部分中文DEMADEX处方信息（仅供参考）
通用名称： 托拉塞米
托拉塞米是新一代高效髓袢利尿剂，于1993年在德国上市，次年在美国上市。20多年临床应用证实，托拉塞米适应证广，利尿作用迅速强大且持久，不良反应发生率低，更符合药物经济学要求，是临床上值得推广的一类高效利尿剂。
药理作用
托拉塞米有利尿、排Na+和排C1-作用，但不显著改变肾小球滤过率、肾血浆流量和酸碱平衡。作用于髓袢升支粗段，干扰管腔细胞膜的Na+、K+、2C1-同向转运体系，抑制cl-和Na+的重吸收，使管腔液NaCl的浓度增高，渗透压增大，肾髓质间液的NaCl减少，渗透压梯度降低，从而干扰尿的浓缩过程，使尿Na+，Cl-和水的排泄增加。人体研究也证实该品作用于该部位，对肾单元其他部位的影响尚不明确。该品的抗高血压机制与其他利尿剂一样尚未完全了解，可能是由于其降低了总外周阻力。
利尿作用
人体试验证实，10mg托拉塞米的利尿作用与20～40mg呋塞米（furosemide）和1mg布美他尼（bumetanide）相当，其利尿阈剂量2.5mg。口服后40min至数小时内利尿作用明显，尿量呈剂量依赖性增加，4h内达利尿高峰，随后药效减弱，但降压速度明显慢于呋塞米。健康人静脉和口服用药，作用可维持6～8h。
排Na+作用
托拉塞米抑制亨氏袢对Na+和c1-的重吸收，而远端肾段不能完全代偿，故产生排Na+和利尿作用。排Na+的阈剂量为2.5mg。治疗剂量范围内，尿Na+和托拉塞米的排泄速率之间呈对数一线性反应曲线。Fowler等[5]报道，该品20mg显著增加各时间段和24h的总排Na+量，而该品10mg或呋塞米40mg仅在前4h内明显增加排Na+量。Knauf等报道，健康志愿者静注20mg托拉塞米，1h内开始排Na+，l～2h达高峰，6h内Na+排出最多，此后排Na+减少，低于基础排Na+量
排K+作用
托拉塞米的排K+作用弱于其他袢利尿剂。托拉塞米缺乏在近曲小管对磷或糖类的重吸收活动，而K+的重吸收也在近曲小管，由此推测排K+量减少。另一方面，也可能与该品的抗醛固酮作用有关，其排K+作用相对弱于其排Na+作用，因此尿Na+/K+增加。呋塞米的排K+作用是该品的3倍。但在临床上监测血K+及尿排K+量，托拉塞米与呋塞米没有显著差异。
其他作用
Kruck报道，用托拉塞米长期治疗血Mg2+无临床意义的变化，但Knauf等报道，服药后24h内Mg2+的变化直接与排K+有关，因此，目前对Mg2+的作用尚无定论。在托拉塞米作用期间内，尿Ca2+和尿Cl-的丢失与尿Na+的排泄平行。24h内尿Ca2+和cl-的排泄率在托拉塞米10.20mg和呋塞米40mg之间无显著差异，血Ca2+和血cl-无变。对尿酸、尿素、肌酐的排出亦无明显影响。
特点
作为新一代高效髓袢利尿剂，与其他利尿剂相比，注射用托拉塞米具有以下优点：
◆ 起效迅速：静脉用药10分钟即可起效，达峰时间为1~2小时。
◆ 作用持久：体内半衰期为3.8小时，作用持续时间长达5~8小时。
◆ 量效关系稳定：在相当大的剂量范围内可保持良好的量效关系。
◆ 适应证广泛：适用于治疗发生于多种组织多种原因所致的中重度水肿、急慢性心力衰竭，防治急慢性肾衰，治疗肝硬化腹水、脑水肿以及急性毒物和（或）药物中毒，以及抢救原发性高血压危象和多器官功能衰竭等急重症。
◆ 疗效好：可充分改善患者的临床预后，降低疾病复发率，提高患者生活质量，缩短住院时间，减少医疗费用。
◆ 安全性和耐受性好：通过肝肾双通道代谢，80%经肝脏代谢，20%以原形经肾脏排泄，有效减轻了肾脏负担和药物蓄积。其独特的醛固酮拮抗作用，使K+等电解质排泄量明显减少，临床上对Mg2+、尿酸、糖和脂类无明显影响。长期应用不易产生利尿抵抗，患者耐受性好。
Demadex is a drug also generically known under the name of Torsemide.
Demadex is a medicine that belongs to the wide class of water pills (loop diuretics). Demadex, just like any other water pill helps decrease the amount of fluid (water) that is retained in the body.
This goal is achieved because Demadex ensures that more salt and more water are eliminated through urine.
Demadex Indications
Demadex is usually indicated in the treatment of patients who have water retention problems that have lead to swellings. Water retention problems are normally caused by:
Kidney problems
Liver disease
Congestive heart failure
Demadex is sometimes recommended in the treatment of other disorders and diseases that have not been mentioned here.
Demadex Warnings
Demadex is a Category B FDA pregnancy drug. Therefore, Demadex is a medicine that should not harm an unborn baby or the carrying mother if taken during pregnancy.
If you are pregnant or if you are planning to get pregnant soon, it is best that you should consult with a doctor before starting taking this drug. It has not been clearly established whether Demadex’s main ingredient (Torsemide) or other of Demadex’s ingredients can pass into breast milk. However, if you are breastfeeding an infant you must not start taking this drug without consulting with your personal physician. 
If you have some of the following conditions you may not be allowed to start a treatment with Demadex:
Allergic reactions sulfa-based drugs (including sulfa-based antibiotics).
Gout Systemic lupus erythematosus
Liver problems
Kidney problems
Diabetes mellitus
If you are suffering from any of the diseases that have been listed here you should consult with your doctor before you start a treatment with Demadex (Torsemide). He might want to monitorize your treatment and its results or to make adjustments (to lower) your normal dose of Demadex.
During a treatment with Demadex, it is recommended to avoid the consumption of alcohol, because alcohol is known to increase the severity of some of Demadex’s side effects. 
Demadex Intake Guidelines Ask your doctor if you should take any necessary precautions during your treatment with Demadex. Follow each and every one of them carefully (do not disobey any of them). If you happen to have any further questions you should ask your doctor, a pharmacist or a nurse. Each dose of this drug is regularly taken with a glass of water.
You can take this drug either on an empty or on a full stomach. Try to take Demadex regularly. You should take this drug during daytime, because it causes more frequent urination. You should not stop your treatment with Demadex without first consulting with your doctor even if you begin to feel better.
Demadex Dosage
The best way to get your correct dosage established is to ask your doctor. In order to tell you the amount of Demadex that you should take he or she must known the patient’s history (old / recent disorders).  The correct dosage sometimes varies from one person to another, as it depends on some variables (among them: body weight, the disorder’s severity, etc).
Demadex Overdose
An overdose with Demadex should trigger the following:
Dizziness
Nausea and vomiting
Muscle cramps
Fatigue
Confusion
Fainting
Irregular pulse
If you have these symptoms and if you suspect that you are suffering from overdose you should seek medical attention at once (contact your local poison control center, inform your personal physician). 
Demadex Missed Dose
Try to follow your dose schedule. If you are taking one pill each day and you miss one of your doses you can take it as soon as you remember (if no more than 12 hours have passed). If more than 12 hours have passed you should skip the dose that you have missed and proceed with your regular treatment.
If you are supposed to take more than one pill of Demadex each day, you should take the dose that you have missed up to 2 hours after your scheduled time. If more than 2 hours have passed, you should skip the dose that you have missed and proceed with your regular treatment.
Demadex Side Effects
A treatment with Demadex sometimes results in some of the following side effects:
Allergic Reactions (such as, throat closing, swelling of the nose, lips, face and throat)
Hearing loss
Weakness
Muscle cramps
Hypotension
Irregular heartbeat
Low blood pressure
Nausea
Rashes
Dry mouth or increased thirst
Photosensitivity
Numbness of limbs
Jaundice
Constipation
Buzzing or ringing in the ears 
Lightheadedness
Headache 
If you are experiencing any of these symptoms you should continue using Demadex but you must inform your personal physician of this. 
There are other side effects and allergic reactions that can also be triggered by Demadex. Inform your personal physician as soon as possible if you experience anything abnormal while taking this drug.
Demadex Drug Reactions
There are some drugs that are known to interact with Demadex:
NSAIDs
Probenecid
Lithium
Diabetes medicines (like Glyburide, glypizide etc) If you have to follow a treatment with another drug (apart from Demadex) you should ask for your doctor’s consent before doing so.
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