy

The use of Diuver during pregnancy is not recommended, especially in the first trimester, due to the lack of data on its safety for the fetus and the possibility of negative effects on its development. Torasemide belongs to the class of loop diuretics, which can reduce plasma volume and reduce placental blood flow, which can potentially lead to fetal hypoxia and other adverse effects.

Studies have shown that many loop diuretics, including torsemide, should not be used during pregnancy unless there is a compelling medical indication that outweighs the potential risks to the fetus. A literature review found no increased risk of adverse effects such as birth defects or fetal growth restriction with diuretic use in utero, but these data did not include specific information for torsemide (Albalas et al., 2009).

Therefore, before using torasemide or other diuretics during pregnancy, you should discuss all potential risks and benefits with your doctor.

Contraindications

1. Anuria is a complete lack of urination, which may indicate severe kidney damage.
2. Severe renal failure (especially if urine formation does not occur).
3. Severe disturbances of water-electrolyte balance - torasemide can aggravate the condition associated with deficiency of substances such as potassium and sodium.
4. Severe hepatic coma or pre-coma.
5. Hypersensitivity to torasemide or other sulfonamides - in case of allergy to sulfonamides, the risk of allergic reactions to torasemide increases.
6. Pregnancy and lactation - the drug may have adverse effects on the fetus or newborn.

Side effects Diouvera

1. Electrolyte disturbances: Decreased levels of potassium, sodium, magnesium, and calcium in the blood, which can lead to muscle cramps, weakness, irregular heartbeat, and other serious conditions.
2. Dehydration: Losing a lot of fluid can lead to dehydration, which can cause dry mouth, fatigue, weakness, and dizziness.
3. Kidney problems: In rare cases, torasemide may cause kidney failure or worsening of kidney function, especially in patients with pre-existing kidney disease.
4. Hypotension: A drop in blood pressure, especially when standing up (orthostatic hypotension), which can cause dizziness or fainting.
5. Hyperuricemia: Increased levels of uric acid in the blood, which can contribute to the development of gout.
6. Gastrointestinal symptoms: Such as nausea, diarrhea or constipation.
7. Metabolic changes: Including elevated blood glucose levels, which can be a problem for people with diabetes.
8. Allergic reactions: Rash, itching, or more serious reactions such as angioedema.

Overdose

1. Electrolyte disturbances: Overdose of torasemide may cause significant losses of potassium, sodium and other electrolytes, which may lead to the development of hypokalemia, hyponatremia and other electrolyte disturbances.
2. Dehydration: Excessive diuretic action of torasemide in case of overdose can lead to severe dehydration and loss of fluid from the body.
3. Hypotension: Loss of fluid and electrolytes can lead to low blood pressure and hypotension.
4. Renal failure: In case of significant overdose, acute renal failure may occur due to decreased blood flow to the kidneys and tissue damage.

Interactions with other drugs

1. Cardiovascular drugs: Torasemide may enhance the effects of other cardiovascular drugs, such as antihypertensives or arrhythmia medications. This may increase the effectiveness of the treatment or may increase side effects.
2. Drugs affecting electrolyte balance: Since torasemide is a diuretic that promotes the excretion of sodium and water from the body, its combination with other drugs affecting electrolyte balance, such as antihypertensives, anticoagulants or drugs affecting potassium, may lead to additional changes in the level of electrolytes in the body.
3. Nonsteroidal anti-inflammatory drugs (NSAIDs): Torasemide may enhance the toxic effect of nonsteroidal anti-inflammatory drugs on the kidneys, especially in patients with pre-existing renal insufficiency.
4. Endocrine-modifying drugs: Torasemide may interact with endocrine-modifying drugs such as glucocorticoids or aldosterone-containing drugs, which may lead to additional changes in electrolytes and renal function.
5. Drugs affecting the central nervous system: The combination of torasemide with drugs affecting the central nervous system (CNS), such as barbiturates or hypnotics, may lead to increased sedative effects.