TOREM

Adults Oedema:

The usual dose is 5mg. once daily. If necessary, the dose can be increased stepwise up to 20mg once daily. In individual cases, as much as 40mg torasemide/day has been administered. Special populations Elderly No special dosage adjustments are necessary.

Children There is no experience of torasemide in children. Patients with hepatic impairment As elimination half-lives of torasemide and its metabolites in patients with mild to moderate hepatic impairment are only slightly increased, dose adjustment in these patients is not required.

4). Extreme caution is required when torasemide is administered in patients with a history of hepatic encephalopathy. Method of administration Torasemide tablets are intended to be administered by oral route. Tablets must be swallowed with some fluid without chewing.

For convenience, the tablets should be taken in the morning.

g. g. g. g. g. Blood triglycerides increased, Blood cholesterol increased) Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.

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Torasemide may lead to a profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required, and dose schedules have to be adjusted to the individual patient's needs. Especially at the start of the treatment and in elderly, patients must be carefully monitored.

Regular blood monitoring of the electrolyte balance, potassium values and the parameters glucose, uric acid, and creatinine should be carried out especially during long-term treatment with torasemide for signs of electrolyte and volume deficiency and haemoconcentration.

Urine retention must be corrected before or during treatment with torasemide. Extreme caution is required when torasemide is administered in patients suffering from severe urine retention. Patients with partial occlusion of the urinary tract must be closely monitored.

There is an increased risk of gout attacks with patients taking diuretics. Caution is required when torasemide is administered in patients with gout. Carbohydrate metabolism in latent or manifest diabetes mellitus should be monitored.

In nephrotic syndrome, treatment of the primary disease should take precedence. In patients with hepatic cirrhosis and ascites, it is recommended that diuresis with any drug be initiated in the hospital. Too rapid diuresis in such patients can precipitate severe electrolyte disturbances and hepatic coma.

Extreme caution is required when torasemide is administered in patients with a history of hepatic encephalopathy. The concomitant use of an aldosterone antagonist or a potassium-sparing drug is recommended to prevent hypokalemia and metabolic alkalosis.

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. Torasemide might cause hypokalaemia that has prominent effects on cardiac, skeletal, and intestinal muscle cells.

1. • Anuria with renal failure. • Hepatic coma until the condition is improved or corrected. • Hypotension • Pre-existing hypovolaemia • Cardiac arrhythmias • Simultaneous therapy with aminoglycosides or cephalosporins • Renal dysfunction due to drugs which cause renal damage