Your doctor may need to adjust your medication or diet. Not considered a preferred agent for initial management of hypertension; 501 502 503 504 however, may be useful in selected patients with renal impairment 500 502 504 or heart failure. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. daflon
Periodically monitor serum potassium and other electrolyte concentrations. Baylis EM, Crowley JM, Preece JM, Sylvester PE, Marks V. Influence of folic acid on blood-phenytoin levels. Inoue F. Clinical implications of anticonvulsant-induced folate deficiency. Use with caution. May make these conditions worse. Tell your doctor if you develop any new symptoms.
When given with aldosterone antagonists, Demadex also caused increases in sodium and fluid excretion in patients with edema or ascites due to hepatic cirrhosis. Urinary sodium excretion rate relative to the urinary excretion rate of Demadex is less in cirrhotic patients than in healthy subjects possibly because of the hyperaldosteronism and resultant sodium retention that are characteristic of portal hypertension and ascites. However, because of the increased renal clearance of Demadex in patients with hepatic cirrhosis, these factors tend to balance each other, and the result is an overall natriuretic response that is similar to that seen in healthy subjects. Chronic use of any diuretic in hepatic disease has not been studied in adequate and well-controlled trials.
If adequate response not observed with 10 mg once daily, an additional antihypertensive agent should be added to antihypertensive therapy. Demadex can cause sudden alterations of fluid and electrolyte balance which may precipitate hepatic coma in patients with hepatic disease with cirrhosis and ascites. In these patients, diuresis with Demadex is best initiated in the hospital. Increase as necessary by approximately doubling dosage until desired diuresis is attained. 12 13 14 Single doses exceeding 40 mg not adequately studied.
Do not consider WebMD User-generated content as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately. Most renal clearance of torsemide occurs via active secretion of the drug by the proximal tubules into tubular urine. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Many patients who have high blood pressure will not notice any signs of the problem. In fact, most patients feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well. Symptoms may include fast or irregular heartbeat; inability to urinate; nausea; severe headache; vomiting. No substantial differences in safety and efficacy relative to younger adults. Some of these products contain sulfites, which can cause allergic reactions in certain individuals eg, asthma patients. If you have previously had allergic reactions to sulfites, contact your pharmacist to determine if the product you are taking contains sulfites. The use of loop diuretics, particularly at high dosages or during chronic therapy, is commonly associated with loss of electrolytes, including potassium, sodium, chloride, magnesium, and calcium. Potassium and magnesium depletion may lead to cardiac arrhythmias and cardiac arrest. Other electrolyte-related complications include metabolic alkalosis and hyponatremia, which are rarely life-threatening. Excessive diuresis, as indicated by rapid weight loss, may induce dehydration and hypovolemia, which can result in acute hypotension, orthostasis, circulatory collapse, vascular thrombosis and embolism, and abrupt reduction in glomerular filtration and renal blood flow. Severe dehydration is most likely to occur in the elderly and patients under prolonged sodium restriction. Therapy with loop diuretics should be administered cautiously in patients with or predisposed to fluid and electrolyte depletion, including patients with primary or secondary aldosteronism may have low potassium levels; those with severe or prolonged diarrhea or vomiting; and those with poor nutritional status. Fluid and electrolyte abnormalities should be corrected before initiating therapy, and blood pressure as well as serum electrolyte concentrations monitored periodically and maintained at normal ranges during therapy. Patients should be advised to immediately report signs and symptoms of fluid or electrolyte imbalance, including dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, arrhythmia, or gastrointestinal disturbances such as nausea and vomiting. Digitalized patients and patients with a history of ventricular arrhythmias should be monitored carefully, since the development of hypokalemia may be particularly dangerous in these patients. The risk of hypokalemia may be minimized by slow diuresis, a lower diuretic dosage, potassium supplementation, or combined use with a potassium-sparing diuretic. Similarly, to prevent excessive dehydration and hyponatremia, sodium intake should be liberalized if clinically feasible. Katz RL, Matteo RS, Papper EM. The injection of epinephrine during general anesthesia with halogenated hydrocarbons and cyclopropane in man. Gupta D, Georgiopoulou VV, Kalogeropoulos AP et al. Dietary sodium intake in heart failure. Circulation.
Urinary excretion accounts for approximately 20% of total clearance in patients with normal renal function. 1 12 Most renal clearance occurs via active secretion of the drug by the proximal tubules into tubular urine. Note: Fraudulent online pharmacies may attempt to sell an illegal generic version of Demadex. These medications may be counterfeit and potentially unsafe. If you purchase medications online, be sure you are buying from a reputable and valid online pharmacy. Ask your health care provider for advice if you are unsure about the online purchase of any medication. In adults, initially, 20 mg once daily. 1 14 Increase as necessary by approximately doubling dosage until desired diuresis is attained. 1 14 Single doses exceeding 200 mg not adequately studied. Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first. Coadministration of digoxin is reported to increase the AUC for torsemide by 50%, but dose adjustment of Demadex is not necessary. Torsemide does not affect the pharmacokinetics of digoxin. The pharmacokinetic profile and diuretic activity of torsemide are not altered by cimetidine. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. Roche Pharmaceuticals. Demadex torsemide tablets and injection prescribing information. Nutley, NJ: 2003 Apr. Serious. These medicines may interact and cause very harmful effects. It is not known whether torsemide passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby. Clinical pharmacology studies have confirmed this site of action in humans, and effects in other segments of the nephron have not been demonstrated. Diuretic activity thus correlates better with the rate of drug excretion in the urine than with the concentration in the blood. It may keep torsemide from working properly. pamelor
The volume of distribution of torsemide is 12 to 15 liters in normal adults or in patients with mild to moderate renal failure or congestive heart failure. In patients with hepatic cirrhosis, the volume of distribution is approximately doubled. Tinnitus and hearing loss, usually reversible, have been observed following rapid IV injection of other loop diuretics and following oral torsemide administration. 1 12 13 14 Administer IV slowly over 2 minutes; do not exceed 200 mg as a single dose. The most common adverse reactions were headache and excessive urination. Berg MJ, Rivey MP, Vern BA, Fischer LJ, Schottelius DD. Phenytoin and folic acid: individualized drug-drug interaction. Dopamine is usually handled and stored by a health care provider. If you are using dopamine at home, store dopamine as directed by your pharmacist or health care provider. This medicine may make you dizzy or drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Sit or lie down if you feel dizzy. Stand up carefully. Importance of informing patients with diabetes mellitus that blood glucose concentrations may increase. order clarinex in canada online clarinex
Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests. Frohlich ED. Recognition of systolic hypertension for hypertension. Hypertension. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC 7. Bethesda, MD: National Institutes of Health; 2004 Aug. NIH publication No. 04-5230. Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus. Food delays the time to peak plasma concentration following oral dosing but does not affect extent of absorption or diuretic activity. Demadex torsemide is a used to reduce edema swelling from multiple causes and also used to treat . Demadex is available as a generic. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Gibberd FB, Nicholls A, Wright MG. The influence of folic acid on the frequency of epileptic attacks. Do not keep outdated medicine or medicine no longer needed. Of the total number of patients who received Demadex in United States clinical studies, 24% were 65 or older while about 4% were 75 or older. No specific age-related differences in effectiveness or safety were observed between younger patients and elderly patients. Products meeting necessary bioequivalence requirements. average wholesale price for imuran
Not known whether torsemide is distributed into milk. 1 12 13 14 Caution if used in nursing women. In patients with essential hypertension, Demadex has been shown in controlled studies to lower blood pressure when administered once a day at doses of 5 mg to 10 mg. The antihypertensive effect is near maximal after 4 to 6 weeks of treatment, but it may continue to increase for up to 12 weeks. Systolic and diastolic supine and standing blood pressures are all reduced. There is no significant orthostatic effect, and there is only a minimal peak-trough difference in blood pressure reduction. For solution and drug compatibility information, see Compatibility under Stability. Administer orally, by direct IV injection, or by continuous IV infusion. May cause side effects to become worse. luhr.info effexor
Melgrave AP. The use of epinephrine in the presence of halothane in children. For information on systemic interactions resulting from concomitant use, see Interactions. Administer IV injections of torsemide either slowly over 2 minutes “bolus” or as a continuous infusion. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. Katz RL, Epstein RA. The interaction of anesthetic agents and adrenergic drugs to produce cardiac arrhythmias. In addition to the use of the medicine your doctor has prescribed, treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet. 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. If Demadex and cholestyramine should be coadministered, administer Demadex at least one hour before or 4 to 6 h after cholestyramine administration. With oral dosing, the onset of diuresis occurs within 1 hour and the peak effect occurs during the first or second hour and diuresis lasts about 6 to 8 hours. Tell you doctor or dentist that you take Demadex before you receive any medical or dental care, emergency care, or surgery. These medicines are used during surgical procedures or in a hospital. If you are to have either inpatient or outpatient surgery, or are to be admitted to the hospital, make sure that all the healthcare professionals are aware of all the different medicines that you are taking. This includes prescription medicines, herbal drugs, and nutraceuticals. Demadex and 3% on placebo. In patients followed for 1 year, there was no progressive change in mean serum potassium levels. In patients with congestive heart failure, hepatic cirrhosis, or renal disease treated with Demadex at doses higher than those studied in United States antihypertensive trials, hypokalemia was observed with greater frequency, in a dose-related manner. The antihypertensive effects of Demadex are, like those of other diuretics, on the average greater in black patients a low-renin population than in nonblack patients. Ikezono E, Yasuda K, Hattori Y. Effects of propranolol on epinephrine-induced arrhythmias during halothane anesthesia in man and cats. Because Demadex and salicylates compete for secretion by renal tubules, patients receiving high doses of salicylates may experience salicylate toxicity when Demadex is concomitantly administered.
NSAIDs. Monitor volume status and renal function periodically. Ask your healthcare professional how you should dispose of any medicine you do not use. Mattson RH, Gallagher BB, Reynolds EH, Glass D. Folate therapy in epilepsy. A controlled study. Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. Torsemide is also used alone or together with other medicines to treat high blood pressure hypertension. High blood pressure adds to the work load of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. Bioavailability is approximately 80%. Maximum of 200 mg as a single dose daily. buy tenormin germany
May use IV administration when a rapid onset of diuresis is desired or when oral therapy is not practical. 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. In the rat study, the high-dose female group demonstrated renal tubular injury, interstitial inflammation, and a statistically significant increase in renal adenomas and carcinomas. The tumor incidence in this group was, however, not much higher than the incidence sometimes seen in historical controls. Similar signs of chronic non-neoplastic renal injury have been reported in high-dose animal studies of other diuretics such as furosemide and hydrochlorothiazide. Excessive diuresis may cause potentially symptomatic dehydration, blood volume reduction and hypotension and worsening renal function, including acute renal failure particularly in salt-depleted patients or those taking renin-angiotensin aldosterone inhibitors. In long-term studies, no clinically important differences in lipid profiles compared to baseline. Torsemide is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. Demadex may cause dizziness. This effect may be worse if you take it with alcohol or certain medicines. Use Demadex with caution. The recommended initial dose is 5 mg once daily. If the 5 mg dose does not provide adequate reduction in blood pressure within 4 to 6 weeks, increase to 10 mg once daily. If the response to 10 mg is insufficient, add another antihypertensive agent to the treatment regimen. Do I need a prescription for bumetanide? Torsemide does not affect the protein binding of glyburide or warfarin. Use Demadex as directed by your doctor. Check the label on the medicine for exact dosing instructions. In healthy subjects, coadministration of torsemide was associated with significant reduction in the renal clearance of spironolactone, with corresponding increases in the AUC. However, the pharmacokinetic profile and diuretic activity of torsemide are not altered by spironolactone. 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. The total clearance of torsemide is approximately 50% of that seen in healthy volunteers, and the plasma half-life and AUC are correspondingly increased. 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. Avoid eating licorice or Korean ginseng while taking Demadex. selegiline online netherlands
Demadex is a strong "water pill" diuretic. Using too much of this drug can lead to serious water and mineral loss. Therefore, it is important that you be monitored by your doctor. Food and Drug Administration. WebMD does not endorse any specific product, service, or treatment. In patients with hepatic cirrhosis, the volume of distribution, plasma half-life, and renal clearance are all increased, but total clearance is unchanged. Laboratory determinations of serum levels of torsemide and its metabolites are not widely available. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Increases in total plasma cholesterol concentrations may occur; usually subside during chronic therapy. Alexander JP. Dysrhythmia and oral surgery. If your symptoms do not improve or if they become worse, check with your doctor. Renal calcifications reported in severely premature infants with edema secondary to patent ductus arteriosus and hyaline membrane disease receiving another loop diuretic. 1 12 14 Increased risk of persistent patent ductus arteriosus in premature neonates with hyaline membrane disease receiving another loop diuretic also has been reported. PREGNANCY and BREAST-FEEDING: If you become pregnant while taking dopamine, discuss with your doctor the benefits and risks of using dopamine during pregnancy. It is unknown if dopamine is excreted in breast milk. If you are or will be breast-feeding while you are using dopamine, check with your doctor or pharmacist to discuss the risks to your baby. Appropriate studies have not been performed on the relationship of age to the effects of torsemide in the pediatric population. Safety and efficacy have not been established. Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take. online wellbutrin side
Matteo RS, Katz RL, Papper EM. The injection of epinephrine during general anesthesia. Should not be used in patients with these conditions. Tell your doctor if your condition does not improve or if it worsens. In geriatric patients, decreased renal clearance. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. chloramphenicol
Ask your health care provider any questions you may have about how to use dopamine. When Demadex is first administered, daily urinary sodium excretion increases for at least a week. With chronic administration, however, daily sodium loss comes into balance with dietary sodium intake. If the administration of Demadex is suddenly stopped, blood pressure returns to pretreatment levels over several days, without overshoot. It is unknown if this drug passes into milk. Consult your doctor before -feeding. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Like other diuretics, torsemide reduces the renal clearance of lithium, inducing a high risk of lithium toxicity. Monitor lithium levels periodically when torsemide is coadministered. James PA, Oparil S, Carter BL et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee JNC 8. JAMA. Dosage is based on your medical condition and response to treatment. not increase your dose or take it more often than directed. Not known whether torsemide is distributed into milk. This information should not be used to decide whether or not to take Demadex or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about Demadex. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to Demadex. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using Demadex. Initially, 5 mg once daily. For these reasons, FAERS case reports cannot be used to calculate incidence or estimates of risk for a particular product or compare risks between products.
At first, 5 or 10 milligrams mg once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 40 mg per day. The information contained in the Truven Health Micromedex products as delivered by Drugs. Warning: The facts and figures contained in these reports are accurate to the best of our capability; however, our metrics are only meant to augment your medical knowledge, and should never be used as the sole basis for selecting a new medication. As with any medical decision, be sure to work with your doctor to ensure the best choices are made for your condition. This medicine will not cure your high blood pressure but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems, such as heart failure, blood vessel disease, stroke, or kidney disease. Additional monitoring of your dose or condition may be necessary if you are presently taking ketanserin. Please refer to the for information on shortages of one or more of these preparations. This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment. Izzo JL, Levy D, Black HR. Importance of systolic blood pressure in older Americans. Hypertension. Increases in plasma triglyceride concentrations reported. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. 'Multum' is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Do not stop taking any medications without consulting your healthcare provider. arava how to order visa
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Management of hypertension alone or in combination with other classes of antihypertensive agents. If you also take cholestyramine, do not take it within 4 hours before or after taking Demadex. Check with your doctor if you have questions. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your or local waste disposal company. PREGNANCY and BREAST-FEEDING: If you plan on becoming pregnant, contact your doctor. You will need to discuss the benefits and risks of using Demadex while you are pregnant. It is not known if this medicine is found in breast milk. If you are or will be breast-feeding while you are using Demadex, check with your doctor. Discuss any possible risks to your baby.
DEMEDEX can increase the risk of renal toxicity related to administration of radiocontrast agents. At first, 20 milligrams mg once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 200 mg per day. Berg MJ, Fincham RW, Ebert BE, Schottelius DD. Phenytoin pharmacokinetics: before and after folic acid administration.
Furlanut M, Benetello P, Avogaro A, Dainese R. Effects of folic acid on phenytoin kinetics in healthy subjects. Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Getting up slowly may help. If the problem continues or gets worse, check with your doctor. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of torsemide in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for elderly patients receiving torsemide.
Demadex is available as white scored tablets in 5-, 10-, 20-, and 100-mg strengths. The information on this page is not a substitute for the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that a drug or drug combination is safe, effective or appropriate for any given patient. Drugs. Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.