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torsemide (torasemide (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
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.
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
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
• 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.
• 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.