Diuver

LEAFLET INCLUDED IN THE PACKAGE: INFORMATION FOR THE USER

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

Diuver (Torasemid-ratiopharm 5 mg Tablets), 5 mg, tablets

Torasemidum
Diuver Torasemid-ratiopharm 5 mg Tabletsare different trade names for the same medicine.

You should read the contents of the leaflet before using 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 as yours.
• 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 package 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 concentration occurs in the serum after 1 to 2 hours. About 80% of the administered dose is excreted in the urine.
Indications for use:

• primary hypertension;
• edema caused by congestive heart failure, pulmonary edema, hepatic edema, and renal 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 urinary excretion disorders, before starting treatment, the cause of these disorders should be eliminated and water-electrolyte balance should be restored (especially in patients undergoing concomitant 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 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 doping control results. 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 strength of heart muscle contraction, and at the same time reduce the frequency of this contraction), there may be an increase in the sensitivity of the heart muscle to these drugs, due to a decrease in potassium and (or) magnesium levels in the serum.
In combination with mineralocorticoids (hormones that regulate mineral and ion metabolism in the body) and glucocorticoids (hormones that regulate protein, carbohydrate, and fat metabolism) and laxatives, it may cause increased potassium excretion in the urine.
Similarly, as with other diuretics (also known as diuretic drugs, drugs that increase the volume of urine excreted), there may be an intensification of the blood pressure-lowering effect during concomitant administration of 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 excretion of salicylates in patients receiving large 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).
Nonsteroidal anti-inflammatory drugs (e.g., indomethacin) may reduce the diuretic and hypotensive (blood pressure-lowering) effect 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 liquid, 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 and 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 a 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 used as directed by your doctor. If you are unsure, consult your doctor or pharmacist.
Recommended dose
Adults:

Primary hypertension

A dose of 2.5 mg orally once a day is recommended. If necessary, the dose can be increased to 5 mg once a day. Studies have shown that doses greater than 5 mg per day do not lead to further lowering of blood pressure. The maximum therapeutic effect is achieved after about 12 weeks of treatment.

Edema

Usually, a dose of 5 mg orally once a day is used. 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 the risk of fluid and electrolyte loss, and subsequently drowsiness, confusion, blood pressure drop, circulatory collapse. Gastrointestinal disorders may occur.
There is no specific antidote. The symptoms of an overdose require a reduction in dose or discontinuation of the medicine, with simultaneous administration of fluids and electrolytes.
If you have taken a higher dose of the medicine than recommended, 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, you should take it at the scheduled time.
Do not take a double dose 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 balance disorders may occur, especially when using a low-sodium diet. Hypokalemia (decreased potassium levels in the blood) may occur, especially in patients on a low-potassium 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 pain and dizziness, blood pressure drops, weakness, drowsiness, confusion, loss of appetite, 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 serum.
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 excretion disorders, sudden cessation of urine production 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 disorders of cardiac and cerebral circulation, caused by blood thickening (including cardiac and cerebral ischemia), leading to arrhythmias, angina pectoris, acute myocardial infarction, or fainting.
Pancreatitis.
Single cases of decreased red and white blood cell counts, as well as platelet counts, have been reported.
Single cases of allergic reactions, such as itching, rash, and hypersensitivity to light, have been reported.
Single cases of vision and hearing disorders (tinnitus, hearing loss) may occur.
Rarely, paresthesia (tingling, numbness, or prickling sensation) of the limbs has been reported.
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.
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 needed. This will help protect the environment.
Translation of some information on the blisters:
Ch.-B. und verwendbar bis: see embossing – Batch number and expiry date: see embossing

6. Contents of the package and other information

What Diuver contains

• The active substance of the medicine is torasemide. Each tablet contains 5 mg of torasemide.

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

What Diuver looks like and contents of the package

Diuver 5 mg is a white or almost white, round, biconvex tablet with a score line on one side and an embossing of 915 on the other side of the tablet.
Package size:
30 tablets in a package.
For more detailed information, you should contact the marketing authorization holder or 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:

PharmaVitae Sp. z o.o. sp. k., ul. E. Orzeszkowej 3/35, 59-820 Leśna

Repackaged by:

Pharma Innovations Sp. z o.o., ul. Jagiellońska 76, 03-301 Warszawa
Medezin Sp. z o.o., ul. Zbąszyńska 3, 91-342 Łódź
LABOR Pharmaceutical-Chemical Company Sp. z o.o., ul. Długosza 49, 51-162 Wrocław
CANPOLAND Joint-Stock Company, ul. Beskidzka 190, 91-610 Łódź
SHIRAZ PRODUCTIONS Sp. z o.o., ul. Tymiankowa 24/28, 95-054 Ksawerów
Authorization number in Germany, the country of export:57688.00.00
Parallel import authorization number:200/17
Date of leaflet approval: 08.06.2022
[Information about the trademark]