Torsemide
Brand Name: Demadex
Generic Available
Common Dosage Forms:
Tablets: 5 mg, 10 mg, 20 mg, 100 mg
Solution for Injection: 10 mg/mL in 2 mL and 5 mL vials
FDA Indications/Dosages:
For the treatment of edema associated with congestive heart failure or chronic renal failure: 20 mg daily by either oral or intravenous routes. If additional diuresis is needed, titrate dose upward by doubling the dose to a maximum of 200 mg/day. Intravenous torsemide should be injected over at least 2 minutes.
For the treatment of edema associated with hepatic cirrhosis: The usual initial dose is 5-10 mg once daily by either oral or intravenous routes. If additional diuresis is needed, titrate dose upward by doubling the dose to a maximum of 200 mg/day. Intravenous torsemide should be injected over at least 2 minutes.
For the treatment of hypertension alone or in combination with other antihypertensives: The usual initial dose is 5 mg once daily. If additional reduction in blood pressure is needed, the dose may be increased to 10 mg once daily. If 10 mg is insufficient, an additional antihypertensive agent should be added to the treatment program.
Monitor: K
Pharmacology/Pharmacokinetics: Torsemide acts from within the lumen of the thick ascending portion of the loop of Henle, where it inhibits the Na+/K+/2Cl- carrier system. Torsemide increases the urinary excretion of sodium, chloride, and water, but it does not significantly alter glomerular filtration rate, renal plasma flow, or acid-base balance. Peak plasma levels after an oral dose are reached in 1 hour and absorption is unaffected by renal or hepatic impairment. Elimination half-life is 3.5 hours through hepatic metabolism (80%) and renal excretion (20%).
Drug Interactions: May decrease the renal excretion of salicylates. Use with caution in patients taking nonsteroidal anti-inflammatory agents due to possible renal dysfunction. Indomethacin and probenecid may decrease effectiveness. Cholestyramine may decrease oral bioavailability if given at the same time. Other diuretics have been reported to increase the toxicity of lithium and aminoglycosides.
Contraindications/Precautions: Contraindicated in patients with known hypersensitivity to torsemide or sulfonylureas and in patients who are anuric. Use with caution in patients with cirrhosis and ascites, since sudden alterations of fluid balances may precipitate hepatic coma. Rapid intravenous administration may cause ototoxicity. Excess diuresis is potentially serious therefore appropriate precautions should be employed to prevent electrolyte imbalance. Periodic monitoring of serum potassium and other electrolytes is advised during treatment with torsemide. Pregnancy Category B.
Adverse Effects: The only frequent adverse effects greater than those seen in placebo are excessive urination.
Patient Consultation:
May be taken with food or milk if GI upset occurs.
Timing of dose is important because of increased diuresis. Usually given in early a.m.
Do not take any nonprescription cough or cold medicines, antacids, laxatives, or antidiarrheals without consulting your pharmacist or physician.
Store in a cool, dry place away from sunlight and children.
If a dose is missed, take it as soon as possible. If it is closer to the time of your next dose than the dose you missed, skip the missed dose and return to your doing schedule. Do not double doses.
Contact a physician if the above side effects are severe or persistent.