Torsemed

Patient Information Leaflet

Caution: Keep this leaflet. Information on the immediate packaging is in a foreign language.
Torsemed (Torasemid HEXAL), 5 mg, tablets
Torasemidum
Torsemed and Torasemid HEXAL are different brand names for the same medicine.
Please read carefully the information in this leaflet before taking the medicine, as it contains
important information for the patient.
Keep this leaflet so that you can read it again if necessary.
If you have any further questions, please consult your doctor or pharmacist.
This medicine has been prescribed for a specific individual. Do not pass it on to others. The medicine may harm someone else, even if their symptoms are the same.
If you experience any adverse reactions, including any not listed in this leaflet, inform your doctor, pharmacist, or nurse. See section 4.
Table of contents:

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

1. What Torsemed is and what it is used for

Torsemed is used to treat:
hypertension in adults;
oedema caused by excessive fluid in the body.
Torsemed is a diuretic medicine, i.e. a medicine that increases urine output.

2. Important information before using Torsemed

When not to use Torsemed
in case of hypersensitivity to:

• torasemide or any of the other ingredients of this medicine (listed in section 6)
• similar medicines called "sulfonamide derivatives", used in the treatment of high blood sugar levels, containing active substances with names ending in “-mid” in case of renal failure with insufficient urine production
  in case of severe liver dysfunction accompanied by loss of consciousness
  in case of low arterial blood pressure
  in case of reduced circulating blood volume
  during breastfeeding
  in case of low levels of potassium or sodium in the blood
  in case of severe urinary tract disorders, e.g. due to enlarged prostate
  in case of gout

in case of irregular heart function
in case of taking medicines used to treat infections, such as cefixime, cefuroxime, cefaclor, cephalexin, cefadroxil, proxetil of cefpodoxime, kanamycin, neomycin, gentamicin, amikacin or tobramycin
in case of kidney dysfunction caused by medicines that damage the kidneys.

Warnings and precautions
If any of the situations listed above apply to the patient, discuss them with a doctor before starting treatment with Torsemed:
acid-base imbalance
blood morphology disorders
diabetes
use of lithium, a medicine used in the treatment of depression.

If the patient is continuously taking Torsemed, the treating physician will regularly order blood tests, especially if the patient is also taking other medicines, has diabetes or irregular heart function.

Children and adolescents
Torsemed is not recommended for use in children and adolescents under 18 years of age.

Torsemed and other medicines
Tell your doctor or pharmacist about all medicines the patient is currently taking or has recently taken, as well as any medicines the patient plans to take.

The following medicines may affect the action of Torsemed and vice versa:
medicines used to treat high blood pressure, particularly those containing active substances with names ending in “-pril”;
medicines that enhance the heart's ability to pump blood, such as digitoxin, digoxin or methyldigoxin;
medicines used to treat diabetes;
probenecid (a medicine used to treat gout);
medicines used to treat inflammation and pain, such as acetylsalicylic acid or indomethacin;
sulfasalazine, mesalazine or olsalazine (medicines used to treat chronic inflammatory bowel diseases);
medicines used to treat infections, such as cefixime, cefuroxime, cefaclor, cephalexin, cefadroxil, proxetil of cefpodoxime, kanamycin, neomycin, gentamicin, amikacin or tobramycin;
platinum compounds, such as cisplatin (a medicine used to treat cancer);
lithium (a medicine used to treat depression);
theophylline (a medicine used to treat asthma);
certain muscle relaxants with names ending in “-curonium” or “-curium”;
all medicines used to treat constipation;
medicines containing cortisone derivatives, such as hydrocortisone, prednisone or prednisolone;
cholestyramine (a medicine used to reduce blood lipid levels);
adrenaline or noradrenaline (medicines used to increase blood pressure or speed up heart action);
warfarin, a medicine used to treat blood clots.

Pregnancy and breastfeeding
If the patient is pregnant or breastfeeding, suspects she may be pregnant, or is planning a pregnancy, she should consult a doctor or pharmacist before using this medicine.

• Pregnancy Torsemed may be used during pregnancy only if the treating physician considers it absolutely necessary. In such a case, the lowest possible dose should be used.
• Breastfeeding Torsemed must not be used in women who are breastfeeding, as it may harm the infant.

Driving and operating machinery
Dizziness or drowsiness may occur during treatment with Torsemed, especially at the beginning of treatment, when increasing the dose, changing medication, starting additional medicines, or consuming alcohol simultaneously. If concentration is impaired, do not drive or operate machinery.

Torsemed contains monohydrate lactose
This medicine contains the sugar monohydrate lactose. If the patient has previously been diagnosed with intolerance to certain sugars, the patient should consult a doctor before taking this medicine.

3. How to use Torsemed

This medicine should always be used as directed by the physician. In case of doubt, consult
your doctor or pharmacist.
Torsemed is available in the following strengths: 5 mg, 10 mg and 20 mg.
Recommended dose:
Treatment of arterial hypertension

• ½ tablet once daily. If necessary, the doctor may increase the dose to 1 tablet once daily, but not earlier than after 2 months of treatment.

Treatment of oedema caused by excess fluid in the body

• 1 tablet once daily. If necessary, the doctor may gradually increase the dose up to 4 tablets (20 mg) once daily.

Tablet splitting
The tablet may be divided into equal doses.

Place the tablet on a hard, flat surface with the dividing line facing upwards.
Press your finger in the middle of the tablet to split it into two halves.
Use in children and adolescents
Due to insufficient experience with the use of torasemide in children and adolescents,
Torsemed is not recommended for patients under 18 years of age.
Liver function disorders (except in cases of marked severity)
Treatment requires caution due to the possibility of increased blood concentration of torasemide.
Method of administration
Tablets should be taken every morning, regardless of meals, without chewing, with 100 ml of water (approximately half a glass).
Duration of treatment
The duration of treatment is determined by the physician. Torsemed may be used continuously for several
years or until resolution of oedema (fluid accumulation in tissues).
Taking more than the recommended dose of Torsemed
Seek immediate medical advice.
Overdose may cause excessive urination, drowsiness, confusion, weakness, dizziness, hypotension, circulatory collapse, and gastrointestinal disturbances.
Take any remaining tablets and the medicine packaging with you to assist identification of the ingested medicine.
Missed dose of Torsemed
Take the missed dose as soon as possible on the same day, or take the next dose the following day at the usual time. Do not take a double dose to make up for a missed dose.
Stopping Torsemed treatment
Do not discontinue treatment without consulting your doctor, as this may cause harmful effects for the patient and reduce the effectiveness of treatment.
If you have any further questions concerning the use of this medicine, consult your doctor or pharmacist.

4. Possible adverse effects

Like all medicines, this medicine can cause adverse effects, although they do not occur in everyone.
Adverse effects may occur with the following frequency:
Common (may occur in less than 1 in 10 people)

• disturbances in body water and mineral levels, especially with restricted salt intake;
• increased alkalinity in the body;
• muscle cramps;
• increased levels of uric acid, blood sugar and blood lipids;
• decreased potassium and sodium levels in the blood;
• reduced blood volume;
• stomach and (or) intestinal disturbances such as loss of appetite, stomach pain, nausea, vomiting, diarrhoea, constipation;
• increased activity of certain liver enzymes, such as gamma-GT;
• headache;
• dizziness;
• feeling of fatigue;
• weakness.

Uncommon (may occur in less than 1 in 100 people)

• increased levels of urea and creatinine in the blood;
• dryness of the mouth;
• tingling or numbness of hands and feet;
• difficulty in passing urine (e.g. due to benign prostatic hyperplasia).

Very rare (may occur in less than 1 in 10,000 people)

• narrowing of blood vessels due to blood concentration;
• lower than normal blood pressure;
• circulatory disturbances, particularly upon standing;
• irregular heartbeat;
• angina pectoris – a condition in which severe chest pain frequently occurs;
• myocardial infarction;
• fainting;
• pancreatitis;
• allergic reactions with itching and rash;
• increased skin sensitivity to light;
• severe skin reactions;
• decreased number of red and white blood cells and platelets;
• visual disturbances;
• ringing or noise in the ears;
• hearing loss.

Frequency not known: frequency cannot be estimated from the available data

• insufficient blood supply to the brain;
• disorientation (confusion).

Reporting of adverse effects
If any adverse effects occur, including any adverse effects not listed in this leaflet, inform a doctor, pharmacist or nurse. Adverse effects can be reported directly to the Department of Monitoring of Adverse Drug Reactions of the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products
Al. Jerozolimskie 181C
02-222 Warsaw
Tel.: + 48 22 49 21 301
Fax: + 48 22 49 21 309
Website: https://smz.ezdrowie.gov.pl
Reporting adverse effects helps to provide more information on the safety of the medicine.

5. How to store Torsemed

• Keep this medicine out of sight and reach of children.
• Do not use this medicine after the expiry date stated on the packaging. The expiry date refers to the last day of the specified month.

Translation of some abbreviations appearing on the blister:
Ch.-B./verwendbar bis: siehe Prägung - Batch number/Expiry date: see imprint (on the blister)

• Do not store above 25°C.
• Medicines must not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures help protect the environment.

6. Contents of the packaging and other information

What Torsemed contains

• The active substance is torasemide. Each tablet contains 5 mg of torasemide.
• The other ingredients are: microcrystalline cellulose, lactose monohydrate, magnesium stearate, maize starch, colloidal anhydrous silica.

What Torsemed looks like and contents of the pack
White or almost white, round tablets with a central dividing line.
Pack sizes: 30, 60 and 90 tablets.
For further information, please contact the marketing authorisation holder or parallel importer:
Marketing authorisation holder in Germany, the country of export:
Hexal AG
Industriestraße 25
83607 Holzkirchen
Germany
Manufacturer:
Lek S.A.
ul. Podlipie 16
95-010 Stryków
Salutas Pharma GmbH
Otto-von-Guericke-Allee 1
39179 Barleben
Germany
Parallel importer:
Delfarma Sp. z o.o.
ul. Św. Teresy od Dzieciątka Jezus 111
91-222 Łódź
Repackaged by:
Delfarma Sp. z o.o.
ul. Św. Teresy od Dzieciątka Jezus 111
91-222 Łódź
German marketing authorisation number (country of export): 58015.01.00
Parallel import authorisation number: 294/15