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There are no available data on use of torsemide in pregnant women and the risk of major birth defects or miscarriage. Tinnitus and hearing loss (usually reversible) have been observed after rapid intravenous (IV) injection of other loop diuretics and have also been observed after oral torsemide. Because of its inhibition of CYP2C9 metabolism, torsemide may affect the efficacy and safety of sensitive CYP2C9 substrates, such as celecoxib, or of substrates with a narrow therapeutic range, such as warfarin or phenytoin. Spironolactone, sold under the brand name Aldactone among others, is a medication that is primarily used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. There is no significant orthostatic effect, and there is only a minimal peak-trough difference in blood pressure reduction. Special dosage adjustment in the elderly is not necessary. Torsemide can increase the risk of renal toxicity related to administration of radiocontrast agents. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Torasemide, also known as torsemide, is a diuretic medication used to treat fluid overload due to heart failure, kidney disease, and liver disease and high blood pressure. The usual oral initial dose is 5 mg once daily. The usual initial dose is 5 mg daily. In these patients, diuresis with torsemide is best initiated in the hospital. Drops per minute can be adjusted on the device. The patients should be told that if syncope occurs, DYTOR should be discontinued until the physician has been consulted. The usual initial dose is 10 mg or 20 mg of once-daily oral or IV torsemide. Consider suspending or discontinuing torsemide. Avoid concomitant use of torsemide and aminoglycoside antibiotics, if possible. Torsemide may be slowly injected over 2 minutes or given by continuous infusion (an IV). Storage requirements: IV: The manufacturer product information should be consulted. Higher than recommended doses, severe renal impairment, and hypoproteinemia, appear to increase the risk of ototoxicity. DYTOR 5 Tablets: Blister pack of 10 tablets, DYTOR 10 Tablets: Blister pack of 10 tablets, DYTOR 20 Tablets: Blister pack of 10 tablets, DYTOR 40 Tablets: Blister pack of 10 tablets, DYTOR 100 Tablets: Blister pack of 10 tablets. The recommended initial dose is 5 mg or 10 mg of once-daily oral or IV torsemide, administered together with an aldosterone antagonist or a potassium-sparing diuretic. In healthy subjects given single doses, the dose-response relationship for sodium excretion is linear over the dose range of 2.5 mg to 20 mg. The following adverse reactions have been identified during the post-approval use of torsemide. Because of reduced renal clearance, a smaller fraction of any given dose is delivered to the intraluminal site of action, so at any given dose there is less natriuresis in patients with heart failure than in normal subjects. Coadministration of organic anion drugs (e.g., probenecid) that undergo significant renal tubular secretion have the potential to reduce secretion of torsemide into the proximal tubule and thereby decreases the diuretic activity of torsemide. If the diuretic response is inadequate, titrated upward by approximately doubling until the desired diuretic response is obtained. Non-Steroidal Anti-Inflammatory Agents (NSAIDs): Because torsemide and salicylates compete for secretion by renal tubules, patients receiving high doses of salicylates may experience salicylate toxicity when torsemide is concomitantly administered. Diuretics can suppress lactation. the IV fluid you can do so by following the two steps shown in the yellow box below: Step 1: Calculate the concentration of the additive in the IV fluid: ! Torsemide increases the urinary excretion of sodium, chloride, and water, but it does not significantly alter glomerular filtration rate, renal plasma flow, or acid-base balance. Beximco Pharmaceuticals Ltd (BPL) is a leading manufacturer of pharmaceutical formulations and Active Pharmaceutical Ingredients (APIs) in Bangladesh. Storage Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. If the diuretic response is inadequate, the dose should be titrated upward by approximately doubling until the desired diuretic response is obtained. Torsemide can cause potentially symptomatic hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, and hypochloremic alkalosis. Please enter the Unique ID (UID) given by Cipla Representative. In patients with congestive heart failure, hepatic cirrhosis, or renal disease treated with torsemide at doses higher than those studied in United States antihypertensive trials, hypokalemia was observed with greater frequency, in a dose-related manner. This medication is … Pantoprazole is a proton pump inhibitor used in the treatment of stomach ulcers, gastroesophageal reflux disease (GERD) and other acidity-related disorders. Chronic use of any diuretic in hepatic disease has not been studied in adequate and well-controlled trials. Among these subjects were 564 who received torsemide during United States-based trials in which 274 other subjects received placebo. You can also report side effects directly via the national pharmacovigilance program of India by calling on 1800 180 3024 or you can report to Cipla Ltd on 1800 267 7779. Learn about the benefits and side effects of Neurobion here. should be titrated upward by approximately doubling until the desired diuretic response is obtained. Axosemide, Tripamide 26. In the U.S. general population, the estimated background risk of major malformations and miscarriage in clinically recognized pregnancies is 2-4%, and 15-20%, respectively. On a body-weight basis, these doses are 27 to 96 times a human dose of 20 mg; on a body-surface-area basis, they are 5 to 8 times this dose. Discontinuation of therapy due to adverse reactions occurred in 3.5% of United States patients treated with torsemide and in 4.4% of patients treated with placebo. Learn about side effects, warnings, dosage, and more. Because of the high bioavailability of torsemide, oral and doses are therapeutically equivalent, so patients may be switched to and from the intravenous form with no change in dose. The renal clearance of torsemide is lower in elderly subjects as compared to younger adults, which is related to  the decline in renal function that commonly occurs with aging. If the diuretic response is inadequate, the dose Laboratory determinations of serum levels of torsemide and its metabolites are not widely available. Reporting suspected adverse reactions after authorisation of the medicinal product is important. Fetal and maternal toxicity (decrease in average body weight, increase in fetal resorption and delayed fetal ossification) occurred in rabbits and rats given doses 4 (rabbits) and 5 (rats) times larger. Uncoated Tablet containing 5 mg, 10, 20, 40 and 100 mg of torsemide and Injection containing 10 mg torsemide. Hypertensive patients who received 10 mg of daily torsemide experienced a mean increase in serum glucose concentration of 5.5 mg/dL (0.3 mmol/L) after 6 weeks of therapy, with a further increase of 1.8 mg/dL (0.1 mmol/L) during the subsequent year. Torsemide does not affect the pharmacokinetics of digoxin. In single-dose studies in patients with non-anuric renal failure, high doses of torsemide (20 mg to 200 mg) caused marked increases in water and sodium excretion. trials. Dytor 10 MG Injection is used for Edema (Swelling), Hypertension etc. Single doses higher than 40 mg have not been adequately studied. After 6 weeks at these doses, the mean decrease in serum potassium was approximately 0.1 mEq/L. There are no data regarding the presence of torsemide in human milk or the effects of torsemide on the breastfed child. The increase in potassium excretion is negligible after a single dose of up to 10 mg and only slight (5 mEq to 15 mEq) after a single dose of 20 mg. Torsemide has been studied in controlled trials in patients with New York Heart Association Class II to Class IV heart failure. If DYTOR is administered through an IV line, it is recommended that, as with other IV injections, the IV line be flushed with Normal Saline (Sodium Chloride Injection, USP) before and after administration. The term injection encompasses intravenous (IV), intramuscular (IM), subcutaneous (SC) and intradermal (ID) administration. Edema associated with Chronic Renal Failure. Monitor patients and adjust dosages if necessary. Gastrointestinal system: Pancreatitis, abdominal pain, Nervous System: Paresthesia, confusion, visual impairment, loss of appetite, Hematologic: Leucopenia, thrombocytopenia, anemia, Hepatobiliary: Increase in liver transaminases, gamma-glutamyltransferase, Metabolism: Thiamine (vitamin B1) deficiency, Skin/hypersensitivity: Stevens-Johnson syndrome, toxic epidermal necrolysis, photosensitivity reaction, pruritus. HOW TO USE: This medication is given by injection into a vein as directed by your doctor, usually once daily. may be switched to and from the intravenous form with no change in dose. If your patient experiences any side-effects, write to drugsafety@cipla.com. It allows continued monitoring of the benefit/risk balance of the medicinal product. DYTOR tablets may be given at any time in relation to a meal, as convenient. As for other drugs which produce changes in blood pressure, patients taking torasemide should be warned not to drive or operate machinery if they experience dizziness or related symptoms. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. In patients with decompensated congestive heart failure, hepatic and renal clearance are both reduced, probably because of hepatic congestion and decreased renal plasma flow, respectively. torsemide can cause sudden alterations of fluid and electrolyte balance which may precipitate hepatic coma in patients with hepatic disease with cirrhosis and ascites. In the placebo-controlled hypertension studies excessive urination was dose related; 1% of patients receiving placebo, 4% of those treated with 5 mg of daily torsemide, and 15% of those treated with 10 mg. The antihypertensive and diuretic effects of torsemide can be reduced by NSAIDs. However, the pharmacokinetic profile and diuretic activity of torsemide are not altered by spironolactone. DYTOR intravenous (IV) injection should be administered either slowly as a bolus over a period of 2 minutes or administered as a continuous IV infusion. Neurobion is a brand of vitamin B supplements that aims to improve nerve function. If the 5 mg dose does not provide adequate reduction in blood pressure within 4 to 6 weeks, the dose may be increased to 10 mg once daily. We are offering Pause-500 Tablets to our client. However, total plasma clearance and elimination half-life remain unchanged. Treating Functional Constipation in Children: PEG 3350 vs... Overuse of Short Acting β2-Agonists in Asthma in European... Edema associated with congestive heart failure, renal disease, or hepatic disease. After a single oral dose, the amounts recovered in urine were: torsemide 21%, metabolite M1 12%, metabolite M3 2%, and metabolite M5 34%. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. Metabolite M1 is formed by methyl-hydroxylation of torsemide, metabolite M3 is formed by ring hydroxylation of torsemide, and metabolite M5 is formed by oxidation of M1. DYTOR (torsemide) is a diuretic of the pyridine-sulfonylurea class. Müller K, Gamba G, Jaquet F, Hess B. Torasemide vs. furosemide in primary care patients with chronic heart failure NYHA II to IV--efficacy and quality of life. Torsemide does not affect the protein binding of glyburide or warfarin. Loop diuretics increase the ototoxic potential of other ototoxic drugs, including aminoglycoside antibiotics and ethacrynic acid. Select one or more newsletters to continue. IV twice a day, Injection optineuron 1 ample in normal saline IV once a day, Injection Lupinox 0.4cc subcutaneous twice a day, injection Piptaz 4.5 gm in 100 ml normal saline IV trice a day, injection Febrinil 75 mg once daily in The signs and symptoms of torsemide overdosage can be anticipated to be those of excessive pharmacologic effect: dehydration, hypovolemia, hypotension, hyponatremia, hypokalemia, hypochloremic alkalosis, and hemoconcentration. There was no effect of age or sex on the incidence of adverse reactions. Its chemical name is 1-isopropyl-3­ urea and its structural formula is: Its empirical formula is C16H20N4O3S, its pKa is 7.1, and its molecular weight is 348.43. PubMed 11. Diuretic activity thus correlates better with the rate of drug excretion in the urine than with the concentration in the blood. If either is found, the ampoule should not be used. This is NOT to be confused with Drops per Minute (gtt/min). In pre-approval studies, torsemide has been evaluated for safety in approximately 4000 subjects; over 800 of these subjects received torsemide for at least 6 months, and over 380 were treated for more than 1 year. >DYTOR INJECTION 2ML(INS) [2ML] ACICLOVIR >DYTOR PLUS 10(INS) [10] ACICLOVIR >DYTOR PLUS 20(INS) [10] ACICLOVIR >DYTOR PLUS 5 (INS) [10`S] >DYTOR … डीटॉर 10 एमजी इंजेक्शन (Dytor 10 MG Injection) उच्च रक्तचाप के उपचार में प्रयोग किया जाता है जो आनुवांशिक और पर्यावरणीय कारकों के … DYTOR intravenous (IV) injection should be administered either slowly as a bolus over a period of 2 minutes or administered as a continuous IV infusion. In doses up to 25 mg/kg/day (75 times a human dose of 20 mg on a body-weight basis; 13 times this dose on a body-surface-area basis), torsemide had no adverse effect on the reproductive performance of male or female rats. All patients should be cautioned that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to an excessive fall in blood pressure, with the same consequences of lightheadedness and possible syncope, Non-Steroidal Anti-inflammatory Drugs (NSAID): Advise patients to discuss with their physician before taking NSAID medications concomitantly, Cipla House, Peninsula Business Park, Ganpatrao Kadam Marg, Lower Parel, Mumbai, Maharashtra, INDIA, Currently there are no topics under this speciality. Torsemide is not dialyzable, so hemodialysis will not accelerate elimination. Know uses, side effects, dosage, contraindications, substitutes, benefit, interactions, purpose, drug interactions, … This effect has been reported with concomitant use of torsemide and gentamycin. Cholestyramine: Concomitant use of torsemide and cholestyramine has not been studied in humans but, in a study in animals, coadministration of cholestyramine decreased the absorption of orally administered torsemide. Know Dytor 10 MG Injection uses, side-effects, composition, substitutes, drug interactions, precautions, dosage, warnings only on … DYTOR is contraindicated in patients with. Data sources include IBM Watson Micromedex (updated 3 Mar 2021), Cerner Multum™ (updated 1 Mar 2021), ASHP (updated 3 Mar 2021) and others. In normal subjects the elimination half-life of torsemide is approximately 3.5 hours. (0.6 mmol/L), the mean increase in serum creatinine was 0.05 mg/dL (4 mmol/L), and the mean increase in serum uric acid was 1.2 mg/dL (70 mmol/L). No mutagenic activity was detected in any of a variety of in vivo and in vitro tests of torsemide and its major human metabolite. torsemide 20 mg caused small increases in total cholesterol and triglycerides in short term hypertension studies. In pregnant rats and rabbits dosed, on a mg/m2 basis, with 10 and 1.7 times a human dose of 20 mg/day, respectively, there was no fetotoxicity or teratogenicity. IV Compatibilities Solution: D5W Y-site: Milrinone IV Administration Administer either as slow injection over 2 minutes or as continuous infusion If given through IV line, flushing with NS before and afterward is recommended Storage In patients followed for 1 year, there was no progressive change in mean serum potassium levels. The other loop diuretic, when administered during the first weeks of life, has also been reported to increase the risk of persistent patent ductus arteriosus . Dosage is based on your Concomitant use of CYP2C9 inhibitors (e.g., amiodarone, fluconazole, miconazole, oxandrolone) can decrease torsemide clearance and increase torsemide plasma concentrations. Blood Urea Nitrogen (BUN), Creatinine and Uric Acid, torsemide produces small dose-related increases in each of these laboratory values. Hypertension alone or in combination with other antihypertensive agents. Partial inhibition of the natriuretic effect of torsemide by concomitant administration of indomethacin has been demonstrated for torsemide under conditions of dietary sodium restriction (50 mEq/day) but not in the presence of normal sodium intake (150 mEq/day). Concomitant use of CYP2C9 inducers (e.g., rifampin) increase torsemide clearance and decrease plasma torsemide concentrations. It … Monitoring : -Metabolic: Monitor electrolytes regularly; creatinine, glucose, lipids, and uric acid should also be monitored regularly in patients taking this drug long-term, especially those with a tendency to hyperuricemia and gout or those with latent or manifest diabetes. If torsemide and cholestyramine should be coadministered, administer torsemide at least one hour before or 4 to 6 h after cholestyramine administration. Nephrocalcinosis/nephrolithiasis has also been observed in children under 4 years of age with no history of prematurity who have been treated chronically with the other loop diuretic. The total clearance of torsemide is approximately 50% of that seen in healthy volunteers, and the plasma half-life and AUC are correspondingly increased. Eptoin in injection form Download Here Free HealthCareMagic App to Ask a Doctor All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. Potassium Chloride Injection Description This Potassium Chloride Injection, is a sterile, nonpyrogenic, highly concentrated, ready-to-use, solution of Potassium Chloride, USP in Water for Injection, USP for electrolyte replenishment in a single dose container for intravenous administration. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Monitor diuretic effect and blood pressure during coadministration. However, in pregnant rats and rabbits administered 50 and 6.8 times the human dose, respectively, decreases in body weight, decreased fetal resorption and delayed fetal ossification was observed. The daily doses of torsemide used in these trials ranged from 1.25 mg to 20 mg, with most patients receiving 5 mg to 10 mg; the duration of treatment ranged from 1 to 52 days, with a median of 41 days. To prevent hypokalemia and metabolic alkalosis, use an aldosterone antagonist or potassium-sparing drug with torsemide in patients with hepatic disease. The tests included the Ames test in bacteria (with and without metabolic activation), tests for chromosome aberrations and sister-chromatid exchanges in human lymphocytes, tests for various nuclear anomalies in cells found in hamster and murine bone marrow, tests for unscheduled DNA synthesis in mice and rats, and others. If adequate response is not obtained, the dose can be increased up to four tablets of DYTOR PLUS 5 or DYTOR PLUS 10. Pharma & Leadership Academy By SSP Sir 5,950 views

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