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))

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.

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.
References in periodicals archive ?
When polled, only 22% of attendees at the session picked "transition to torsemide" as the best approach for restoring fluid balance with the lowest adverse potential in a 74-year-old woman with nonischemic cardiomyopathy on furosemide 80 mg twice daily who has been hospitalized for fluid overload three times in the year.
Among the calcium channel blockers, Amlodipine followed by Cilnidipine and sustained release Nifedipine was most commonly prescribed and among the diuretics it is Torsemide. Cilnidipine though has its longer duration of action of 24 hours, also prevents reflex tachycardia as it selectively acts on both L and N type of calcium channels, still Amlodipine (L type of calcium channel blocker) was prescribed because of free supply by the Government of the State.
Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide and furosemide in patients with congestive heart failure.
Medication name Medication type Oral health effect(s) Fluticasone Nasal corticosteroid None reported ProAir HFA Beta2 agonist Xerostomia Adcirca Phosphodiesterast-5 None reported inhibitor Torsemide Antihypertensive None reported Warfarin Vitamin K antagonist Oral ulcers, taste distortion Ability Antipsychotic Xerostomia Pravachol Antilipemic agent None reported Spironolactone Antihypertensive, None reported diuretic Allopurinol Anti-gout None Trazadone Antidepressant Severe xerostomia Lamictal Anticonvulsant Xerostomia Colchicine Anti-gout Bosentan (generic Endothelia receptor Brandname Tracleer) antagonist, Tracleer vasodilator reported to cause periodontal bleeding.
Research, published in the Journal of the American College of Cardiology, found that between torsemide, furosemide and bumetanide, torsemide was shown to be more effective and better tolerated than the other two.
Preoperative optimisation with metoprolol 25 mg once daily, ramipril 2.5 mg once daily and a combination of torsemide 20 mg and spironolactone 50 mg was initiated.
Home/Admission Medications Torsemide 100 mg twice daily, Acetylsalicyclic acid 81 mg daily, Warfarin 2.5 mg daily, Metoprolol 25 mg daily, Isosorbide mononitrate 120 mg daily, Atorvastatin 40 mg nightly, Lanoxin 0.125 mg every other day, Insulin 70/30 twice daily, Fluticasone propionate and Salmeterol inhaler 250/50 one puff twice daily, Tiopropium Bromide inhaled 18 mcg daily, Ipratropium inhaler prn Medications added on admission: Furosemide 20mg/hr intravenously
Loop diuretics: Agents belonging to this group include furosemide, torsemide and bumetinide.
Camber most recently launched torsemide, AB-rated and bioequivalent to Roche's Demadex.
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.