Forestem caps. 50mg 20 mg No. 30 (10 x 3) blister

Forestem caps. 50mg 20 mg No. 30 (10 x 3) blister

Product Code: 12418
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active ingredients:1 capsule contains spironolactone 50 mg furosemide 20 mg

excipients:mannitol (E 421), sodium croscarmellose, silicon colloidal dioxide, sodium lauryl sulfate, povidone, magnesium stearate

gelatin capsule shell containsmethylparahydroxybenzoate (E 218), propylparahydroxybenzoate (e 216), glycerol, silicon dioxide, sodium lauryl sulfate, acetic acid, gelatin.


Dosage form


basic physical and chemical properties:hard gelatin capsule № 2 with a transparent lid and a body containing a homogeneous powder partially compressed white or almost white.


drug description

Diuretics combined funds. Furosemide in combination with potassium-sparing drugs. Code ATH S0ZE B01.


Pharmacological properties


Furosem - combination drug containing a diuretic a short-acting furosemide and aldosterone antagonist long-acting spironolactone.

Furosemide is a fast-acting loop diuretic, which is a relatively strong and short-term diuretic effect. Furosemide blocks Na + K + 2Cl-kotransporter, located in the basal membranes of the cells of the thick segment of the ascending part of the loop Genle: the effectiveness of the saluretic action of furosemide, thus, depends on whether the drug gets to the tubules in the places of the lumen by anion transport mechanism. Diuretic effect occurs as a result of inhibition of sodium chloride reabsorption in this segment of the Genle loop. As a result, fractional sodium excretion can reach 35% of glomerular sodium filtration. The secondary effects of increased sodium excretion are increased urine excretion (due to osmotically bound water) and increased distal kanaltsevoy potassium secretion. Also increases the excretion of calcium and magnesium ions. Furosemide causes dose-dependent stimulation of renin-angiotensin-aldosterone. In heart failure furosemide leads to acute reduction of cardiac preload (by narrowing the capacitive venous vessels). This early vascular effect is prostaglandinsynthase suggests adequate renal function with activation of the renin-angiotensin and sound synthesis of prostaglandins. In addition, due to its inherent natriuretic effect furosemide reduces vascular reactivity relative to catecholamines, increased in patients with hypertension.

Antihypertensive efficacy of furosemide is explained by increased sodium excretion, reduced blood volume and reduced response of vascular smooth muscles to stimulation by vasoconstrictors or vasoconstrictors.

dose-Dependent increase in diuresis and natriuresis was observed in healthy volunteers receiving furosemide at a dose of 10-100 mg.

Spironolactone is a competitive antagonist of aldosterone. It affects the distal tubules of the kidneys.

because of the aldosterone blockade suppresses water retention and Na+and promotes retention of K+, which not only increases the excretion of Na+and Cl-, and reduces the excretion of K+with urine, but also reduces the excretion of H+. As a result, the diuretic effect also has a hypotensive effect.


since the drug is combined, pharmacokinetics has not been investigated.


treatment of persistent edema if it is associated with secondary hyperaldosteronism; treatment of conditions including chronic heart failure and cirrhosis of the liver.

Application Forestia for control of hypertension should be restricted to patients with marked hyperaldosteronism. Forestem prescribed when titration of the drug components separately shows that this drug is useful for treatment.


hypersensitivity to furosemide, spironolactone, sulfamides or sulfonamide derivatives, or to an auxiliary substance of the preparation.

Hypovolaemia or dehydration (with or without accompanying hypotension), the impaired renal function and the CC below 30 ml/min per 1.73 m2of the body surface is anuria or renal failure in the form of anuria, if not observed therapeutic response to furosemide; renal failure due to poisoning with nephrotoxic or hepatotoxic drugs or renal failure associated with hepatic coma; hyperkalemia; severe hypokalaemia severe hyponatraemia Addison's disease; pregnancy or breast-feeding.


Interaction with other medicinal products and other forms of interaction

Perhaps an excessive reduction of blood pressure with simultaneous use Forestia with cardiac glycosides, diuretics, antihypertensive agents or other drugs that reduce blood pressure, so the required correction doses of the above means.

a marked reduction in blood pressure and deterioration of renal function occurs with simultaneous use of furosemide with ACE inhibitors or antagonists of angiotensin II receptors or increase their dosage.

Forestia the Dose should be reduced within 3 days to cancel it before you start the use of ACE inhibitors or angiotensine I or to increase the dose.

When using Forestia in combination with potassium salts, with drugs which reduce potassium excretion, with nonsteroidal anti-inflammatory drugs or ACE inhibitors may increase the concentration of potassium in the blood serum and cause hyperkalemia.

Toxic effects of nephrotoxic drugs may be increased with concomitant use of potent diuretics such as furosemide.

Forestem and sucralfate should not be taken within 2:00 of each other, as sucralfate decreases the absorption of furosemide from the intestine and so reduces its effect.

Furosemide reduces the excretion of lithium salts and may lead to an increase in serum lithium levels, resulting in an increased risk of lithium toxicity, including a higher risk of cardiotoxic and neurotoxic effects of lithium. Therefore, it is recommended to carefully monitor the level of lithium in patients receiving this combination therapy. should be taken and risk and benefit carefully weighed before deciding to use combination therapy or concomitant use with furosemide or other potent diuretics.

the Simultaneous use of nonsteroidal anti-inflammatory drugs such as indomethacin, acetylsalicylic acid, can reduce the effect Forestia and cause acute renal failure in cases where previously patients had hypovolemia or dehydration.

Under the action Forestia may increase the toxicity of salicylate. Forestem can sometimes reduce the effects of other drugs (e.g. the effects of antibiotics and Pressor amines) and sometimes potentiate them (e.g. the effects of esters of salicylic acid, theophylline and muscle relaxants of the curare type).

Furosem may potentiate the ototoxicity of aminoglycosides and other ototoxic drugs. This can lead to irreversible consequences, these drugs should be used with caution together with Turistima.

if cisplatin and furosemide are used simultaneously, there is a risk of ototoxic effects. In addition, may increase the nephrotoxicity of cisplatin, if furosemide is not administered in low doses (e.g. 40 mg in patients with normal renal function) and with positive fluid balance when used to achieve forced diuresis during cisplatin therapy.

Spironolactone may lead to increased digoxin levels.

Some electrolyte disorders (such as hypokalemia, hypomagnesemia) may increase the toxicity of certain drugs (such as digitalis and DRUGS that cause Qt prolongation syndrome).

the Reduction of efficiency Forestia may occur after joint application of phenytoin.

the use of corticosteroids, carbenoxolone, licorice root in high doses and prolonged use of laxatives can increase the risk of hypokalemia.

Corticosteroids may cause sodium retention when used simultaneously.

Spironolactone and carbenoxolone may weaken the effects of other drugs. This licorice in large quantity acts as carbenoxolone.

Probenecid, methotrexate and other drugs which, like furosemide, are subject to significant tubular secretion in the kidneys, can reduce the effectiveness of Forestia. Conversely, furosemide can reduce the excretion of these drugs by the kidneys. Treatment with high doses (particularly as furosemide and other drugs) can lead to an increase in their levels in serum and increased risk of adverse effects due to furosemide or the use of concomitant therapy.

impaired renal function may develop in patients receiving therapy with furosemide and high doses of individual cephalosporins.

Concomitant use of cyclosporine a and furosemide is associated with an increased risk of gout arthritis, secondary to hyperuricemia caused by furosemide, and violation of renal excretion of urates caused by cyclosporine.

application Features

the Spironolactone may lead to the voice changes. Particular attention should be paid to patients whose voice is important to their work (in particular actors, singers, teachers).

patients with partial obstruction of urine outflow, such as prostate hypertrophy or urination impairment, have an increased risk of acute delay and require careful monitoring; constant urine outflow should be ensured during treatment.

If indicated, before treatment, should take measures for the correction of arterial hypertension or hypovolemia.

particularly careful monitoring is Needed:

  • patients with arterial hypotension;
  • patients who fall into the group of special risk due to a significant decrease in blood pressure;
  • patients with latent or severe diabetes mellitus,
  • The
  • patients with gout;
  • patients with hepatorenal syndrome, that is, functional renal failure, associated with severe liver disease
  • patients with hypoproteinemia, for example, associated with nephrotic syndrome (furosemide effect may be weakened simultaneously with the potentiation of ototoxicity).

Application Forestia should be avoided in the presence of elevated levels of potassium in the blood serum.

the Simultaneous use of triamterene, amiloride, potassium of impurities or NSAIDs is Not recommended due to the occurrence of hyperkalemia.

be wary of the drug to patients with deficiency and electrolyte balance.

Regular monitoring of sodium, potassium, creatinine, serum and glucose in General is recommended during therapy Furostanol.

Especially in need of careful monitoring of patients high risk of developing electrolyte imbalances or in case of significant additional fluid loss (e.g., vomiting, diarrhoea or intense sweating).

Hypovolemia or dehydration of the body, as well as any significant violations of electrolyte and acid-base balance should be corrected. This may require temporary cessation of therapy Furostanol.

Regular monitoring of potassium level in serum is necessary in patients with impaired renal function and creatinine clearance below 60 ml/min per 1.73 m2of surface area of the body and in the case where Forestem used in conjunction with some other drugs that can increase potassium levels.

in patients who belonged to high risk group due to nephropathy therapy Radiocontrast substances, the treatment with furosemide was observed a higher frequency of worsening renal function after receiving Radiocontrast substances compared with patients of high risk group who underwent only intravenous hydration prior to the appointment of Radiocontrast substances.

elderly Patients.

in elderly patients, the excretion of furosemide and spironolactone is slow.

Simultaneous application with risperidone

In studies of risperidone in elderly patients with dementia a higher level of mortality was observed in patients receiving furosemide concurrently with risperidone compared to patients receiving only risperidone, or only furosemide. The simultaneous use of risperidone with other diuretics (mainly thiazide diuretics at low doses) was not associated with a similar conclusion.

no pathophysiological mechanism has been established to explain this conclusion, and no pattern has been observed for the cause of death.

care should be taken to carefully weigh the risks and benefits before deciding to use this combination of simultaneous treatment with other potent diuretics.

by Athletes.Furosem can cause a positive result in doping control.

the Drug contains methylparahydroxybenzoate and propylparahydroxybenzoate, which may cause allergic reactions (possibly. Delayed.)

elderly Patients.Furosemide and spironolactone are slowly excreted.

use during pregnancy or lactation.

the Drug is contraindicated during pregnancy and lactation.

breastfeeding Period.

Furosemide, canrenone, a metabolite of spironolactone, get into breast milk, so

Furosem should not be used during breast-feeding.

breast-feeding should be discontinued if treatment is needed.

Ability to influence the reaction rate when driving motor transport or operating other mechanisms.

the Reduction of mental activity may reduce the ability of driving vehicles or other mechanisms. This is especially evident at the beginning of treatment.

Method of application and doses

treatment with the drug should be carried out in cases where there is refractoriness to diuretics in the form of monotherapy in recommended doses.

this fixed combination is used only when titration of the components of the drug separately shows that the drug is useful for treatment.

Adults1-4 capsules per day

the Capsules should be swallowed as a whole. The drug is better to take during Breakfast or lunch, drinking plenty of liquid (about 1 glass). Evening dose is not recommended, especially at the beginning of treatment, due to increased urination currently.


children do not use the drug.

there is evidence of nephrocalcinosis/nephrolithiasis in newborns.


Symptoms:the clinical picture of acute or chronic overdose depends primarily on the degree and effects of electrolyte and fluid loss and includes symptoms such as hypovolemia, dehydration, hemoconcentration, cardiac arrhythmias (including AV blockade and ventricular fibrillation) due to excessive diuresis. The symptoms of these disorders include severe hypotension (progressing to shock), acute renal failure, thrombosis, delirium, flaccid paralysis, apathy and confusion.

Treatment.Treatment should begin with the replacement of lost fluid in the body and the correction of electrolyte imbalance.

in conjunction with the prevention and treatment of severe complications from these disorders and other effects on the body (e.g. hyperkalemia), General and specific intensive therapeutic interventions (e.g. promoting potassium elimination) may be required.

there is no Specific antidote.

measures such as gastric lavage or the use of activated carbon should be taken to limit further systemic uptake.

Side effects

the Frequency for the following adverse reactions is unknown (cannot be estimated due to lack of data).

in the case of arrhythmia, fatigue or muscle weakness (e.g. in the legs), particular attention should be paid to the possibility of hyperkalemia.

from the blood side:frequent - hemoconcentration; infrequently - thrombocytopenia, leukopenia, eosinophilia; very rarely - agranulocytosis, aplastic anemia or hemolytic anemia.

About the oppression of the bone marrow was reported as a rare complication that requires discontinuation of the drug.

from the nervous system:rarely - paresthesia; often - in patients with hepatocellular insufficiency may occur hepatic encephalopathy.

From the urinary system:the level of calcium in blood serum can be reduced; very rare, tetany, renal failure. Increased urine production can increase the number of complaints from patients with obstruction of urine outflow. Thus, there may be an acute urinary retention with possible secondary complications, for example, in patients with bladder emptying disorders, prostate hyperplasia or urethra contraction. Rarely-tubulo-interstitial nephritis.

From the hearing:is rarely possible hearing loss and ringing in the ears, although these are usually transitory, particularly in patients with renal failure, hypoproteinemia (e.g. in nephrotic syndrome) and/or in case of too rapid administration of furosemide.

cases of deafness, sometimes irreversible, has been reported after oral or intravenous administration of furosemide.

on the part of the cardiovascular system:furosemide can cause hypotension, which in turn can lead to violations of concentration and reactions, light-headedness, feeling of pressure in head, headache, dizziness, drowsiness, weakness, disorders of vision, dry mouth , orthostatic hypotension, arrhythmia.

from the digestive system:intrahepatic cholestasis, increased hepatic transaminase or acute pancreatitis may develop in some cases.

the skin isvery rarely there may be allergic reactions such as rashes, photosensitivity, vasculitis, fever or interstitial nephritis, which requires discontinuation of the drug in some cases can cause reactions in the skin and mucous membranes, such as itching, urticaria, other skin rashes or bullous rash, erythema multiforme, bullous pemphigoid, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, purpura, in some cases - increased sensitivity to light (photosensitivity), acute generalized absentmindly pustules (AGEP) and DRESS-syndrome (drug rash with eosinophilia and systemic symptoms).

Metabolic disturbances:as well as after administration of other diuretics may be impaired fluid and electrolyte balance as a result of diuresis after prolonged therapy.

Application Forestia leads to increased excretion of the organism of sodium and chloride and, consequently, of water. In addition, increased excretion of other electrolytes (in particular potassium, calcium and magnesium).

serum potassium Concentration may decrease, especially at the beginning of treatment (as a result of the earlier onset of furosemide), although as treatment continues, potassium concentration may increase (as a result of the later action of spironolactone), especially in patients with renal insufficiency.

Symptomatic electrolyte imbalance disorders and metabolic alkalosis can take the form of a gradually increasing electrolyte deficiency. In the case of appointment to patients with normal liver function of higher doses of furosemide, acute deterioration of the patient's condition may occur as a result of a large loss of electrolytes.

The warning symptoms of disorders of electrolyte balance include increased feeling of thirst, headache, confusion, seizures, tetany, muscle weakness, disorders of cardiac rhythm and symptoms from the digestive tract.

Previous metabolic alkalosis (e.g. decompensated liver cirrhosis) may hinder furosemide therapy. Pseudo-Bartter syndrome may occur with improper use and/or prolonged use of furosemide. Especially pronounced electrolyte imbalance in need of correction.

the Diuretic effect of furosemide can lead to or contribute to hypovolemia and dehydration of the body, especially in elderly patients. To prevent this, it is necessary to compensate for any unwanted fluid loss (e.g. due to vomiting or diarrhea, or intense sweating). A significant decrease in the amount of fluid in the body can lead to increased blood clotting processes with a tendency to thrombosis.

During treatment with furosemide may increase cholesterol and triglycerides in the blood serum. During long-term therapy, they usually return to normal within 6 months.

glucose Tolerance may decrease as a result of the use of furosemide. In patients with diabetes mellitus this may lead to deterioration of metabolic control; diabetes can move from a latent form in the expressed form of the disease.

as with other diuretics, treatment with furosemide can lead to a temporary increase in creatinine and urea levels in the blood.

you Can increase the levels of uric acid in the serum and cause gout attacks.

from the immune system:severe anaphylactic or anaphylactoid reactions (e.g. shock) are rare.

from the digestive tract:there may be slight adverse reactions such as nausea, stomach upset (vomiting or diarrhea) that are not heavy enough to cancel therapy with the drug.

Spironolactone can cause dysfunction of the digestive tract (diarrhea, vomiting). There have been anecdotal reports on the occurrence of gastric ulcers and duodenal ulcers (sometimes with bleeding). Spironolactone can cause inhibition, drowsiness, headache, ataxia, confusion, hyperkalemia.

on the part of the reproductive system:through chemical similarity with sex hormones spironolactone can make the mammary glands more sensitive to palpitation. Possible erectile dysfunction in men, menstrual disorders in women.

mastodynia dose-Dependent and reverse gynecomastia are possible in both women and men.

Oh and aromatase maculopapular skin rash has been reported rarely, and other moderate androgenic symptoms such as hirsutism.

from the respiratory system:rarely spironolactone can cause voice changes in the form of dysphonia (in women) and decrease (in men) or increase the voice tone. In some patients, these changes persist even after discontinuation of treatment with the drug.


shelf Life

2 years.

storage Conditions

Store in its original packaging at a temperature not exceeding 25 ° C.

keep out of reach of children.



10 capsules in a blister. 3 blisters in a cardboard bundle.


Category vacation

According to the recipe.



S. K. Labormed-Farma, S. A./SC Labormed-Pharma SA

location of the manufacturer and address of the place of business

44B Theodor Pallade, third district, Bucharest, code 032266, Romania/44B Theodor Pallady, 3rddistrict, Bucharest, code 032266, Romania.


Homvio-Prostan drops for oral use – homeopathic medicine. The effect of the drug has a preventive and curative effect in diseases of the genitourinary tract. For easy use and accurate compliance with the dosing tool that comes in a vial-dropper. 

with prolonged use, analgesic, anti-inflammatory, antispasmodic effect is observed. At the same time normalizes the muscle membrane of the bladder.

When given

Uncontrolled self-medication may worsen physical condition, so the medication and therapy regimen are prescribed by a physician at:

  • small Diseases of the genitourinary system.
  • The
  • Increase in size of the prostate gland (only male patients).
  • The
  • Urethritis.
  • The
  • Prostatitis.
  • The
  • Chronic form of cystitis.
  • Chronic, acute form of urination delay.
  • The
  • to suffer.
  • The
  • Pyelonephritis.
  • urinary Incontinence.

instructions for use

If you are diagnosed with the disease in the chronic form, Homvio-prostan issued at a dosage of 10 drops up to 3 times in 24 hours. The average daily norm can be increased to 15 drops on the lack of effectiveness of therapy. 

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