Torem


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torsemide (torasemide (UK))

Demadex, Torem (UK)

Pharmacologic class: Loop diuretic

Therapeutic class: Diuretic, antihypertensive

Pregnancy risk category B

Action

Inhibits sodium and chloride reabsorption from ascending loop of Henle and distal renal tubule; increases renal excretion of water, sodium, chloride, magnesium, calcium, and hydrogen. Also may exert renal and peripheral vasodilatory effects. Net effect is natriuretic diuresis.

Availability

Injection: 10 mg/ml

Tablets: 5 mg, 10 mg, 20 mg, 100 mg

Indications and dosages

Heart failure

Adults: 10 to 20 mg P.O. or I.V. daily. If response inadequate, double dosage until desired response occurs. Don't exceed 200 mg as a single dose.

Hypertension

Adults: 5 mg P.O. daily. May increase to 10 mg daily after 4 to 6 weeks; if drug still isn't effective, additional antihypertensives may be prescribed.

Chronic renal failure

Adults: 20 mg P.O. or I.V. daily. If response inadequate, double dosage until desired response occurs. Don't exceed 200 mg as a single dose.

Hepatic cirrhosis

Adults: 5 or 10 mg P.O. or I.V. daily, given with aldosterone antagonist or potassium-sparing diuretic. If response inadequate, double dosage. Don't exceed 40 mg as a single dose.

Contraindications

• Hypersensitivity to drug, thiazides, or sulfonylureas

• Anuria

Precautions

Use cautiously in:

• severe hepatic disease accompanied by cirrhosis or ascites, preexisting uncorrected electrolyte imbalances, diabetes mellitus, worsening azotemia

• elderly patients

• pregnant or breastfeeding patients

• children younger than age 18.

Administration

• Give I.V. by direct injection over at least 2 minutes or by continuous I.V. infusion.

• Flush I.V. line with normal saline solution before and after administering.

Adverse reactions

CNS: dizziness, headache, asthenia, insomnia, nervousness, syncope

CV: hypotension, ECG changes, chest pain, volume depletion, atrial fibrillation, ventricular tachycardia, shunt thrombosis

EENT: rhinitis, sore throat

GI: nausea, diarrhea, vomiting, constipation, dyspepsia, anorexia, rectal bleeding, GI hemorrhage

GU: excessive urination

Metabolic: hyperglycemia, hyperuricemia, hypokalemia

Musculoskeletal: joint pain, myalgia

Respiratory: increased cough

Skin: rash

Other: edema

Interactions

Drug-drug. Aminoglycosides, cisplatin: increased risk of ototoxicity

Amphotericin B, corticosteroids, mezlocillin, piperacillin, potassium-wasting diuretics, stimulant laxatives: additive hypokalemia

Antihypertensives, nitrates: additive hypotension

Lithium: increased lithium blood level and toxicity

Neuromuscular blockers: prolonged neuromuscular blockade

Nonsteroidal anti-inflammatory drugs, probenecid: inhibited diuretic response

Sulfonylureas: decreased glucose tolerance, hyperglycemia in patients with previously well-controlled diabetes

Drug-diagnostic tests. Glucose, uric

acid: increased levels

Potassium: decreased level

Drug-herbs. Dandelion: interference with diuresis

Ephedra (ma huang): reduced hypotensive effect of torsemide

Geranium, ginseng: increased risk of diuretic resistance

Licorice: rapid potassium loss

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Patient monitoring

• Monitor vital signs, especially for hypotension.

• Assess ECG for arrhythmias and other changes.

• Monitor weight and fluid intake and output to assess drug efficacy.

• Monitor electrolyte levels, particularly potassium. Stay alert for signs and symptoms of hypokalemia.

• Assess hearing for signs and symptoms of ototoxicity.

• Monitor blood glucose level carefully in diabetic patient.

Patient teaching

• Advise patient to take in morning with or without food.

• Instruct patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure drop.

• Tell patient to monitor weight and report sudden increases.

• Instruct diabetic patient to monitor blood glucose level carefully.

• Caution patient to avoid alcohol during drug therapy.

• Advise patient to consult prescriber before using herbs.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.

Torem

A brand name for TORACEMIDE.
References in periodicals archive ?
Otro parametro estudiado es el tamano de particula de la cascara de coco; es conocido que la capacidad de adsorcion de diferentes materiales varia de acuerdo con el tamano de particula; consecuentemente, la superficie de contacto entre el sorbente y la fase liquida (solvente) tambien tiene un papel importante (Huaman and Torem.
Kunz, Ross and Torem are remarkable during each of the story's passages through their final year at home, consistently able to find surprising moments that unveil their characters' complexities, and driven to avoid cliche.
As escalas auto-aplicaveis mais utilizadas sao a Analog Alexithymia Scale (Faryna, Rodenhauser, & Torem, 1986), a MMPI Alexithymia Scale (Kleiger & Kinsman, 1980), a Schalling-Sifneos Personality Scale (Apfel & Sifneos, 1979) e a Revised Schalling-Sifneos Personality Scale (Sifneos, 1986).
omnem itaque de tuo pectore praesentem tristitudinem mitte et angorem animi depelle, nam lusus iste, quem publice gratissimo deo Risui per annua reuerticula solemniter celebramus, semper commenti nouitate florescit, iste deus auctorem et <ac-> torem suum propitius ubique comitabitur amanter, nec umquam patietur ut ex animo doleas, sed frontem tuam serena uenustate laetabit adsidue, at tibi ciuitas omnis pro ista gratia honores egregios obtulit [.
For another solution, based on the apportionment of damages between the parties, see ARIEL PORAT, HAGANAT ASHAM TOREM BE-DINE HOZIM [CONTRIBUTORY FAULT IN THE LAW OF CONTRACT] (1997); Ariel Porat, Contributory Negligence in Contract Law: Toward a Principled Approach, 28 U.
3]) place(**) Meranti and Area I Group of Meranti 640,000 mixed jungle trees Group of mixed 360,000 jungle tree Area II Group of Meranti 530,000 Group of mixed 265,000 jungle tree Other than Meranti/ Area I/II Beautiful trees 905,000 other than mixed without diameter jungle trees limit (including Sonokeling, Ramin and Ulin) Area I Torem tree 360,000 Area II Torem tree 265,000 Other group Area I Mentaos, Kisereh, 640.
Torem (torasemide) is a loop diuretic for treatment of hypertension.
2) Zakres przedmiotu zamwienia: a) budowa torw nr 31, 32, 33, 34, 35 oraz 36, b) polaczenie toru 36 z duzym obwodowym torem objazdowym, c) polaczenie hali napraw i hali zajezdni drzwiami podwjnymi w osi 9, d) wykonanie sterowania zwrotnic wjazdowych na tory 31, 32, 33, 34 w hali i toryobjazdowe 35, 36 poza hala, e) wykonanie swietlika dachowego w rejonie przebudowy nad pomieszczeniami biurowymi, f) zakup i montaz urzadzen wyposazenia hali zuraw przyscienny Q = 1 000 kg, g) Montaz obrotnicy zakupionej przez Zamawiajacego w etapie III i polaczenie hali napraw z hala zajezdni torem poprzecznym (wykonanie wg.
Torem reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
The EUR120m deal covers the world-wide rights to Marcoumar, Torem, Tilcotil and Aurorix, which together represent annual sales of some SEK500m.
The first questionnaire asked respondents for their gender and age; these items were included not only to ascertain basic sample characteristics but also because there are some reports suggesting that proneness to dissociation may vary with gender and age (Irwin, 1994; Ross, Ryan, Anderson, Ross, & Hardy, 1989; Torem, Hermanowski, & Curdue, 1992).
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