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Before starting to use the drug, it is necessary to eliminate the existing hypokalemia, hyponatremia or hypovolemia. With long-term use of torasemide, regular monitoring of the electrolyte balance, in particular, potassium in the blood serum, is necessary, especially in patients simultaneously taking digitalis glycosides, glucocorticosteroids, mineralocorticosteroids or laxatives. In addition, it is necessary to regularly monitor the content of glucose, uric acid, creatinine and lipids in the blood. Torasemide should be used with extreme caution in patients suffering from liver disease, accompanied by cirrhosis of the liver and ascites, since sudden changes in water and electrolyte balance can lead to hepatic coma.
Therapy with torasemide (as well as other diuretics) in patients of this group should be carried out in a hospital setting. To prevent hypokalemia and metabolic acidosis, the drug should be administered with aldosterone antagonist drugs or drugs that promote potassium retention in the body. After the use of torasemide, cases of ototoxicity (tinnitus and hearing loss) were observed, which were reversible, but a direct connection with the use of the drug was not established. When prescribing diuretics, it is necessary to carefully monitor the clinical symptoms of electrolyte imbalance, hypovolemia, extrarenal azotemia and other disorders, which may manifest as dry mouth, thirst, weakness, lethargy, drowsiness, agitation, muscle pain or cramps, myasthenia gravis, hypotension, oliguria, tachycardia, nausea, vomiting.
Excessive diuresis can lead to dehydration, lead to a decrease in circulating blood volume, thrombus formation and embolism, especially in elderly patients. Patients with impaired water and electrolyte balance should stop using the drug and, after eliminating undesirable effects, restore therapy, starting with lower doses. Due to the fact that during treatment with torasemide, an increase in blood glucose may be observed, for patients with latent and overt diabetes mellitus, a careful check of carbohydrate metabolism is necessary. You should also regularly monitor the blood picture (erythrocytes, leukocytes, platelets).
Especially at the beginning of treatment for elderly patients, special attention should be paid to the appearance of symptoms of electrolyte loss and blood clotting. In the absence of sufficient clinical experience of use, torasemide should not be prescribed for the following diseases and conditions: gout; arrhythmias, for example, with sinoatrial blockade, atrioventricular blockade of the II and III degrees; with pathological changes in acid-base metabolism; concomitant therapy with lithium preparations, aminoglycosides, or cephalosporins; pathological changes in the blood picture, for example, thrombocytopenia or anemia in patients without renal failure; impaired renal function caused by nephrotoxic substances.
The drug contains lactose, therefore, patients with such rare hereditary diseases as galactose intolerance, Lapp lactase deficiency or impaired glucose-galactose malabsorption should not use this drug. The use of the drug Toraren can be the reason for obtaining a positive result when performing a doping test. It is impossible to predict the effect on health if the drug Toraren is used incorrectly, that is, for the purpose of doping; in this case, possible harm to health cannot be ruled out.
Keep out of the reach of children in its original packaging at a temperature not exceeding 25 ° C.
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