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Lasix (furosemide) vs. Demadex (torsemide): What's the difference?
- Lasix (furosemide) and Demadex (torsemide) are diuretics (water pills) used to treat edema (water retention) due to congestive heart failure, kidney disease, chronic kidney failure, or liver disease. Lasix and Demadex are also used with other high blood pressure medications to treat high blood pressure (hypertension).
- Lasix is a brand name for furosemide.
- Demadex is a brand name for torsemide.
- Side effects of Lasix and Demadex that are similar include dehydration, nausea, diarrhea, and dizziness.
- Side effects of Lasix that are different from Demadex include low blood pressure, electrolyte depletion, yellowing skin and eyes (jaundice), ringing in the ears, sensitivity to light, rash, pancreatitis, abdominal pain, increased blood sugar, and increased uric acid levels.
- Side effects of Demadex that are different from Lasix include headache, excessive urination, runny nose, weakness, ECG abnormality, cough, constipation, joint pain, stomach upset, sore throat, muscle pain, insomnia, edema, and nervousness.
What are Lasix and Demadex?
Lasix is a potent diuretic (water pill) that is used to eliminate water and salt from the body. In the kidneys, salt (composed of sodium and chloride), water, and other small molecules normally are filtered out of the blood and into the tubules of the kidney. The filtered fluid ultimately becomes urine. Most of the sodium, chloride, and water filtered out of the blood is reabsorbed into the blood before the filtered fluid becomes urine and is eliminated from the body. Lasix works by blocking the absorption of sodium, chloride, and water from the filtered fluid in the kidney tubules, causing a profound increase in the output of urine (diuresis).
Demadex is a diuretic (water pill) used to treat edema (water retention) due to congestive heart failure, kidney disease, chronic kidney failure, or liver disease. It also is used to treat high blood pressure (hypertension). 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 Lasix (furosemide) and Bumex (bumetanide).
What are the side effects of Lasix and Demadex?
Common side effects of Lasix are:
Other important side effects include:
- Ringing in the ears (tinnitus)
- Sensitivity to light (photophobia)
- Abdominal pain
Increased blood sugar and uric acid levels also may occur.
Potent medication like Demadex can cause low blood levels of potassium, magnesium, sodium, and calcium. Additionally, fluid losses may lead to dehydration. The symptoms of dehydration may include:
- Dry mouth
- Reduced kidney function
- Heart arrhythmias
- Muscle aches and pains
Possible side effects of this medication reported often include:
- Excessive urination
- Runny nose
- ECG abnormality
- Joint pain
- Stomach upset
- Sore throat
- Muscle pain
Possible serious side effects and adverse effects include:
- Atrial fibrillation
- Chest pain
- Gastrointestinal bleeding
- High blood sugar (hyperglycemia)
- Increased uric acid (hyperuricemia)
- Low blood potassium (hypokalemia)
- Low blood pressure (hypotension)
- Dehydration (symptoms listed previously)
- Shunt thrombosis
- Rectal bleeding
- Ventricular tachycardia
- Serious skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis)
- Allergic reactions
- Reduced number of white blood cells and platelets
Demadex can cause dehydration and loss of potassium and other electrolytes. Low potassium levels (hypokalemia) can cause abnormal heartbeats 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 is the dosage of Lasix vs. Demadex?
- The usual starting oral dose for treatment of edema in adults is 20 to 80 mg as a single dose. The same dose or an increased dose may be administered 6 to 8 hours later. Doses may be increased by 20 to 40 mg every 6 to 8 hours until the desired effect occurs. The effective dose may be administered once or twice daily. Some patients may require 600 mg daily.
- The starting oral dose for children is 2 mg/kg. The starting dose may be increased by 1 to 2 mg/kg every 6 hours until the desired effect is achieved. Doses greater than 6 mg/kg are not recommended.
- The recommended dose for treating hypertension is 40 mg twice daily. The dose of other blood pressure medications should be reduced by half when Lasix is added.
- Demadex (torsemide) 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.
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What drugs interact with Lasix and Demadex?
- Administration of Lasix with aminoglycoside antibiotics (for example, gentamicin) or ethacrynic acid (Edecrin, another diuretic) may cause hearing damage.
- Lasix competes with aspirin for elimination in the urine by the kidneys. Concomitant use of Lasix and aspirin may, therefore, lead to high blood levels of aspirin and aspirin toxicity.
- Lasix also may reduce excretion of lithium (Eskalith, Lithobid) by the kidneys, causing increased blood levels of lithium and possible side effects from lithium.
- Sucralfate (Carafate) reduces the action of Lasix by binding Lasix in the intestine and preventing its absorption into the body. Ingestion of Lasix and sucralfate should be separated by two hours.
- When combined with other antihypertensive drugs, there is an increased risk of low blood pressure or reduced kidney function.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) -- for example, ibuprofen, indomethacin (Indocin, Indocin-SR) -- may interfere with the blood pressure-reducing effect of Lasix.
Several medicines may cause interactions with Demadex.
- Demadex can cause low blood potassium, calcium, and magnesium levels. These changes can increase the risk of toxicity from digoxin (Lanoxin). Combining Demadex 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 Demadex. 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 Lasix) and it probably can do the same with Demadex. Other nonsteroidal anti-inflammatory drugs (NSAIDs) -- for example, ibuprofen (Motrin), naproxen (Naprosyn) -- may interact similarly.
- Concomitant use of Demadex and aminoglycosides may increase the risk of hearing impairment since both agents can affect hearing.
- Probenecid decreases the diuretic effect of Demadex by reducing secretion of Demadex into the kidney tubules.
Are Lasix and Demadex safe to use while pregnant or breastfeeding?
Lasix (furosemide) and Demadex (torsemide) are diuretics (water pills) used to treat edema (water retention) due to congestive heart failure, kidney disease, chronic kidney failure, or liver disease. Lasix and Demadex are also used with other high blood pressure medications to treat high blood pressure (hypertension).
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Liver disease can be cause by a variety of things including infection (hepatitis), diseases, for example, gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause and may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Kidney (Renal) Failure
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, or medication. Some of the renal causes of kidney failure include sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones.Treatment options included diet, medications, or dialysis.
High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms. Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure. The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater. If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
Congestive Heart Failure (CHF)
Congestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Heart disease (coronary artery disease) occurs when plaque builds up in the coronary arteries, the vessels that supply blood to the heart. Heart disease can lead to heart attack. Risk factors for heart disease include: Smoking High blood pressure High cholesterol Diabetes Family history Obesity Angina, shortness of breath, and sweating are just a few symptoms that may indicate a heart attack. Treatment of heart disease involves control of heart disease risk factors through lifestyle changes, medications, and/or stenting or bypass surgery. Heart disease can be prevented by controlling heart disease risk factors.
Heart failure (congestive) is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats. There are two types of congestive heart failure, systolic or left-sided heart failure; and diastolic or right-sided heart failure. Treatment, prognosis, and life-expectancy for a person with congestive heart failure depends upon the stage of the disease.
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Hypertensive Kidney Disease
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
Diabetes and Kidney Disease
In the United States diabetes is the most common cause of kidney failure. High blood pressure and high levels of blood glucose increase the risk that a person with diabetes will eventually progress to kidney failure. Kidney disease in people with diabetes develops over the course of many years. albumin and eGFR are two key markers for kidney disease in people with diabetes. Controlling high blood pressure, blood pressure medications, a moderate protein diet, and compliant management of blood glucose can slow the progression of kidney disease. For those patients who's kidneys eventually fail, dialysis or kidney transplantation is the only option.
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