Torsemide

Class
Diuretics
Subclass
Loop diuretics
Substance name
Torsemide, torasemide
Brand names
Soaanz®
Common formulations
Film-coated tablet
Dosage and administration
Adults patients
Edema in patients with congestive HF
•
Start at: 10-20 mg PO daily
•
Maximum: 200 mg per day
Edema in patients with kidney disease
•
Start at: 20 mg PO daily
•
Maximum: 200 mg per day
Edema in patients with liver cirrhosis
•
Start at: 5-10 mg PO daily
•
Maximum: 40 mg per day
Hypertension
•
Start at: 5 mg PO daily for 4-6 weeks
•
Maintenance: 5-10 mg PO daily
Indications for use
Labeled indications
Adults
•
Treatment of edema in patients with congestive HF
•
Treatment of edema in patients with kidney disease
•
Treatment of edema in patients with liver cirrhosis
•
Treatment of hypertension
Safety risks
Contraindications
Hypersensitivity to torsemide or its components or povidone
Anuria
Hepatic coma
Warnings and precautions
Electrolyte abnormalities
•
Maintain a high level of suspicion, as torsemide can cause hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, hypochloremic alkalosis, hyperglycemia, and hyperuricemia. Monitor serum electrolytes and blood glucose periodically.
Hypotension, renal failure
•
Use caution in patients with salt depletion or taking concomitant renin-angiotensin-aldosterone inhibitors or nephrotoxic drugs.
Ototoxicity
•
Use caution in patients with severe renal impairment, hypoproteinemia, or taking higher than recommended doses.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required. Do not use in patients with anuria.
Intermittent hemodialysis
•
Use acceptable. No dose adjustment required. Do not use in patients with anuria.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required. Do not use in patients with anuria.
Hepatic impairment
Any severity
•
Use with caution. Monitor for electrolyte disturbances. Do not use in patients with hepaitc coma.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Consider alternative agents that may be safer.
•
Diuretics can suppress lactation.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Unknown frequency
•
Hypotension, hearing loss, tinnitus, abdominal pain, paresthesia, confusion, visual disturbances, loss of appetite, ↓ WBC count, anemia, ↓ platelet count, ↑ serum gamma-glutamyltransferase, ↑ serum transaminases, pruritus, photosensitivity of skin, urinary retention, ↓ serum potassium, ↑ BUN, ↑ serum creatinine, ↑ blood glucose, ↑ serum cholesterol, ↑ serum triglycerides, ↓ serum magnesium, hypochloremic alkalosis, ↓ serum sodium, ↑ serum uric acid, renal failure, acute pancreatitis, thiamine deficiency, Stevens-Johnson syndrome, toxic epidermal necrolysis
Interactions
Drug(s)
Check Interactions
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