Torsemide

Indications

Torsemide is used for: Hypertension, Oedema

Adult Dose

Oral Hypertension Adult: 2.5-5 mg once daily. Max: 5 mg daily. Oedema in patients with hepatic cirrhosis Adult: Initially, 5-10 mg once daily, given together with an aldosterone antagonist or a potassium-sparing diuretic, titrated upwards until the desired diuretic response is obtained. Max: 40 mg daily. Oedema Adult: 5 mg once daily, increased to 20 mg once daily if necessary. Max: 40 mg/day. Intravenous Oedema Adult: 10-20 mg daily as IV inj slowly over 2 min. Max: 200 mg daily.

Child Dose

Renal Dose

Administration

May be taken with or without food.

Contra Indications

Hypersensitivity to sulfonylureas, renal failure with anuria, hepatic coma and pre-coma, hypotension, cardiac arrhythmias. Pregnancy and lactation.

Precautions

Risk of hyperuricaemia, gout and DM. Correct electrolyte distubances and disorders of micturition before treatment. Monitor electrolyte balance, glucose, uric acid, creatinine and lipids regularly. May impair ability to drive or operate machinery.

Pregnancy-Lactation

Pregnancy There are no available data on use in pregnant women and the risk of major birth defects or miscarriage; however, in pregnant rats and rabbits administered 50 and 6.8 times the human dose, respectively, decreases in body weight, decreased fetal resorption and delayed fetal ossification were observed Lactation There are no data regarding the presence in human milk or effects on the breastfed child; diuretics can suppress lactation

Interactions

Increased risk of severe hypokalaemia with amphotercin B, corticosteroids, carbenoxolone, hypokalaemia-causing medications. Increased risk of lithium toxicity. Increased potential for ototoxicity and nephrotoxicity with nephrotoxic or ototoxic medications e.g. aminoglycosides. High dose salicylates may increase the risk of salicylate toxicity. Increased risk of toxicity with digoxin. Reduced diuretic effect with NSAIDs. Increased risk of hypotension with antihypertensives.

Adverse Effects

Side effects of Torsemide : 1-10% 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%) <1% Fatigue Hyperuricemia Low back pain Muscle cramps Orthostatic hypotension Ototoxicity (tinnitus and hearing loss, usually reversible; avoid doses >200 mg) Pruritus Rash

Mechanism of Action

Torasemide, a sulfonylurea loop diuretic, acts from within the lumen of the thick ascending portion of the loop of Henle, where it inhibits the Na+/K+/2CI--carrier system.