"Trigrim": analogues, instructions for use, indications

Anatoly Shishigin

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Trigrim is a fairly popular drug in medical practice because it does an excellent job of removing excess fluid from the body while retaining beneficial substances. The diuretic is used for edema in the chronic stage, including kidney pathologies. Trigrim is very effective, but has a large number of contraindications and side effects, which must be taken into account by the doctor when prescribing the drug, and by the patient when taking it.

Release form, composition and packaging

The instructions for Trigrim say that this medicine is produced in the form of round, biconvex white tablets.

1 tablet contains 2.5 mg of torasemide. Additional substances include corn starch, magnesium stearate, lactose, colloidal silicon dioxide.

Trigrim is also made in the form of white, round, flat tablets, which have a long score in the center. 1 tablet contains 5 mg or 10 mg of torasemide. Additional components include corn starch, magnesium stearate, lactose, colloidal silicon dioxide.

In pharmacies it is sold in the form of blisters of 10 pcs.

Negative reviews

There were also some negative reviews. Trigrim was not suitable for some patients. In their comments, they point out the following disadvantages of the drug:

• the product does not always effectively relieve severe swelling;
• the appearance of constant nagging pain in the lower abdomen;
• high price;
• small tablets that are almost impossible to correctly divide into 2 equal parts.

How to choose the right diuretic for yourself? "Britomar", "Diuver" or "Trigrim" - which is better? These questions often worry patients suffering from edema. The effectiveness of each drug has been proven by many studies, but it is worth remembering that the medicine should only be prescribed by the specialist treating you. You cannot start taking the drug yourself or change it to an analogue.

Reviews from doctors

HELL. Likhanova, general practitioner, Podolsk: “I prescribe this medication when edema of various etiologies appears in patients. In most cases, the remedy works productively and allows you to quickly eliminate symptoms. The drug is safe for the health of patients. For this reason, I can recommend taking it to everyone. But before this, it is important to get advice from an experienced specialist and undergo examinations, if necessary. Only after this will it be possible to prescribe medication and begin treatment.”

I.D. Nefedova, general practitioner, Vologda: “The medication shows high effectiveness in the fight against edema. If a patient wants to buy medicine without a doctor's prescription, this will not be possible. Therefore, you need to go to a specialist who will not only prescribe the drug, but also tell you about the correct dosage regimen and side effects. If they are observed during treatment, it is important to consult a doctor in time for advice. Self-medication can lead to consequences that are irreversible for the patient’s health. So you don’t have to try to make a decision yourself.”

Positive reviews

Trigrim is an inexpensive and effective remedy, which makes it popular with both doctors and patients. In their opinion, the drug has the following advantages:

• instantly relieves minor swelling;
• unlike other diuretics, it does not remove electrolytes (magnesium and potassium) from the body, which is useful for heart disease;
• does not cause excessive urination;
• the medicine can be used once to relieve swelling of the face;
• People taking Trigrim practically do not experience the side effects described above.

Pharmacological action of Trigrim

The instructions for Trigrim show that the drug being analyzed and Trigrim analogues belong to the group of diuretic drugs . The principle of operation of the tablets is explained by the connection of torasemide with the Na+/2Cl-/K+ contransporter, which is located in the apical membrane of the thick segment of the ascending loop of Henle. That is why we can say that in the human body the reabsorption of sodium ions is significantly reduced or almost completely slowed down, and the reabsorption of sodium ions is also prevented. The result of this process is a decrease in the osmotic pressure of the intracellular fluid, as well as the reabsorption of water.

Reviews of Trigrim note that the drug, due to its antialdosterone effect, which is much less pronounced than that of furosemide, practically does not provoke hypokalemia, despite the greater activity of its components and long-lasting action.

Drug compatibility

Trigrim is capable of greatly increasing the toxicity of glycosides to the heart.

When using Trigrim together with mineral corticoids and laxatives, the risk of potassium deficiency in the body increases. Trigrim enhances the effect of antihypertensive drugs.

Trigrim leads to increased nephrotoxicity and ototoxicity of antibiotic drugs related to aminoglycosides, and cardiac and brain toxicity of drugs with lithium.

The drug leads to a decrease in the effectiveness of hypoglycemic medications. Taking Trigrim with ACE inhibitors carries the risk of an excessive drop in blood pressure, which can be avoided by reducing the initial dosage of the inhibitor or the amount of torasemide.

Sometimes women use diuretics to lose weight. However, Trigrim is not intended for this, since it has too many associated negative effects. Doctors are convinced that critical pathologies should be treated with this drug and additional vitamins should be taken during therapy.

Patient reviews

Peter, 39 years old, Novosibirsk: “The product works great against edema. This has been a long-standing problem. Therefore, it was decided to contact a specialist to find out the causes of the pathology. After the tests were taken and the necessary examinations were completed, this remedy was prescribed for treatment. I noticed significant results after 2 days. I’m happy with everything and recommend the product for use.”

Zhanna, 27 years old, Orsk: “Swelling has been a long-standing problem. At the next consultation, I told the therapist about this, who prescribed this medicine. Since it helped and was cheap, I can recommend it for use.”

Method of use of Trigrim and dosage regimen

The instructions for Trigrim say that this drug, as well as Trigrim analogues, are taken orally. Trigrim is prescribed for adults. It is allowed to take tablets before or during meals.

If the patient has edema, then in such a case the drug is prescribed 5 mg no more than 1 time per day. In case of urgent need, the dosage can be increased to 20 mg (this should be done gradually) 1 time per day. In some cases, Trigrim should be consumed up to 40 mg within 24 hours.

If a patient has edema, the cause of which is associated with congestive heart failure, then the specialist prescribes 5 to 20 mg of the drug per day to such a patient. As stated in the instructions for Trigrim, under the supervision of a medical professional, the dosage can be gradually increased to a maximum of 200 mg.

For edema, the cause of which is associated with chronic renal failure, first of all, 20 mg of the analyzed drug per day is prescribed. If an urgent need arises, the dosage is gradually increased (no more than 200 mg within 24 hours). This is done to achieve the best diuretic effect.

For edema, which is directly related to liver cirrhosis, the patient is prescribed a daily dose of 5-10 mg. In some cases, this dosage can be doubled (this should be done gradually), which allows you to achieve the best diuretic effect. Until now, there have been no medical studies that would indicate the possible consequences that occur in patients taking more than 40 mg of the drug for liver diseases.

If the patient has primary arterial hypertension, he is prescribed 2.5 mg of the drug per day. By increasing the dose to 5 mg, blood pressure remains unchanged. The maximum effect of the course of treatment occurs only after 12 weeks.

Reviews of Trigrim note that elderly patients do not need additional advice regarding the dosage and analogues of Trigrim.

Indications for use

The instructions for use describe in detail the reasons why patients are forced to take Trigrim. Its analogues have similar actions, differing only in cost. The medicine is a diuretic, that is, a drug that has a positive effect on the activity of the kidneys and organs of the genitourinary system. Once in the body, such substances inhibit the absorption of water and salts in the renal tubules, thus increasing the rate of urine formation. As a result, the fluid leaves the body faster, without having time to transform into edema.

Excessive swelling is the main reason that Trigrim tablets eliminate. What does it come from? Edema, as a rule, appears with diseases of the kidneys, liver and cardiovascular system. The drug also helps in the treatment of primary hypertension, which is expressed by high blood pressure. It is successfully used both for monotherapy and in combination with other drugs. However, do not rush to take Trigrim if you notice these symptoms. Treatment with the drug is possible only after consultation with your doctor.

Contraindications

• arterial hypotension;
• arrhythmia;
• anuria;
• precomatose state and hepatic coma;
• chronic renal failure with increasing azotemia;
• age under 18 years (efficacy/safety has not been established for this group of patients);
• pregnancy and lactation (there is no information on the effectiveness/safety of using Trigrim during breastfeeding);
• individual intolerance to the components of the drug, as well as hypersensitivity to sulfonamides.

Diseases/conditions in which the use of Trigrim requires caution (relative contraindications):

• water-electrolyte imbalance;
• predisposition to the development of hyperuricemia;
• cirrhosis of the liver;
• gout;
• diabetes;
• liver function disorders.

When is it prohibited to take the drug?

Among the contraindications to Trigrim are the following conditions:

• Liver coma or pre-coma state.
• Anuria.
• Renal failure and development of azotemia.
• Arrhythmic symptoms.
• Arterial hypotension.
• Pregnancy.
• Breastfeeding period.
• Children under 18 years of age.
• High sensitivity to sulfonamides and the main component of Trigrim.

With extreme caution, the drug is prescribed to people suffering from diabetes, problems with water-electrolyte metabolism, gout, liver problems, hepatic cirrhosis, and if there is a risk of hyperuricemia.

Trigrim drug interactions

When taking Trigrim, the myocardium's perception of cardiac glycosides increases significantly if the body lacks calcium and potassium. If you take Trigrim or Trigrim analogues together with laxatives or glucocorticoids, the process of removing potassium from the body may increase.

When used with antihypertensive drugs, the analyzed drug enhances their effect on the body. When taking Trigrim in an increased dosage, the toxic manifestations of a number of drugs (cisplatin, antibiotics) may increase.

Taking salicylates in increased dosages, there is an increase in their toxic interaction on the body. The effect of antidiabetic drugs becomes weaker, as do some vasoconstrictors (for example, norepinephrine and epinephrine).

NSAIDs in some cases reduce the hypotensive and diuretic effects of Trigrim . The effect of cholestyramine sometimes provokes a decrease in the absorption of torasemide from the digestive system (this is confirmed by numerous experiments conducted on animals).

Interaction with other medications

Before taking a drug with such a pronounced diuretic effect, you must first learn about its interactions with other drugs. For example, taking Trigrim with laxatives and glucocorticoids, the volume and frequency of feces excreted can greatly increase. Torsemide as part of the medication intensively increases the effect of antibiotics, aminoglycosides and theophylline. The effect of antihypertensive drugs is also greatly accelerated.

Trigrim diuretic, taken simultaneously with drugs for vasoconstriction, dramatically enhances their effect. Taking torasemide and cholestyramine can reduce the absorption of Trigrim in the stomach and intestines. Before using the drug, you must carefully study all possible reactions and interactions with other drugs indicated by the manufacturer in the annotation.

Therapeutic effects

Torsemide is a loop diuretic; it removes excess fluid to a greater extent than other diuretics. Prescribed mainly for chronic heart failure with congestive edema.

By blocking aldosterone receptors, Trigrim inhibits the excretion of potassium ions from the body, but at the same time the excretion of sodium increases, which leads to a decrease in edema.

Compared to the popular Furosemide, Trigrim does not cause a lack of potassium ions in the blood and has a longer and more pronounced effect. At the same time, it is characterized by high bioavailability and is taken once a day.

The main effects of torasemide: lowering blood pressure, eliminating edema, preserving potassium in the body, increasing renal blood flow.

When is Trigrim prohibited?

Trigrim, as a potent diuretic drug, should not be taken by patients with the following types of pathologies:

• special sensitivity to torasemide and other components of the drug;
• kidney failure, accompanied by cessation of fluid filtration and insufficient flow of urine into the bladder;
• problems in the hematopoietic system, decreased blood volume;
• liver coma;
• deficiency of sodium and potassium in the patient’s body;
• stable arterial hypotension;
• problems and acute urinary retention;
• fast heart rate;
• arterial hypotension.

Side effects of Trigrim

Reviews of Trigrim note that among the most common side effects after taking this drug, there is a decrease in the concentration of leukocytes, red blood cells and platelets.

In some cases, there is an increase in serum uric acid, lipids and even glucose. Hypokalemia may also occur. Very rarely, disruptions in normal blood circulation occur and blood pressure is disturbed.

Reviews of Trigrim show that problems with the functioning of the gastrointestinal tract, decreased appetite, and discomfort in the oral cavity often occur. Quite rarely - pancreatitis and increased activity of liver enzymes, urinary retention, as well as an increase in the concentration of creatinine and urea in plasma.

There are also frequent severe headaches, weakness, dizziness, confusion, drowsiness, cramps in the arms and legs, impaired hearing, vision, as well as complete deafness, itching and skin rashes.

Overdose

In case of an overdose, unpleasant symptoms may also appear, greatly increasing the side effects. These include:

• confusion and drowsiness;
• forced urination;
• drop in blood pressure;
• decreased electrolyte balance;
• disruption of the gastrointestinal tract.

To treat an overdose, you should consult a specialist. As a rule, he will recommend reducing the amount of the drug taken or stopping it altogether. The patient must also replenish the lack of fluid and electrolytes in the body in a short time.

special instructions

With a long course of treatment, it is recommended to monitor the following indicators: electrolyte balance, glucose, uric acid, creatinine and blood lipids.

In patients with hypokalemia, hyponatremia, hypovolemia or urinary disorders, the following conditions must be eliminated before prescribing Trigrim.

In case of diabetes mellitus, carbohydrate metabolism should be monitored.

In patients with gout or increased uric acid concentrations, Trigrim is prescribed with caution.

In case of suppression of bone marrow function or thrombocytopenia, as well as in case of skin rashes, the drug should be discontinued.

Considering the profile of adverse reactions, including the likelihood of developing dizziness, it is recommended to refrain from driving at the beginning of the course of treatment with Trigrim.

Side effects

Trigrim causes the following side effects:

• Thromocytopenia, leukopenia, reduction in the number of red blood cells.
• Failures in the blood supply system, decreased pressure, thromboembolism.
• Digestive dysfunction, dry mucous membranes, pancreatitis, anorexia.
• In the presence of obstruction of the urinary organs, urinary retention and an increase in creatinine and urea in the blood may occur.
• Pain in the head, dizziness, fatigue, constant desire to sleep, cramps and paresthesia of the legs, confusion of thoughts.
• Allergies can manifest themselves in the form of rashes and itching.

Analogs

Furosemide

Dalkhimfarm, Russia

The average cost of the medicine is 22 rubles per package.

Furosemide is the most famous diuretic from the group of loop diuretics. The drug is characterized by aggressiveness and speed of action. After the injection, the effect develops within 15 minutes, and after oral administration - after half an hour. The medicine is also characterized by a short duration of action, no more than two hours from the onset of action. The drug is dangerous because it is cheap and available over-the-counter, which prompts many women to use it not for the purpose of treating a specific disease, but to drain extracellular fluid, which weighs on average about 1.5 - 2 kg. Inexperienced female users attribute this weight loss to weight loss, but in fact, uncontrolled use of furosemide leads to severe disturbances in the water-salt balance, the occurrence of kidney disease, and even greater swelling in the end, because the kidneys wear out over time and stop functioning normally.

Pros:

• An effective medicine
• Low cost in pharmacies.

Minuses:

• Over-the-counter release
• Enjoys “harmful” popularity.

"Britomar": instructions for use

"Britomar" are tablets whose active ingredient is also torasemide. They practically do not differ in composition from Trigrim, but are sold in packs of 15 pieces. The medicine can be taken with caution during lactation, which is considered its advantage. At the same time, it is forbidden to use it if the kidneys and liver are not functioning properly. The cost of the product is significantly higher than the price of Trigrim and starts at 350 rubles per package. The medicine is produced by a well-known pharmacological company from Switzerland.

The instructions for use call the drug "Britomar" an effective remedy, but it has many more side effects. As a rule, they are similar to Trigrim, except for the possible occurrence of nosebleeds, diarrhea, flatulence and tachycardia.

Features of use

Before prescribing Trigrim tablets, the doctor must carefully read the instructions and also pay attention to several features of the correct use of this drug, which include:

• Long-term use of the drug requires periodic laboratory monitoring of the acid-base status, the level of essential minerals, glucose, lipids, uric acid in the blood, as well as indicators of the functional activity of the liver and kidneys.
• The drug is used with caution for gout, as this leads to an increase in the level of uric acid in the blood.
• With concomitant diabetes mellitus, periodic laboratory monitoring of sugar levels and dosage adjustment of hypoglycemic drugs or insulin are required if necessary.
• In some pathological conditions (hypokalemia, hypovolemia), corrective pathogenetic therapy is carried out before prescribing the drug.
• The active components of Trigrim tablets may interact with drugs from other pharmacological groups, so you should warn your doctor about their possible use.
• The appearance of signs of inhibition of bone marrow hematopoiesis is the basis for discontinuation of the drug.
• During the first time after starting a course of drug therapy, it is recommended to refuse to perform work that requires sufficient concentration of attention and speed of psychomotor reactions.

Trigrim: analogues of the drug

Cheaper and more effective substitutes for Trigrim are:

• Britomar;
• Aquaphor;
• Arifon;
• Diuver;
• Furosemide;
• Aldactone;
• Torasemide;
• Brinaldix;
• Bufenox;
• Spironolactone;
• Isobar;
• Canephron.

If the patient for some reason cannot take Trigrim, the doctor can prescribe him one of the analogues described below.