EMEDZ.NET

Disclaimer Notice:

Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

The information provided on Emedz.net is for doctors and pharmacists only to manage their patients in the best way and avoid medications-related errors.

Still, for the general population, this should not be considered professional medical advice or a substitute for consultation with a licensed healthcare provider. The content on this blog is not intended to diagnose, treat, cure, or prevent any disease or health condition.

Always seek the advice of a qualified healthcare professional before making any changes to your diet, exercise routine, medication, or any other aspect of your healthcare. We strongly discourage self-medication and self-treatment.

Even though the primary author of emedz.net is an experienced health professional, the blog is not intended to replace medical advice sought at the Doctor’s Clinic.

The authors share personal experiences, research findings, and general knowledge about health and wellness and medications-related topics.

However, individual health situations vary, and what works for one person may not work for another. It's important to consult with a healthcare provider for personalized guidance.

We strive to provide accurate and up-to-date information, but medical knowledge is constantly evolving. Therefore, we do not guarantee the accuracy, completeness, or timeliness of the information presented in this blog.

Emedz.net is not an online pharmacy:

Online pharmacies sell medicines and pharmaceutical products. EMEDZ.net is intended to provide drug-related information to pharmacists and physicians. It is intended to provide authentic information about medicines so as to prevent errors related to prescriptions.

We do not sell medicines, so please don’t ask for them.

We are not affiliated with any pharmaceutical companies:

Emedz.net has no affiliation with any pharmaceutical companies. We do not promote any product. Sometimes brand names are also mentioned in the title of the page, but that is what is called a “Featured Image”. It has nothing to do with selling or promoting that brand. Just to make things easier, generic and brands are mentioned in the blog.

Emedz.net may contain links to external websites or resources for your convenience. We do not endorse or take responsibility for the content of these external sites.

In no event shall Emedz.net, its authors, contributors, or any related parties be liable for any damages or consequences arising from the use of the information provided on this blog.

By using Emedz.net, you acknowledge and agree to this disclaimer and our Terms of Use. If you do not agree with this disclaimer or our Terms of Use, we advise you to refrain from using our website.

Remember, your health is a valuable asset, and decisions about your health should always be made in consultation with a qualified healthcare professional.

Torsemide (torasemide) - Uses, Dose, Side effects

Torsemide (Torasemide) is a diuretic drug that causes water excretion by inhibiting the reabsorption of sodium and chloride in the ascending loop of Henle and distal renal tubules.

Torsemide Uses:

Edema:
- It is used for treating edema associated with heart failure and hepatic or renal disease.
Hypertension:
- Torsemide is indicted for the management of hypertension.

Note: It is not used as first line therapy for hypertension.

Torsemide dose in adults:

Note: Torsemide 20 mg = bumetanide 1 mg = furosemide 40 mg = ethacrynic acid 50 mg

Torsemide dose in patients with Edema:

Chronic renal failure:
- Oral: Initial: 20 mg once daily; up to the desired diuretic effect, the dose may be gradually increased by doubling.
Heart failure:
- 10–20 mg taken orally once daily at first.
- You can gradually raise the dose by doubling it up until you get the desired diuretic effect.
- 200 mg per day is the maximum dosage.
Hepatic cirrhosis:
- Initially, take 5 to 10 mg orally once daily.
- Up until the desired diuretic response is attained, the dose may be gradually raised by doubling dose.
- The maximum single dose that is advised is 40 mg.
- It should be administered along with an aldosterone antagonist or a potassium-saving diuretic, as noted.

Torsemide dose in the treatment of Hypertension:

5 mg used orally once daily at first;
The dose may be increased to 10 mg once daily after 4-6 weeks if inadequate antihypertensive response.

Torsemide use in children:

The drug's effectiveness and safety in children are unknown.

Torsemide pregnancy Risk Factor: C

Animal reproduction studies showed some adverse outcomes.

Torsemide use during breastfeeding:

Torsemide secretion in breast milk is unknown, however, diuretics can suppress lactation.

Torsemide dose adjustment in renal disease:

There are no dosage adjustments provided in the manufacturer’s labeling.
Higher doses may be required to achieve diuretic response.

Torsemide dose adjustment in liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling; use with caution.
It is contraindicated in hepatic coma

Side Effects of Torsemide:

Cardiovascular:
- ECG Abnormality
- Chest Pain
Central Nervous System:
- Nervousness
Gastrointestinal:
- Constipation
- Diarrhea
- Dyspepsia
- Nausea
- Sore Throat
Neuromuscular & Skeletal:
- Arthralgia
- Myalgia
- Weakness
Renal:
- Polyuria
Respiratory:
- Rhinitis
- Cough

Contraindications to Torsemide:

Hypersensitivity to torsemide and any component of the formulation
Anuria
Hepatic coma.

Warnings and precautions

Fluid and electrolyte losses:
- The effects of torsemide on fluid and electrolyte levels can be severe.
- Monitoring is necessary for hypokalemia (hypokalemia), hyponatremia (hypomagnesemia), hypocalcemia (hypochloremic alkalosis), hyponatremia (hypomagnesemia), hyponatremia and hypomagnesemia).
- Patients with electrolyte problems can be predisposed to serious arrhythmias.
Hyperuricemia:
- It can cause hyperuricemia and gout.
Nephrotoxicity:
- Monitors should be kept on the lookout for signs such as oliguria, azotemia and reversible rises in creatinine and BUN.
Ototoxicity:
- Tinnitus and hearing loss can be caused by severe renal impairment, excessive dosages, hypoproteinemia, or the use of aminoglycosides.
Allergy to sulfonamide ("sulfa")
- T-cell-mediated (type IV), reactions are observed when sulfa-containing drugs cause a maculopapular eruption.
- These drugs should not be used if you have severe reactions, such as Stevens Johnson syndrome or toxic epidermal neural neurolysis.
Insufficiency of the adrenal gland:
- Patients with Addison disease should not use Torsemide to treat hypertension.
Bariatric surgery
- Bariatric surgery should not be performed with diuretics as they can cause electrolyte disturbances or dehydration.
Diabetes:
- Patients with diabetes should use it.
Hepatic impairmen
- Hepatic encephalopathy can be caused by electrolyte or acid/base imbalance. You should not use it if you have cirrhosis.

Torsemide (torasemide): Drug Interaction

Risk Factor C (Monitor therapy)
Ajmaline	Sulfonamides may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased.
Alfuzosin	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Allopurinol	Loop Diuretics may intensify Allopurinol's harmful or toxic effects. Allopurinol's serum levels may rise in response to loop diuretics. In particular, Oxypurinol, an active metabolite of Allopurinol, may be increased in concentration by Loop Diuretics.
Alpelisib	May lower the serum level of CYP2C9 substrates (High risk with Inducers).
Amikacin (Oral Inhalation)	Loop Diuretics may increase Amikacin's nephrotoxic impact (Oral Inhalation). Loop Diuretics may increase Amikacin's ototoxic effects (Oral Inhalation).
Aminoglycosides	Aminoglycosides may have a worse or more toxic effect when used with loop diuretics. ototoxicity and nephrotoxicity in particular.
Amphetamines	May lessen the effectiveness of antihypertensive agents.
Angiotensin-Converting Enzyme Inhibitors	Angiotensin-Converting Enzyme Inhibitors' hypotensive effects may be strengthened by loop diuretics. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by loop diuretics.
Antidiabetic Agents	The therapeutic benefit of anti-diabetic agents may be reduced by hyperglycemia-associated agents.
Antipsychotic Agents (Second Generation [Atypical])	Antipsychotic drugs' hypotensive effects may be enhanced by blood pressure-lowering medications (Second Generation [Atypical]).
Barbiturates	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Benperidol	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Beta2-Agonists	May intensify Loop Diuretics' hypokalemic impact.
Bilastine	The QTc-prolonging effects of loop diuretics may be enhanced by bilastine.
Brigatinib	May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents.
Brimonidine (Topical)	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Cardiac Glycosides	Cardiac Glycosides may have a worse or more toxic effect when used with loop diuretics. Particularly, the hypokalemic and hypomagnesemic impact of loop diuretics may worsen cardiac glycoside toxicity.
Cefazedone	May intensify Loop Diuretics' nephrotoxic effects.
Cefotiam	Loop Diuretics may intensify Ceftiam's nephrotoxic effects.
Cefpirome	Loop Diuretics may enhance the nephrotoxic effect of Cefpirome.
Ceftizoxime	Loop Diuretics may enhance the nephrotoxic effect of Ceftizoxime.
Cephalothin	Loop Diuretics may enhance the nephrotoxic effect of Cephalothin.
Cephradine	May enhance the nephrotoxic effect of Loop Diuretics.
CISplatin	Loop Diuretics may enhance the nephrotoxic effect of CISplatin. Loop Diuretics may enhance the ototoxic effect of CISplatin.
Corticosteroids (Orally Inhaled)	May enhance the hypokalemic effect of Loop Diuretics.
Corticosteroids (Systemic)	May enhance the hypokalemic effect of Loop Diuretics.
CycloSPORINE (Systemic)	May enhance the adverse/toxic effect of Loop Diuretics.
CYP2C9 Inducers (Moderate)	May lower the serum level of CYP2C9 substrates (High risk with Inducers).
CYP2C9 Inhibitors (Moderate)	Torsemide serum concentration can rise.
Dexmethylphenidate	May diminish the therapeutic effect of Antihypertensive Agents.
Diacerein	May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased.
Diazoxide	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
DULoxetine	The hypotensive impact of DULoxetine may be enhanced by blood pressure lowering medications.
Eltrombopag	May raise the level of OATP1B1/1B3 (SLCO1B1/1B3) Substrates in the serum.
Empagliflozin	May enhance the hypotensive effect of Loop Diuretics.
Fosphenytoin	May diminish the diuretic effect of Loop Diuretics.
Gemfibrozil	May raise the level of OATP1B1/1B3 (SLCO1B1/1B3) Substrates in the serum.
Herbs (Hypertensive Properties)	May diminish the antihypertensive effect of Antihypertensive Agents.
Herbs (Hypotensive Properties)	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Hypotension-Associated Agents	Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents.
Ipragliflozin	May intensify Loop Diuretics' harmful or hazardous effects. In particular, there may be an elevated risk for intravascular volume depletion.
Ivabradine	Loop Diuretics may enhance the arrhythmogenic effect of Ivabradine.
Levodopa-Containing Products	Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products.
Licorice	May enhance the hypokalemic effect of Loop Diuretics.
Lithium	Loop Diuretics may lower the level of lithium in the blood. Loop Diuretics may raise the level of lithium in the blood.
Lormetazepam	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Lumacaftor	May lower the serum level of CYP2C9 substrates (High Risk with Inhibitors or Inducers). The serum concentration of CYP2C9 Substrates may rise when taking lumacaftor (High Risk with Inhibitors or Inducers).
Methylphenidate	May diminish the antihypertensive effect of Antihypertensive Agents.
Molsidomine	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Naftopidil	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Neuromuscular-Blocking Agents	Loop Diuretics may diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Loop Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents.
Nicergoline	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nicorandil	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Nitroprusside	Nitroprusside's hypotensive impact may be strengthened by blood pressure-lowering medications.
Opioid Agonists	Could make diuretics' harmful or toxic effects worse. Opioid antagonists may reduce diuretics' therapeutic benefit.
Pentoxifylline	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Phenytoin	May diminish the diuretic effect of Loop Diuretics.
Pholcodine	Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine.
Phosphodiesterase 5 Inhibitors	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Probenecid	May enhance the adverse/toxic effect of Loop Diuretics. Probenecid may diminish the diuretic effect of Loop Diuretics. Probenecid may increase the serum concentration of Loop Diuretics. Management: Monitor for decreased diuretic effects or increased adverse effects of loop diuretics with concomitant use of probenecid. Bumetanide prescribing information recommends against concomitant use of probenecid.
Prostacyclin Analogues	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Quinagolide	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Reboxetine	May enhance the hypokalemic effect of Loop Diuretics.
Rifapentine	May lower the serum level of CYP2C9 substrates (High risk with Inducers).
RisperiDONE	Loop Diuretics may intensify RisperiDONE's harmful or hazardous effects.
Salicylates	May lessen Loop Diuretics' diuretic effects. The content of salicylates in the serum
Teriflunomide	May rise when using loop diuretics.
Tobramycin (Oral Inhalation)	May raise the level of OATP1B1/1B3 (SLCO1B1/1B3) Substrates in the serum.
Topiramate	Loop Diuretics may increase Tobramycin's nephrotoxic effects (Oral Inhalation). Loop Diuretics may increase Tobramycin's ototoxic effects (Oral Inhalation).
Warfarin	Topiramate's effect on hypokalemia may be enhanced by loop diuretics. Torsemide may raise the Warfarin serum levels.
Xipamide	May intensify Loop Diuretics' harmful or hazardous effects. Particularly, there may be a higher chance of hypovolemia, electrolyte imbalances, and prerenal azotemia.
Yohimbine	May diminish the antihypertensive effect of Antihypertensive Agents.
Risk Factor D (Consider therapy modification)
Amifostine	Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered.
Bile Acid Sequestrants	May decrease the absorption of Loop Diuretics.
Canagliflozin	May enhance the hypotensive effect of Loop Diuretics. Management: If canagliflozin is combined with a loop diuretic, monitor for symptoms of intravascular volume depletion and hypotension. Canadian product labeling recommends avoiding the combination of canagliflozin and loop diuretics.
Dabrafenib	May lower the serum level of CYP2C9 substrates (High risk with Inducers). Management: When possible, look for CYP2C9 substrate substitutes. If concurrent therapy cannot be avoided, pay special attention to the substrate's clinical consequences (particularly therapeutic effects).
Dofetilide	Loop Diuretics may increase Dofetilide's ability to extend QTc. Management: When dofetilide is taken with loop diuretics, serum potassium and magnesium levels should be continuously monitored. The need for therapy change may arise.
Enzalutamide	May lower the serum level of CYP2C9 substrates (High risk with Inducers). Treatment: Enzalutamide should not be used concurrently with CYP2C9 substrates that have a limited therapeutic index. Enzalutamide use, like with the use of any other CYP2C9 substrate, should be done with caution and under close observation.
Foscarnet	Loop Diuretics may raise the level of foscarnet in the blood.
Methotrexate	May reduce Loop Diuretics' therapeutic efficacy. Loop diuretics may raise the level of methotrexate in the serum. Loop Diuretics' serum levels may be raised by methotrexate. Management involves monitoring for elevated methotrexate and/or loop diuretic levels/toxicity with concurrent use of these drugs as well as for diminished loop diuretic therapeutic effects. It could be essential to reduce the dosage of loop diuretics or methotrexate.
MiFEPRIStone	May elevate CYP2C9 substrates' serum levels (High risk with Inhibitors). Management: During and for two weeks after mifepristone treatment, use CYP2C9 substrates at the lowest dose advised and keep a close eye out for any negative effects.
Nonsteroidal Anti-Inflammatory Agents	May diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended.
Obinutuzumab	May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion.
Sodium Phosphates	Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with diuretics, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, hydrate adequately and monitor fluid and renal status.
Tolvaptan	May raise the level of OATP1B1/1B3 (SLCO1B1/1B3) Substrates in the serum.
Risk Factor X (Avoid combination)
Bromperidol	The hypotensive impact of bromperidol may be enhanced by blood pressure lowering medications. Blood Pressure Lowering Agents' hypotensive effects may be lessened by bromperidol.
Desmopressin	Desmopressin's hyponatremic impact may be increased by loop diuretics.
Levosulpiride	Loop Diuretics may enhance the adverse/toxic effect of Levosulpiride.
Mecamylamine	Sulfonamides may enhance the adverse/toxic effect of Mecamylamine.
Promazine	Loop Diuretics may enhance the QTc-prolonging effect of Promazine.

Monitoring parameters:

BP
Blood glucose
Renal function tests
Serum electrolytes
Diuretic effect

How to administer Torsemide?

It should be given orally as food slows the rate and reduces the extent of absorption and may reduce diuretic efficacy.

Mechanism of action of Torsemide:

It inhibits sodium and chloride absorption in the ascending loops of Henle, and distal renal tubule.
Although the excretion of calcium, sodium, chloride and magnesium is increasing, glomerular flow rate, renal plasma flow or an acid-base equilibrium remain constant.

Peak diuretic effect It is visible in 1 to 2 hours. The peak antihypertensive effect can be seen in 4 to 6 weeks (may take as long as 12 weeks).

The duration ofDiuresis can last 6-8 hours

Protein binding: >99%

Metabolism: Liver disease (80%) via CYP2C9, CYP2C8 or CYP2C18

Bioavailability: 80%

Half-life elimination: 3.5 Hours

Time to get therepeak plasma concentrationIt takes less than an hour. If administered with food, it may take up to half an hour.

Excretion: Urine (21%).

Torsemide Brand Names (International):

Demadex
Britomar
Cardiotimide
Dilast
Diuver
Dytor
Examide
Kamez
Luprac
Luretic
Onced
Setoram
Sutril
Sutrilneo
Tomide
Toradiv
Toral
Torem
Torrem
Torsem
Torsid
Torsix
Trifas
Tuosai
Unat

Torsemide Brand Names in Pakistan:

No Brands Available in Pakistan.

Torsemide (torasemide) - Uses, Dose, Side effects

Torsemide Uses:

Edema:

Hypertension:

Torsemide dose in adults:

Torsemide dose in patients with Edema:

Chronic renal failure:

Heart failure:

Hepatic cirrhosis:

Torsemide dose in the treatment of Hypertension:

Torsemide use in children:

Torsemide pregnancy Risk Factor: C

Torsemide dose adjustment in renal disease:

Torsemide dose adjustment in liver disease:

Side Effects of Torsemide:

Cardiovascular:

Central Nervous System:

Gastrointestinal:

Neuromuscular & Skeletal:

Renal:

Respiratory:

Contraindications to Torsemide:

Warnings and precautions

Fluid and electrolyte losses:

Hyperuricemia:

Nephrotoxicity:

Ototoxicity:

Allergy to sulfonamide ("sulfa")

Insufficiency of the adrenal gland:

Bariatric surgery

Diabetes:

Hepatic impairmen

Monitoring parameters:

How to administer Torsemide?

Mechanism of action of Torsemide:

Torsemide Brand Names (International):

Torsemide Brand Names in Pakistan:

Recent Posts

Related Posts