Diuver

LEAFLET INCLUDED IN THE PACKAGING: INFORMATION FOR THE PATIENT

Warning! Keep the leaflet, the information on the immediate packaging is in a foreign language!

Diuver(Torasemid-ratiopharm 10 mg Tablets)

10 mg, tablets

Torasemidum
Diuver and Torasemid-ratiopharm 10 mg Tablets are different trade names for the same drug.

You should read the contents of the leaflet before taking the medicine, as it contains important information for the patient.

• You should keep this leaflet, so that you can read it again if you need to.
• If you have any doubts, you should consult a doctor or pharmacist.
• This medicine has been prescribed specifically for you. Do not pass it on to others. The medicine may harm another person, even if their symptoms are the same.
• If the patient experiences any side effects, including any side effects not listed in this leaflet, they should tell their doctor or pharmacist. See section 4.

Table of contents of the leaflet:

• 1. What is Diuver and what is it used for
• 2. Important information before taking Diuver
• 3. How to take Diuver
• 4. Possible side effects
• 5. How to store Diuver
• 6. Contents of the pack and other information

1. What is Diuver and what is it used for

Diuver is a diuretic. After oral administration, torasemide is rapidly and almost completely absorbed, and maximum concentrations are reached in the serum after 1 to 2 hours. About 80% of the administered dose is excreted in the urine.
Indications:

• edema caused by congestive heart failure, pulmonary edema, liver-related edema, kidney-related edema.

2. Important information before taking Diuver

When not to take Diuver

• if the patient is hypersensitive to torasemide, sulfonylurea derivatives (drugs used in diabetes) or any of the other ingredients of this medicine (listed in section 6);
• if the patient has renal function disorders with anuria;
• if the patient has hepatic coma and pre-coma states;
• if the patient has arterial hypotension;
• if the patient is breastfeeding.

Warnings and precautions

Before starting treatment with Diuver, you should discuss it with your doctor or pharmacist.

• if the patient has disorders of urination, before starting treatment, the cause of these disorders should be eliminated and water-electrolyte balance restored (especially in patients undergoing concurrent treatment with digitalis glycosides, glucocorticoids, mineralocorticoids, or laxatives);

if torasemide therapy is long-term. During long-term treatment, regular monitoring of water-electrolyte balance, glucose, uric acid, creatinine, and lipid levels in the blood, as well as blood morphology (red and white blood cells and platelets), is recommended;

• if the patient has a tendency to increased uric acid levels in the blood and gout;
• if the patient has latent or overt diabetes. In these patients, carbohydrate metabolism should be monitored. Due to insufficient experience with torasemide treatment, caution should be exercised in the following situations:
• pathological changes in acid-base balance,
• concomitant treatment with lithium, aminoglycosides, or cephalosporins,
• renal failure caused by nephrotoxic factors,
• children under 12 years of age.

Taking Diuver may lead to positive results in anti-doping tests. Using Diuver as a doping agent can pose a health risk.

Children and adolescents

There is a lack of clinical experience with the use of torasemide in this age group.

Diuver and other medicines

You should tell your doctor or pharmacist about all the medicines you are taking now or have taken recently, as well as any medicines you plan to take.
In the case of concomitant use of torasemide with cardiac glycosides (drugs that stimulate heart function, increase the force of contraction of the heart muscle, and at the same time reduce the frequency of this contraction), there may be an increased sensitivity of the heart muscle to these drugs due to decreased potassium and (or) magnesium levels in the serum.
In combination with mineralocorticoids (hormones that regulate mineral and ionic balance in the body) and glucocorticoids (hormones that regulate protein, carbohydrate, and fat metabolism), as well as laxatives, it may cause increased potassium excretion in the urine.
Similarly, as with other diuretics (also known as diuretic drugs, drugs that increase urine output), there may be an enhancement of the blood pressure-lowering effect when administered concurrently with other antihypertensive drugs.
Torasemide, especially in high doses, may increase the toxicity of aminoglycoside antibiotics, cisplatin, the toxic effect of cephalosporins on the kidneys, and the toxic effect of lithium on the heart and central nervous system.
The action of curare-like muscle relaxants and the action of theophylline may be enhanced during concomitant use with torasemide.
Since torasemide inhibits the tubular secretion of salicylates in patients receiving high doses of salicylates, their toxicity may increase.
The action of antidiabetic drugs may be weakened.
The use of angiotensin-converting enzyme inhibitors after torasemide treatment, or the initiation of combined therapy with these drugs, may cause transient blood pressure drops. This effect can be minimized by reducing the initial dose of the angiotensin-converting enzyme inhibitor and (or) reducing the dose or temporarily discontinuing torasemide for 2-3 days before using the drug from the group of angiotensin-converting enzyme inhibitors.
Torasemide may reduce the reactivity of arteries to vasoconstrictor drugs (e.g., adrenaline, noradrenaline).
Non-steroidal anti-inflammatory drugs (e.g., indomethacin) may reduce the diuretic and hypotensive effects of torasemide by inhibiting prostaglandin synthesis.
Probenecid may reduce the effectiveness of torasemide by inhibiting its secretion in the renal tubules.
The concomitant administration of torasemide and cholestyramine has not been studied in humans, but in animal studies, a decrease in torasemide absorption has been observed.

Diuver with food and drink

Diuver should be taken in the morning with a small amount of fluid, regardless of meals.

Patients with liver function disorders

During torasemide treatment, patients with liver function disorders should be under special supervision due to the risk of increased torasemide levels in the blood.

Patients of advanced age

In elderly patients, there is no need to adjust the dosage.

Pregnancy, breastfeeding

If the patient is pregnant or breastfeeding, thinks she may be pregnant, or plans to have a child, she should consult a doctor or pharmacist before taking this medicine.
Pregnancy:
Diuver is contraindicated during pregnancy.
Breastfeeding:
There is no data on the penetration of the drug into breast milk. Diuver is contraindicated during breastfeeding.
Fertility:
In non-clinical studies, no effect of torasemide on fertility was found.

Driving and using machines

As with other blood pressure-lowering drugs, patients who take torasemide and experience dizziness or similar symptoms should not drive vehicles or operate machines.

Diuver contains lactose monohydrate

If the patient has previously been diagnosed with intolerance to some sugars, the patient should contact their doctor before taking the medicine.

Diuver contains sodium

The medicine contains less than 1 mmol (23 mg) of sodium per dose, which means the medicine is considered "sodium-free".

3. How to take Diuver

This medicine should always be taken according to the doctor's recommendations. In case of doubts, you should consult a doctor or pharmacist.
Recommended dose
Adults:

Edema

Usually, 5 mg is taken orally once a day. If necessary, the dose can be gradually increased to 20 mg once a day. In individual, exceptional cases, doses of up to 40 mg per day have been used.

Taking a higher dose of Diuver than recommended

The typical picture of torasemide overdose is not known. In the case of an overdose, significant diuresis may occur with a risk of fluid and electrolyte loss, and subsequently drowsiness, confusion, blood pressure drop, and circulatory collapse. Gastrointestinal disorders may also occur.
There is no specific antidote. The symptoms of an overdose require a reduction in dose or discontinuation of the medicine, along with the administration of fluids and electrolytes.
If a higher dose of the medicine than recommended is taken, you should immediately consult a doctor or pharmacist.

Missing a dose of Diuver

A missed dose should be taken as soon as possible. If it is almost time for the next dose, it should be taken at the scheduled time.
A double dose should not be taken to make up for a missed dose.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.
Common(may affect up to 1 in 10 people):
Similarly to other diuretics, depending on the dose used and the duration of treatment, water-electrolyte disorders may occur, especially when using a low-sodium diet.
Hypokalemia (decreased potassium levels in the blood) may occur, especially in patients on a potassium-poor diet, with vomiting, diarrhea, using large amounts of laxatives, and in cases of liver function disorders.
In the case of significant diuresis, especially at the beginning of treatment, and in elderly patients, symptoms of electrolyte and fluid loss may occur, such as headaches and dizziness, blood pressure drops, weakness, drowsiness, confusion, loss of appetite, and muscle cramps. It may be necessary to adjust the dose of the medicine.
Torasemide may cause increased levels of uric acid, glucose, and lipids in the blood.
Metabolic alkalosis symptoms may worsen.
Gastrointestinal disorders (e.g., loss of appetite, abdominal pain, nausea, vomiting, diarrhea, constipation) may occur.
Torasemide may cause increased activity of certain liver enzymes, e.g., gamma-GT (gamma-glutamyltransferase).
Uncommon(may affect up to 1 in 100 people):
In patients with urinary outflow disorders, sudden cessation of urination may occur.
Increased levels of urea and creatinine in the blood may occur.
Rare(may affect up to 1 in 1,000 people):
Paresthesia of the limbs
Very rare(affects less than 1 in 10,000 people, including single cases):
Thrombotic complications and circulatory disorders of the heart and brain, caused by blood thickening (including myocardial infarction and cerebral infarction), leading to arrhythmias, angina pectoris, acute myocardial infarction, or fainting.
Pancreatitis.
There have been reports of single cases of decreased red and white blood cell counts, as well as platelet counts.
In single cases, allergic reactions, such as itching, rash, and photosensitivity, may occur.
Single cases of visual and hearing disorders (tinnitus, hearing loss) may occur.
Rarely, there have been reports of paresthesia (tingling, numbness) of the limbs.
Frequency not known(cannot be estimated from the available data):
Dryness of the mucous membranes of the mouth.

Reporting side effects

If you experience any side effects, including any side effects not listed in this leaflet, you should tell your doctor or pharmacist. Side effects can be reported directly to the Department of Monitoring of Adverse Reactions to Medicinal Products, Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products, Al. Jerozolimskie 181 C, 02-222 Warsaw, Tel.: +48 22 49 21 301, Fax: +48 22 49 21 309, website: https://smz.ezdrowie.gov.pl
By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store Diuver

The medicine should be stored out of sight and reach of children.
Do not store above 25 °C.
Do not use this medicine after the expiry date stated on the packaging. The expiry date refers to the last day of the month.
Translation of some inscriptions on the blister pack:
Ch.-B. und verwendbar bis: siehe Prägung - Batch number and expiry date: see imprinting
Medicines should not be disposed of via wastewater or household waste.
You should ask your pharmacist how to dispose of medicines that are no longer used.
This will help protect the environment.

6. Contents of the pack and other information

What Diuver contains

• The active substance of the medicine is torasemide. Each tablet contains 10 mg of torasemide.

Other ingredients of the medicine are: lactose monohydrate, corn starch, sodium carboxymethyl starch (type A), colloidal anhydrous silica, magnesium stearate.

What Diuver looks like and what the pack contains

Diuver 10 mg is a white or almost white, round, biconvex tablet with a score line on one side and the imprint 916 on the other side of the tablet.
Pack size: 30 tablets in a pack.
For more detailed information, you should contact the marketing authorization holder or the parallel importer.

Marketing authorization holder in Germany, the country of export:

ratiopharm GmbH
Graf-Arco-Str. 3
89079 Ulm
Germany

Manufacturer:

Merckle GmbH
Ludwig-Merckle-Str. 3
89143 Blaubeuren
Germany

Parallel importer:

Medezin Sp. z o.o.
ul. Zbąszyńska 3
91-342 Łódź

Repackaged by:

Medezin Sp. z o.o.
ul. Zbąszyńska 3
91-342 Łódź
CEFEA Sp. z o.o. Sp. komandytowa
ul. Działkowa 56
02-234 Warsaw
SHIRAZ PRODUCTIONS Sp. z o.o.
ul. Tymiankowa 24/28
95-054 Ksawerów
CANPOLAND SPÓŁKA AKCYJNA
ul. Beskidzka 190
91-610 Łódź
Marketing authorization number in Germany, the country of export: 57688.01.00

Parallel import authorization number: 308/22 Date of leaflet approval: 16.08.2022

[Information about the trademark]