PREPARATIONS: Tablets: 5, 10, 20, and 100 mg; Injection: 10 mg/ml
- 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.
PREGNANCY AND BREASTFEEDING SAFETY: ;Safe use of torsemide by pregnant women has not been established. It is not known whether torsemide is excreted in human milk.
STORAGE: Torsemide should be stored at room temperature,15 C to 30 C (59 F to 86 F).
- Torsemide tablets may be given at any time without regard to meals.
- For treatment of 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.
DRUG CLASS AND MECHANISM:
- Torsemide is a potent diuretic (water pill) that 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 diuretics called "loop" diuretics which also includes 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 bumetanide 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.
- The FDA approved torsemide in August, 1993.
REFERENCE: FDA Prescribing Information.
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