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torsemide (torasemide (UK))

Demadex, Torem (UK)

Pharmacologic class: Loop diuretic

Therapeutic class: Diuretic, antihypertensive

Pregnancy risk category B


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.


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.


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.


• Hypersensitivity to drug, thiazides, or sulfonylureas

• Anuria


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.


• 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


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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


A brand name for TORACEMIDE.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
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Torem (2008), also included the following research study findings: Rossi (1993), when patients shift into a state of hypnosis, we can communicate with the unconscious mind and speak directly to tissues and cells by using all five senses.
Torem described two new approaches in his work with HG patients, which serve as an introduction to the application of P.S.H.
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., 2008).
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With: Molly Kunz, Tyler Ross, Allison Torem, Matt DeCaro, Sadieh Rifai, Stephen Cone, Cliff Chamberlain, Sadie Rogers, Ann Whitney, Rodney Lee Rogers.
Moshe TOREM. "Tiur Tekhni shel Mafsek Grama shel Meniqt Ha'Moneq" in Rabbi Moshe Harari, Kedushat Ha'Shabbat, pp.
The EUR120m transaction, initially announced in August, covers world-wide rights to Marcoumar, Torem, Tilcotil and Aurorix, which together represent annual sales of some SEK500m.
We're the last class to come through and there are definitely some big shoes to fill," said Ensign Philip Torem, of OCS 20-07.
Several interventions have increased appropriate transition behaviors in students with autism including video priming (Schreibman et al., 2000), activity scheduling (Dooley, Wilczenski, & Torem, 2000), visual prompting (Dettmer, Simpson, Myles, & Ganz, 2000), photographic cueing (Schmit, Alper, & Raschke, 2000), verbal cueing (Tustin, 1995), and teaching transition routines at the beginning of the academic year (Gettinger, 1988).
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