torsemide (Rx)

Brand and Other Names:Demadex
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg
  • 20mg
  • 100mg

injectable solution

  • 10mg/mL

Congestive Heart Failure

10-20 mg PO/IV once daily initially; doubled until desired diuretic effect is achieved; individual dose not to exceed 200 mg

Chronic Renal Failure

20 mg PO/IV once daily initially; doubled until desired diuretic effect is achieved; individual dose not to exceed 200 mg

Hepatic Cirrhosis

5-10 mg PO/IV once daily initially with aldosterone antagonist or potassium-sparing diuretic; individual dose not to exceed 40 mg

Hypertension

2.5-5 mg/day PO initially; increased to 10 mg/day PO in 4-6 weeks PRN

Dosing Considerations

Use for fluid retention refractory to thiazides or with impaired renal function

Overdose management

  • Normal saline may be used for volume replacement
  • Dopamine or norepinephrine may be used to treat hypotension
  • If dysrhythmia due to decreased potassium or magnesium is suspected, replace aggressively
  • Discontinue treatment if no symptoms are apparent after 6 hours

Safety and efficacy not established

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Interactions

Interaction Checker

and torsemide

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            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

            Postmarketing Reports

            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

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            Warnings

            Contraindications

            Known hypersensitivity to torsemide or to povidone

            Anuria

            Hepatic coma

            Cautions

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

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            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

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Sulfonylurea diuretic; loop diuretic acting at Na-K-2Cl reabsorptive pump at ascending loop of Henle; interferes with chloride-binding cotransport system, causing increased excretion of water, sodium, chlorine, magnesium, and calcium

            Absorption

            Bioavailability: 80%

            Onset: PO, 1 hr

            Duration: PO, 6-8 hr; IV, 6 hr

            Peak plasma time: PO, 1 hr

            Peak effect: Diuresis, 1-2 hr; antihypertensive effect, 4-6 weeks

            Distribution

            Protein bound: 99%

            Vd: 12-15 L (doubled in cirrhosis)

            Metabolism

            Metabolized in liver by CYP450 system

            Metabolites: M1 (active), M3 (active), M5 (inactive)

            Elimination

            Half-life: 3.5 hr

            Dialyzable: Hemodialysis, no

            Renal clearance: 0.38-0.78 L/hr

            Excretion: Urine (20%)

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            Administration

            IV Compatibilities

            Solution: D5W

            Y-site: Milrinone

            IV Administration

            Administer either as slow injection over 2 minutes or as continuous infusion

            If given through IV line, flushing with NS before and afterward is recommended

            Storage

            Store at controlled room temperature

            Protect from freezing

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.