Torsemide Spironolactone 40mg 50 mg Tablet

TORWISE-S (Torsemide Spironolactone  40mg 50 mg Tablet)

Torwise S tablets contain Torsemide 40 mg+ Spironolactone 50 mg respectively.  Torasemide is a high-ceiling loop diuretic. Structurally, it is a pyridine-sulfnyl urea used as an antihypertensive agent.
Spironolactone is a potassium sparing diuretic  that competitively inhibits mineralocorticoid receptors in the distal convoluted tubule to promote sodium and water excretion and potassium retention.

  Indication
• Edema
• Congestive heart failure
• Renal or hepatic diseases
• Hypertension
• Acne


  Dosage : As directed by physician

  Mechanism of Action
• Torsemide is part of the loop diuretics and thus, it acts by reducing the oxygen demand in the medullary thick ascending loop of Henle. Torsemide is known to have an effect in the renin-angiotensin-aldosterone system by inhibiting the downstream cascade after the activation of angiotensin II. This inhibition will produce a secondary effect marked by the reduction of the expression of aldosterone synthase, TGF-B1 and thromboxane A2 and a reduction on the aldosterone receptor binding.
• Spironolactone is structurally similar to progesterone and as a result is associated with progestogenic and antiandrogenic effects. Spironolactone competitively inhibits aldosterone dependant sodium potassium exchange channels in the distal convoluted tubule. This action leads to increased sodium and water excretion, but more potassium retention. The increased excretion of water leads to diuretic and also antihypertensive effects.

  Pharmacology
• Torsemide 
  Absorption
Torsemide is the diuretic with the highest oral bioavailability even in advanced stages of chronic kidney disease. This bioavailability tends to be higher than 80% regardless of the patient condition.

  Distribution 
The volume of distribution of torsemide is 0.2 L/kg.

  Excretion
Torsemide is mainly hepatically processed and excreted in the feces from which about 70-80% of the administered dose is excreted by this pathway. On the other hand, about 20-30% of the administered dose is found in the urine.
• Spironolactone
  Absorption
Spironolactone reaches a maximum concentration in 2.6 hours and an active metabolite (canrenone) reaches a maximum concentration in 4.3 hours. When taken with food, the bioavailability of spironolactone increases to 95.4%
  Distribution
Volume of distribution data is not readily available.
  Excretion
Spironolactone are excreted 42-56% in urine, and 14.2-14.6% in the  feces. No unmetabolized spironolactone is present in the urine.

  Contraindication
• Joint disorder
• Dehydration
• High amount of triglyceride in the blood
• Hearing loss
• Hardening of the liver
• Decreased kidney function
• Decreased blood volume
• Cessation of urine production
  Precautions
• Dry mouth
• increased thirst
• Muscle cramps
• Dizziness 
• Loss of hearing
• Nausea
• Diarrhea

Introduction