Torsemide

As a diuretic, Torsemide is useful in the treatment of edema and the prevention of shortness of breath, as well as the reduction of swelling in the abdomen, arms and legs.

Overview

Torsemide, which is often marketed under the brand names Examide, Diuver and Demadex, is a pyridine-sulfonyl urea loop diuretic which is used to combat edema associated with congestive heart failure, renal problems and liver disease at more effective rates and with decreased potassium loss in comparison to other diuretics.

The medicine was formally approved by the FDA in 1994 and has been used worldwide ever since. In addition to being a popular medication choice for those suffering from heart failure, liver disease and kidney disease, Torsemide has also proven useful (albeit at lower doses) in combatting high blood pressure (hypertension). It works by reducing swelling and water retention, and this makes it much easier for patients to function in everyday life.

Conditions treated:

  • Congenital heart failure
  • Kidney disease
  • Liver disease
  • Hypertension

Type of medicine:

  • Diuretic

Side effects:

Some of the most common side effects reported by patients treated with Torsemide include dizziness, headaches, mood changes, appetite loss, increased thirst, decreased urination, unusual weakness, tiredness, impairment of movement and/or a dry mouth.

The majority of these symptoms should subside as the patient continues to take the medication as prescribed by a doctor. In the instance of a dry mouth, patients are advised to try sucking on ice cubes or sugar-free candy, or to chew sugarless gum, or drink a glass of cold water. If side effects last for a prolonged period of time or appear to worsen, the patient is advised to contact his or her doctor immediately, in order to rule out any potentially harmful issues.

Most patients only experience mild side effects when taking Torsemide, if any whatsoever. Other symptoms which occur less frequently include black or tarry stools, faintness or dizziness when getting up from a prone position, a ringing or buzzing in the ears, joint pain, indigestion, runny nose, sore throat, swollen joints, difficulty sleeping, heartburn, coughing, belching, sour stomach, muscle pain and stiffness and/or a light skin rash. These symptoms are rare but should also pass after the patient adjusts to the medication. Healthcare professionals should be able to offer advice on how to alleviate these symptoms if they are causing temporary discomfort.

Dosage:

Torsemide comes as a tablet (taken orally). It is typically taken once every day. In order to get into a routine and to ensure the effectiveness of the medication, patients are advised to take Torsemide at the same time every day.

Torsemide can be taken with or without food. It is recommended that the tablets are taken with a glass of water. In addition to prescribing Torsemide, a doctor may advise a patient to stick to a specialist diet – one low in sodium or with an increase in potassium (extra bananas, raisins, prunes and orange juice) for example. These instructions should be followed carefully.

Like all prescribed medicines, Torsemide should only be taken as directed by a qualified doctor. Patients should avoid taking excess doses of the drug, and should stick to the prescribed frequency (usually once a day). If a doctor recommends cessation of treatment with Torsemide, the patient should stop taking the medication as advised, even if they have a supply of tablets remaining.

For edema associated with congestive heart failure and renal disease (kidney failure), Torsemide should be taken orally at a starting dose of 20mg, once a day. If the effects of the medication prove inadequate, dosage can be increased by doubling it until the desired patient response is reached. Doses can range from anything between 20-200mg per day dependent on the physiology and other personal circumstances of the patient.

For edema associated with hepatic disease (liver failure), the typical starting dose of Torsemide can range between 5 to 10mg, in conjunction with another potassium-sparing diuretic or aldosterone agonist. If the desired effects are not achieved at these small doses, the level of Torsemide can be gradually increased until the patient achieves the required response. Doses can vary up to 40mg and above, depending on the patient.

For the treatment of hypertension, doctors will typically prescribe 5mg of Torsemide per day. If the desired effects are not achieved within four to six weeks, an increased dose of 10mg orally per day can be prescribed. In the event of 10mg not achieving the desired effects, an additional antihypertensive may also be prescribed in conjunction with Torsemide, at the discretion of the patient’s doctor.

There are no recommended doses for children under the age of 18, as the safety and efficacy of the drug has not been established in minors – however, it may still be prescribed to those under the age of 18 under the direction of a doctor. In these instances, the manufacturer of the medication leaves doses and frequencies up to the administering healthcare professional.

Overdosing on Torsemide can lead to serious, and even fatal, consequences. Some of the symptoms associated with overdose of this medicine include:

  • Severe chest pain
  • Peeling skin or blisters
  • Hives
  • Severe itching
  • Vomiting blood
  • Rapid weight loss
  • Ongoing stomach pain which spreads to the back

In the event of experiencing any of the above symptoms, patients and caregivers should seek emergency medical assistance immediately, by calling the Poison Control Center on 1-800-222-1222 or emergency services on 911.

Interactions:

All drugs have the propensity to interact with other medications or chemicals in the body, and these interactions can cause changes to the effects or efficacy of the medicines involved. Interactions can, for instance, cause one medication to become ineffective or even result in the patient experiencing potentially dangerous side effects. With this in mind, it is incredibly important for patients to keep a detailed list of all medications they are currently taking – and this extends to over the counter treatments, vitamin supplements and herbal remedies.

Below is a list of some medications known to have majorly interacted with Torsemide. Patients who are currently taking one or more of these medicines should make their doctor aware before taking their first dose of Torsemide to rule out any potential issues and to avoid harmful reactions:

  • Anzamet
  • Amikin
  • Amiodarone
  • Arsenic trioxide
  • Cisapride
  • Cidomycin
  • Cordarone
  • Dofetilide
  • Eskalith
  • Etelcalcetide
  • Sodium biphosphate
  • Gentamicin
  • Insapine
  • Lithium
  • Nebcin
  • Pacerone
  • Streptomycin
  • Tizanidine
  • Tobramycin
  • Zanaflex
  • Ziprasidone

Other drugs may have minor interactions with Torsemide, and this can result in unpleasant (although not entirely unbearable) symptoms which may dissipate as treatment continues, however it is important that patients speak to a doctor regarding these symptoms, which include nausea, faintness, and mood changes, if taking one or more of the following medicines:

  • Ampicillin
  • Arthritis medication
  • Cystex
  • Duraxin
  • Magnesium salicylate
  • Garlic oil
  • Kapectolin
  • Migraine formula
  • Probenicid
  • Rexolate
  • Ritonavir

Patients are also advised to tell their doctors if they are currently taking any other substances which may affect how Torsemide functions. For example, alcohol works as a diuretic, and when taken in conjunction with Torsemide this could result in severe dehydration, low blood pressure, faintness, dizziness, fainting and/or other symptoms associated with Torsemide overdose.

Warnings:

In addition to advising a healthcare professional of a list of drugs currently being taken, patients should also disclose any allergies and discuss and previous personal health problems with their physician. Torsemide is known to sometimes cause issues in people with diabetes or gout – patients suffering from either condition should discuss alternative treatments with their doctor, dependent on the seriousness of their current condition.

In addition to this, levels of electrolytes, glucose, uric acid, lipids and creatinine should be monitored regularly in patients who have been prescribed Torsemide long-term (in excess of six months).

Torsemide should only be used during pregnancy if clearly required, as evidence exists of fetoxicity in doses which produce maternal toxicity. Although the effects of Torsemide on nursing infants is unknown, caution is advised to patients who are currently breastfeeding, as Torsemide is known to be excreted into breast milk.

Patients who are currently prescribed Cholestyramine are advised to take it either four hours prior to taking Torsemide, or one hour afterwards. During the course of treatment, regular blood pressure tests should be taken alongside blood plasma tests to ensure that the medication is functioning as it should and to rule out any other potential issues.

Storage:

Torsemide should be stored in the container it was issued in, with the lid tightly closed. It should be stored out of the reach of children, and away from excess heat. This medication should also be kept in a dry place and is therefore not suitable for storing in the bathroom.

In the event of a patient no longer needing to take Torsemide, any excess tablets should be disposed of in a safe and thoughtful manner to ensure that pets, children or other people cannot consume them, either intentionally or accidentally. Most pharmacies and garbage recycling departments can offer advice on the best way to dispose of unwanted or unused Torsemide, and many communities have take-back programs in place so that unused medications can be re-used by patients who need them.

Summary:

Torsemide is an effective treatment in edema associated with many different conditions. While it is greatly beneficial to many patients around the world, it can pose a serious risk to those who misuse it or fail to communicate effectively with their doctors. It is designed to reduce the level of excess fluid which can occur because of heart failure, liver disease and kidney disease, but it can also cause impairments in terms of reacting to stimuli. Because of this, patients are advised to avoid operating heavy machinery in the workplace or driving until the response to the initial treatment has been determined. If the initial dose does not have the required effect, patients are advised to abstain from the same activities while the dose is upped, until it is maintained at a satisfactory level and the response to treatment has been determined.

When taken correctly, Torsemide can provide relief to the symptoms of edema in a much more satisfactory way than older diuretics, and without flushing the body of essential minerals like sodium and potassium.

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Last Reviewed:
December 25, 2017
Last Updated:
December 22, 2017
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