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Chỉ định và Liều dùng
Intravenous
Oedema Adult: 10-20 mg daily as IV inj slowly over 2 min. Max: 200 mg daily. Oral Oedema in patients with hepatic cirrhosis Adult: Initially, 5-10 mg once daily, given together with an aldosterone antagonist or a potassium-sparing diuretic, titrated upwards until the desired diuretic response is obtained. Max: 40 mg daily. Oral Hypertension Adult: 2.5-5 mg once daily. Max: 5 mg daily. Oral Oedema Adult: 5 mg once daily, increased to 20 mg once daily if necessary. Max: 40 mg/day.
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Cách dùng
May be taken with or without food.
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Chống chỉ định
Hypersensitivity to sulfonylureas, renal failure with anuria, hepatic coma and pre-coma, hypotension, cardiac arrhythmias. Pregnancy and lactation.
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Thận trọng
Risk of hyperuricaemia, gout and DM. Correct electrolyte distubances and disorders of micturition before treatment. Monitor electrolyte balance, glucose, uric acid, creatinine and lipids regularly. May impair ability to drive or operate machinery.
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Phản ứng phụ
Electrolyte disturbances e.g. hypokalaemia, dehydration, dry mouth, headache, dizziness, hypotension, weakness, drowsiness, confusional states, loss of appetite, cramps, increased serum uric acid, glucose, lipids, urea and creatinine, increase in LFT, metabolic alkalosis, tinnitus and hearing loss.
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Quá liều
Symptoms: Marked diuresis with severe dehydration and electrolytes disturbances. Somnolence, confusion, hypotension, circulatory collapse and GI disturbances. Management: Reduce or stop torasemide. There is no antidote and treatment involves simultaneous replacement of fluid and electrolytes. Haemodialysis unlikely to be useful.
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Tương tác
Increased risk of severe hypokalaemia with amphotercin B, corticosteroids, carbenoxolone, hypokalaemia-causing medications. Increased risk of lithium toxicity. Increased potential for ototoxicity and nephrotoxicity with nephrotoxic or ototoxic medications e.g. aminoglycosides. High dose salicylates may increase the risk of salicylate toxicity. Increased risk of toxicity with digoxin. Reduced diuretic effect with NSAIDs. Increased risk of hypotension with antihypertensives.
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Tác dụng
Description: Torasemide, a sulfonylurea loop diuretic, acts from within the lumen of the thick ascending portion of the loop of Henle, where it inhibits the Na+/K+/2CI--carrier system.
Onset: Diuresis: Oral: Within 1 hr; IV: Within 10 min. Duration: Diuresis: Oral and IV: 8 hr. Pharmacokinetics: Absorption: Absorbed rapidly and almost completely (oral). Peak serum levels after 1-2 hr. Food decreases rate but not extent of absorption. Distribution: Protein-binding: >99%. Apparent distribution volume: 16 L. Metabolism: Metabolised by the cytochrome P450 isoenzyme CYP2C9. Elimination half-life: 3.5 hr. Excretion: Excreted by urine as unchanged drug (24%) and metabolites. |
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