Torsemide

DEA Class; Rx

Common Brand Names; Demadex (DSC), Soaanz

• Diuretics, Loop

Oral loop diuretic
Used for hypertension, and for edema associated with heart failure, chronic renal failure, and hepatic cirrhosis
Twice as potent as furosemide with a higher bioavailability and longer half-life; may have less pronounced effect on potassium excretion

Indicated for treatment of edema associated with heart failure or renal disease

Indicated for treatment of edema associated with hepatic disease

Hypersensitivity to torsemide or to povidone

Anuria

Hepatic coma

• Excessive urination (7%)
• Headache (7%)
• Electrolyte imbalance (2-4%)
• Dizziness (3%)
• Rhinitis (3%)
• Constipation (2%)
• Cough (2%)
• Diarrhea (2%)
• Dyspepsia (2%)
• Nausea (2%)
• Insomnia (1%)
• Nervousness (1%)
• Gastrointestinal system: Pancreatitis, abdominal pain
• Nervous System: Paresthesia, confusion, visual impairment, loss of appetite
• Hematologic: Leucopenia, thrombocytopenia, anemia
• Hepatobiliary: Increase in liver transaminases, gamma-glutamyltransferase
• Metabolism: Thiamine (vitamin B1) deficiency
• Skin/hypersensitivity: Stevens-Johnson syndrome, toxic epidermal necrolysis, photosensitivity reaction, pruritus
• Urogenital: Acute urinary retention

Use with caution in diabetes mellitus, fluid or electrolyte imbalance (hypokalemia, hyponatremia), hyperglycemia, hyperlipidemia, hyperuricemia or gout, severe liver disease with cirrhosis and ascites

Use with caution in cirrhosis; avoid changes in fluid and electrolyte balance and acid-base status, which may lead to hepatic encephalopathy

Monitor fluid status and renal function to prevent azotemia, oliguria, and reversible increases in blood urea nitrogen (BUN) and creatinine

Excessive diuresis may cause potentially symptomatic dehydration, blood volume reduction and hypotension and worsening renal function, including acute renal failure particularly in salt-depleted patients or those taking renin-angiotensin aldosterone inhibitors; worsening of renal function can also occur with concomitant use of nephrotoxic drugs (e.g., aminoglycosides, cisplatin, and NSAIDs); monitor volume status and renal function periodically

Can cause potentially symptomatic hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, and hypochloremic alkalosis; therapy can cause an increase in blood glucose levels and hyperglycemia; asymptomatic hyperuricemia can occur, and gout may rarely be precipitated; monitor serum electrolytes and blood glucose periodically

Tinnitus and hearing loss (usually reversible) have been observed with loop diuretics; higher than recommended doses, severe renal impairment, and hypoproteinemia, appear to increase the risk of ototoxicity

No data are available on use in pregnant females and risk of major birth defects or miscarriage

There are no data regarding presence of torsemide in human milk or effects of on breastfed children

Diuretics can suppress lactation