Torsemide (Oral)

Torsemide is used to help lower the body's water content in patients suffering from conditions including severe liver disease (cirrhosis), congestive heart failure, or kidney disease.

Overview

Torsemide is a loop diuretic (water pill) prescription medication used to increase the flow of urine and subsequently reduce the volume of water in the body for patients who have conditions like congestive heart failure, liver disease (cirrhosis), and kidney disease. It's also used as a treatment for hypertension (high blood pressure). Designed to prevent your body from absorbing too much salt, torsemide works by allowing the kidneys to remove excess water and salt from the body through the urine. It does this by preventing the kidneys from retaining water. By blocking the reabsorption back into the blood of sodium and water that's been filtered out of the blood in the kidneys, torsemide may cause dehydration as well as loss of electrolytes, such as calcium, potassium, sodium, and magnesium.

Also known as Demadex, torsemide comes in tablet form and should be taken only as directed by your doctor. Avoid taking prescription and OTC medications without first talking to your doctor, as torsemide can interact with certain medications and cause an increased risk of side effects. Torsemide can help reduce blood pressure and improve overall quality of life for patients with high blood pressure. It can prevent the above medical conditions from getting worse and causing stroke, heart failure, kidney disease, or blood vessel disease.

Condition(s) treated

  • Edema (fluid retention excess fluid in body tissue) caused by:
  • Kidney disease
  • Severe liver disease (cirrhosis)
  • Congestive heart failure
  • High blood pressure

Type of medicine

  • Loop diuretic (water pill)

Side Effects

Torsemide may cause some unwelcome side effects. Some less common side effects include:

  • Dry mouth
  • Nausea or vomiting
  • Chest pain
  • Increased thirst
  • Shortness of breath
  • Loss of appetite
  • Convulsions
  • Muscle cramps or pain
  • Decreased urination
  • Irregular heartbeat
  • Unusual weakness or tiredness
  • Swelling of the feet, hands, or lower legs
  • Electrocardiogram (ECG) changes
  • Mood changes
  • Tingling or numbness in lips, feet or hands

Rare side effects of Torsemide include:

  • Skin rash
  • Black, tarry stools
  • Ringing or buzzing in the ears
  • Faintness, dizziness, lightheadedness when getting up from a sitting position, or from a lying down position

Some side effects do not require medical attention, as they tend to go away during the course of treatment once your body starts getting used to the medication. These side effects include:

  • Increased urination
  • Sleeplessness or trouble sleeping
  • Stomach discomfort, pain, or upset
  • Muscle pain or stiffness
  • Difficulty moving
  • Runny nose
  • Heartburn
  • Stuffy nose
  • Indigestion
  • Swollen joints
  • Lack or loss of strength
  • Belching
  • Nervousness
  • Decreased sex drive, impotence, or difficulty having an orgasm
  • Acid or sour stomach
  • Difficulty having a bowel movement
  • Increased cough
  • Sneezing
  • Joint pain
  • Sore throat

Dosage

Dosage varies from patient to patient, so follow your doctor's directions or the direction on the label. Your dosage will depend on several factors, including your age, the condition being treated, how you react to the first dose, how severe your condition is, and other medical conditions you have. The following information is a general guideline for how the medication should be taken.

To reduce the amount of water in the body, adults should take 5 to 20 milligrams (mg) of the oral tablet once per day. Children should consult a doctor for correct dosage information.

To treat high blood pressure, adults should take 5 to 10 milligrams (mg) once per day. Children should consult a doctor for proper dosage information.

To treat heart failure, take 10 to 20 milligrams (mg) by mouth or injections once per day. In this case, the dose can be doubled until the anticipated results are accomplished. The maximum dose is 200 milligrams (mg) per day.

To treat chronic kidney failure, take 20 to 200 milligrams (mg) by mouth or injections once per day.

To treat liver cirrhosis, take 5 to 40 milligrams (mg) orally or by injections once per day. Typically, torsemide is combined with aldosterone antagonists or potassium-sparing diuretics.

If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. If that's the case, skip the missed dose and return to your regular dosing schedule. Never double up on doses to make up for missed doses.

Symptoms of overdose include:

  • Drowsiness
  • Coma
  • Dizziness
  • Headache
  • Blurred vision
  • Confusion
  • Increased heart rate
  • Weak pulse
  • Decreased urine output
  • Fatigue
  • Sweating
  • Irritability
  • Rapid breathing
  • Fainting
  • Lightheadedness
  • Wrinkled skin
  • Sunken eyes

Interactions

Torsemide has 26 major drug interactions, 662 moderate drug interactions, and 74 minor drug interactions. This means that some medications should not be combined. However, in some cases--despite the interaction--some medications may be combined. In such instances, your doctor might alter the dose of your medication and other precautions may be taken. Let your doctor know if you're taking any of the medications listed below.

  • Aceclofenac
  • Bromfenac
  • Acematacin
  • Feprazone
  • Dexketoprofen
  • Amtolmetin Guacil
  • Proglumetacin
  • Floctafenine
  • Arsenic Trioxide
  • Diclofenac
  • Propyphenazone
  • Tolfenamic Acid
  • Aspirin
  • Choline Slicylate
  • Fluconazole
  • Clonixin
  • Pixantrone
  • Dexibuprofen
  • Bufexamac
  • Ketoprofen
  • Celecoxib
  • Diflunisal
  • Ceritinib
  • Tolmetin
  • Proquazone
  • Tiaprofenic Acid
  • Piroxicam
  • Digitoxin
  • Flufenamic Acid
  • Piketoprofen
  • Dipyrone
  • Fluribuprofen
  • Dofetilide
  • Valdecoxib
  • Nepafenac
  • Felbinac
  • Droperidol
  • Tenoxicam
  • Foscarnet
  • Doxicam
  • Ibuprofen
  • Niflumic Acid
  • Etodolac
  • Sulindac
  • Fenoprofen
  • Ketanserin
  • Warfarin
  • Etofenamate
  • Sotalol
  • Etoricoxib
  • Fepradinol
  • Ketorolac
  • Levomethadyl
  • Lithium
  • Lornoxicam
  • Sodium Salicylate
  • Loxoprofen
  • Nimesulide
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Nimesulide Beta Cyclodetrin
  • Metolazone
  • Rofecoxib
  • Oxaprozin
  • Morniflumate
  • Phenylbutazone
  • Nabumetone
  • Salicylic Acid
  • Oxyphenbutazone
  • Naproxen
  • Parecoxib
  • Salsalate

Taking torsemide in combination with any of the above-mentioned medications can cause a heightened risk of some side effects. However, sometimes it's necessary for your treatment to include torsemide in conjunction with one of the medications on this list. You and your doctor must be able to determine whether the risk of side effects is worth the treatment.

Other medications that can cause interactions include:

  • Alacepril
  • Gossypol
  • Benazepril
  • Spirapril
  • Imidapril
  • Captopril
  • Temocapril
  • Quinapril
  • Cilazapril
  • Delapril
  • Licorice
  • Perindopril
  • Enalapril
  • Lisinopril
  • Enalaprilat
  • Fosinopril
  • Trandolapril
  • Germanium
  • Ramipril
  • Moexipril
  • Ginseng
  • Pentopril
  • Zofenopril

Torsemide can also interact with certain kinds of food, tobacco, or alcohol. Discuss your use of each of these with your healthcare provider.

Certain medical conditions can also affect the way torsemide works for you, which includes a recent heart attack, electrolyte losses, severe kidney disease (renal dysfunction), kidney failure (anuria), type 2 diabetes mellitus, liver disease, hearing problems (ototoxicity) and gout. Torsemide can make hearing problems worse and can increase your blood sugar level.

Warnings

Before you start taking torsemide, tell your doctor if you're allergic to torsemide, sulfonamide medicine, or any other medicines. Tell your doctor if you're allergic to any of the ingredients in this medication. Follow the directions on the label carefully.

If you are unable to urinate, you should not take torsemide.

If you need to have any type of CT scan or x-ray using a dye that's injected into your veins, you should not take torsemide.

Tell your doctor if you're taking any vitamins, prescription or nonprescription medications, herbal products, or nutritional supplements.

Your doctor may instruct you to change your diet, restricting you to a low-salt or low-sodium diet. You may need to increase your potassium intake through potassium-rich foods, such as orange juice, raisins, prunes and bananas. Incorporate these items into your diet exactly as directed by your doctor.

Torsemide can cause a loss of potassium from your body. To prevent this from happening, your doctor may direct you to take a potassium supplement, take additional medication to prevent the loss of potassium, or eat or drink foods high in potassium, such as orange juice. If you're currently on a special diet (such as for diabetes), do not try to change your diet on your own. Too much potassium in your diet can be harmful.

Tell your doctor if you start to feel sick, especially in cases of severe or continuing diarrhea, nausea, or vomiting.

If you've ever had kidney disease, tell your doctor, as you might not be able to take torsemide.

Patients with ascites should take caution when using this medication because sudden changes in fluid and electrolyte balance may cause hepatic coma.

Do not freeze this medication.

Tell your doctor if you plan to have any lab tests completed, as torsemide can interact with certain blood tests. Make sure to keep any appointments you have with the laboratory and have your blood pressure checked regularly.

Avoid driving, operating heavy machinery, or doing other tasks that require alertness until you know how this medication affects you.

If you're taking torsemide and you have hypertension (high blood pressure), talk to your doctor before using any OTC products, as they can raise blood pressure. Some of these products include diet pills, ibuprofen (and similar products), stimulants, cough and cold drugs, and some natural aids or products.

Before having surgery (even dental surgery) or emergency treatment, let your healthcare providers know that you're on this medication. Talk to your doctor if you're sweating too much, you have too much fluid loss, or loose stools, or if you've been throwing up, as these conditions can lead to a reduction in blood pressure.

Do not share your medication with anyone and do not take anyone else's medication.

Torsemide is not recommended for children under 18 years old because giving torsemide to children can cause a severe allergic reaction. Symptoms of a severe allergic reaction include hives, trouble breathing, or swelling of the tongue or throat. Taking this medication can be fatal to a child under 18.

This medication should not be administered to patients with a coma caused by hepatic encephalopathy.

If you do not take this medication as prescribed for your edema, your heart will have to work harder and you'll have trouble breathing because of fluid buildup.

Do not start taking any new prescription or OTC drugs while taking torsemide. Always talk to your doctor first before taking any new medications.

Keep a list of all of the current prescription and nonprescription medications you're taking, as well as products like dietary supplements, vitamins, or minerals. Keep this list with you whenever you go to a doctor's appointment or to the pharmacy. It's also good to have in case of an emergency.

You may experience fainting, lightheadedness, or dizziness upon standing. These symptoms are more likely to appear if you exercise, stand for long durations, drink alcohol, or if there is a period of warm weather. This usually happens at the start of treatment. To prevent this from happening, rest your feet on the floor for a few minutes before standing up slowly to get out of bed. Limit your alcohol consumption while taking this medication as it can increase the side effects. Also, it's important to use caution in any of these situations and to be careful going up and down the stairs.

Avoid medications for asthma, hay fever, appetite control, or sinus issues, as these medications may raise your blood pressure.

Torsemide is not known to be harmful to pregnant women. The drug is not expected to harm an unborn baby. However, you should still talk to your doctor if you're pregnant (or planning to get pregnant) and planning to take torsemide. Nursing mothers should not take torsemide because it is still not known whether this medication can pass into breast milk or if it can harm a nursing baby. Tell your doctor if you're breastfeeding prior to taking this medication.

If you're taking torsemide for high blood pressure, keep taking the medication even if you feel well. Since high blood pressure has no symptoms, you won't be able to tell whether the medication is responsible for your improved condition.

Tell your doctor if you're taking any of the following medications:

  • Aminoglycoside antibiotics like amikacin, gentamicin (Garamycin), tobramycin (Bethkis), aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin, Advil, etc.), and naproxen (Aleve)
  • Digoxin (Lanoxin), ethacrynic acid (Edecrin), indomethacin (Indocin), lithium (Lithobid), probenecid, or medications for high blood pressure or pain
  • Corticosteroids such as budesonide (Entocort), betamethasone (Celestone), cortisone (Cortone), fludrocortisone (Floriner), dexamethasone (Dexpak, Dexasone, Decadron, etc.), prednisolone (Prelone), methylprednisolone (Meprolone, Medrol, etc.), triamcinolone (Azmacort, Aristocort), prednisone (Rayos), and hydrocortisone (Hydrocortone, Cortef)

If you are taking one of these medications, your doctor may have to adjust your dosage and monitor you closely for potential side effects. Do not change your dose without the consent of a licensed medical professional. If you're taking lithium, talk to your doctor, as you may need to have your blood work checked more carefully while you're on torsemide tablets.

Tell your doctor if you're taking cholestyramine (Questran); it needs to be taken four hours before or one hour after taking torsemide.

This medication does not cure high blood pressure; it helps to control it. You might have to take medication for high blood pressure for the rest of your life. If left untreated, high blood pressure can cause additional medical problems, such as stroke, heart failure, kidney disease, or blood vessel disease.

Elderly patients (age 65 and older) may need a lower dose of this medication or a different dosing schedule.

Torsemide can cause you to pass urine more frequently. To avoid having trouble sleeping, take this medication before 6pm and no later. It can be taken with or without food and should be taken for the full course of treatment, as recommended by your doctor.

Storage

Keep this medication in the container it came in and make sure it's tightly closed. Keep it out of sight and reach of children. Torsemide can be stored at room temperature and should be kept away from extreme moisture and heat. Therefore, storing it in the bathroom would not be a good idea. If you're using a weekly pill reminder, make sure it's locked and out of reach of children or pets, as these containers aren't self-locking like most medication bottles.

Dispose of any unused or expired medication properly, which means not flushing it down the toilet or simply throwing it in the trashcan. Talk to your doctor or pharmacist about whether your community has a take-back program. You can also try contacting your local garbage or recycling department to ask about take-back programs near you.

Summary

Torsemide is a beneficial drug used to treat edema associated with conditions such as congestive heart failure, severe liver disease (cirrhosis), and kidney disease. A loop diuretic, torsemide prevents your body from absorbing too much salt, which allows the salt to be passed into your urine. While mainly used for these reasons, torsemide can also be used to treat hypertension (high blood pressure). By helping prevent the kidneys from retaining water, torsemide helps remove excess salt and water from the body. This can result in the loss of electrolytes, such as calcium, potassium, sodium, and magnesium. To prevent this loss, it's important for the patient to stay hydrated, avoid standing for long durations, drinking alcohol, exercising and being in the heat too long, as all of these activities can cause dehydration.

When taken correctly, torsemide can provide relief of edema due to congestive heart failure, severe liver disease (cirrhosis), and kidney disease. It also brings down blood pressure in patients with hypertension. In some cases, the patient must work with the doctor to find the correct dosage, as dosage varies from patient to patient.

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Last Reviewed:
December 23, 2017
Last Updated:
April 05, 2018
Content Source: