torsemide (Demadex)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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What is torsemide, and how does it work?

Torsemide (Demadex) is a potent drug that's a diuretic (water pill).  This medicine causes a profound increase in urine output (diuresis) by preventing the kidney from retaining water. Specifically, it blocks the reabsorption back into the blood of sodium and water that has been filtered out of the blood in the kidneys.

It is in a class of diuretic drugs called "loop" diuretics, which also includes the drugs furosemide (Lasix) and bumetanide (Bumex). Torsemide 10-20 mg is approximately equivalent to 1 mg of bumetanide and 40 mg of furosemide. The potent diuretic effect of torsemide can cause the loss of large amounts of body water leading to dehydration as well as the loss of electrolytes (for example, sodium, potassium, magnesium, and calcium). Therefore, careful medical supervision is necessary during treatment.

What brand names are available for torsemide?

Demadex is the brand name for this medication in the US.

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Is it available as a generic drug?

Yes, it's available as a generic drug.

Do I need a prescription for it?

Yes, your medical doctor or health care professional will need to write you a prescription for the medication.

What are the uses for torsemide?

This drug is prescribed by doctors to treat several diseases and conditions.

Who shouldn't take Demadex?

  • Patient's shouldn't take Demadex if they are allergic to it or to sulfonylureas to which it is related.
  • Don't take it if you aren't able to urinate.
  • Patients with liver disease with cirrhosis and ascites should use this drug with caution because sudden changes in fluid and electrolyte balance can cause hepatic coma.

Torsemide side effects

Potent medication like torsemide can cause low blood levels of potassium, magnesium, sodium, and calcium. Additionally, fluid losses may lead to dehydration. The symptoms of dehydration may include:

Possible side effects of this medication reported often include:

Possible serious side effects adverse effects include:

Ringing in the ears (tinnitus) and reversible hearing loss may occur.

Demadex can cause dehydration and loss of potassium and other electrolytes. Low potassium levels (hypokalemia) can cause abnormal heart beats especially in people with heart disease or those taking the medicine digoxin (Lanoxin). Levels of potassium and other electrolytes should be monitored during medical treatment with this medicine.

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What dosages are available for torsemide, and how do I take it?

  • Torsimide (Demadex) comes in tablets of 5, 10, 20, and 100 mg. The 10 mg/ml injectable solution has been discontinued.
  • Patients can take the tablets at any time without regard to meals. (You can take it on an empty stomach.)
  • For the treatment for patients with heart failure the initial dose is 10 to 20 mg by mouth or injection once daily. The dose may be doubled until the desired diuretic effect is achieved. The maximum dose is 200 mg daily.
  • Chronic kidney failure is treated with 20 to 200 mg orally or by injection once daily.
  • The dose for treating high blood pressure is 2.5 to 10 mg orally once daily.
  • Liver cirrhosis is treated with 5 to 40 mg orally or by injection once daily. It is combined with aldosterone antagonists or potassium-sparing diuretics.

Which drugs or supplements might cause interactions?

Several medicines may cause interactions with torsemide.

  • Torsemide can cause low blood potassium, calcium, and magnesium levels. These changes can increase the risk of toxicity from digoxin (Lanoxin). Combining torsemide with other diuretics such as metolazone (Zaroxolyn), hydrochlorothiazide, or chlorthalidone (Hygroton) can exaggerate the losses of potassium and magnesium.
  • The body's ability to eliminate lithium (Lithobid, Eskalith) may decrease in patients receiving torsemide. Therefore, careful monitoring of lithium levels in blood is recommended when torsemide and lithium are taken together in order to prevent increases in lithium levels and lithium toxicity.
  • Indomethacin (Indocin) can reduce the diuretic and blood pressure-lowering effects of other loop diuretics (for example furosemide) and it probably can do the same with torsemide. Other nonsteroidal anti-inflammatory drugs, for example, ibuprofen (Motrin), naproxen (Naprosyn) may interact similarly.
  • Concomitant use of torsemide and aminoglycosides may increase the risk of hearing impairment since both agents can affect hearing.
  • Probenecid decreases the diuretic effect of torsemide by reducing secretion of torsemide into the kidney tubules.

Is torsemide safe to use during pregnancy or while breastfeeding?

  • Researches, doctors, and other health care professionals haven't established the safety of Demadex in pregnant women.
  • It's also not known whether it's excreted in human milk.

Storage and FDA approval

  • Keep this drug stored at room temperature, 15 C to 30 C (59 F to 86 F).
  • The FDA approved torsemide in August, 1993.

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Overdose information

There have been no human experiences with overdoses of this medication. Signs and symptoms of overdose may include:

If you think someone has taken an overdose of this drug call 911 or the poison control center at 1-800-222-1222.

REFERENCE: FDA Prescribing Information.

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Reviewed on 3/3/2017
References
REFERENCE: FDA Prescribing Information.

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