torsemide


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torsemide

 [tor´sĕ-mīd]
a diuretic related to sulfonylurea, used in treatment of edema and hypertension, administered orally or intravenously.

torsemide (torasemide (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.

torsemide

/tor·se·mide/ (tor´sĕ-mīd) a diuretic related to sulfonylurea, used in the treatment of edema and hypertension.

torsemide

(tôr′sə-mīd′)
n.
A loop diuretic used to treat edema caused by congestive heart failure, renal disease, and other conditions, and to treat hypertension.

torsemide

[tor′sĕ-mīd]
a loop diuretic related to sulfonylurea, used in treatment of edema and hypertension. It is administered orally or intravenously.

torsemide (tor´səmīd´),

n brand name: Demadox;
drug class: loop diuretic;
action: acts on loop of Henle to decrease the reabsorption of chloride and sodium with resultant diuresis;
uses: treatment of hypertension and edema associated with congestive heart failure (CHF), liver disease, and chronic renal failure.
References in periodicals archive ?
Among the calcium channel blockers, Amlodipine followed by Cilnidipine and sustained release Nifedipine was most commonly prescribed and among the diuretics it is Torsemide.
Dose response study of intravenous torsemide in congestive heart failure.
Camber torsemide tablets are available in 5-mg, 10-mg, 20-mg and 100-mg strengths in bottle sizes of 100.
Loop diuretics, such as furosemide (Lasix[R]) and torsemide (Demadex[R]), are another commonly prescribed class.
My current medications include warfarin, Terasozin, levothyroxine, Prilosec, Torsemide, and Digoxin.
CYP enzymes of the P-450 2C9 subfamily are produced in the liver, are responsible for 50% of the epoxygenase activity in human liver, and metabolize a wide variety of clinically important drugs, including losartan, torsemide, and S-warfarin (1).
Other diuretics used were hydrochlorothiazide, metolazone, spironolactone, bumetanide, and torsemide.
chlorothiazide (Diuril) hydrochlorothiazide (Esidrix, Hydrodiuril, Microzide, Oretic ) Loop Diuretics: bumetanide (Bumex) furosemide (Lasix) torsemide (Demadex) spironolactone (Aldactone) Decreases blood pressure amiloride (Midamor) but holds onto potassium.
The patient was started on treatment with Tab Nicoumalone (acitrom) 2 mg, Tab Bosentan 125 mg OD, Tab Tadalafil 20mg OD, and Tab Torsemide 10 mg OD.
Also inform them if you take tamoxifen (Nolvadex), which is given to treat breast cancer, the diabetes drug tolbutamide (Orinase), and the diuretic torsemide (Demadex), used to treat high blood pressure and prevent the fluid retention that occurs with heart disease.