Torasemide

Torsemide

• Torasemide is an anilinopyridine sulfonylurea belonging to the class of loop diuretics.

Torasemide (also known as torsemide in the U.S.) is a loop diuretic primarily used in the treatment of edema (fluid overload) associated with heart failure, renal disease, or liver disease. It is also prescribed for the treatment of hypertension (high blood pressure).

What are the uses of Torasemide?

• Torsemide tablets are a loop diuretic indicated for:
• The treatment of edema associated with heart failure, renal disease or hepatic disease.
• The treatment of hypertension, to lower blood pressure.
• Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions.

Dosage and administration?

Edema associated with:

• Heart failure: initial dose is 10 or 20 mg once daily. Titrate by factors of two; doses above 200 mg have not been studied.
• Chronic renal failure: initial dose is 20 mg once daily. Titrate by factors of two; doses above 200 mg have not been studied.
• Hepatic cirrhosis: initial dose is 5 or 10 mg once daily. Titrate by factors of two; doses above 40 mg have not been studied.

Hypertension:

• The recommended initial dose is 5 mg once daily. After 4 to 6 weeks, increase to 10 mg once daily, if needed. If 10 mg is insufficient, consider adding another agent.

What are the dosage forms and strengths?

• Tablets: 5 mg, 10 mg, 20 mg and 100 mg

Contraindications?

• Hypersensitivity to torsemide, anuria, and hepatic coma.

What are the warnings and precautions?

• Hypotension and worsening renal function: monitor volume status and renal function periodically
• Electrolyte and metabolic abnormalities: monitor serum electrolytes and blood glucose periodically.
• Ototoxicity

What are the the side effects?

• The most common adverse reaction is excessive urination (6.7%).

What are the common drug interactions?

• Non-steroidal anti-inflammatory drugs (NSAIDS): reduced diuretic, natriuretic, and antihypertensive effects; risk of renal impairment.
• Cyp2c9: concomitant use with cyp2c9 inhibitors can decrease torsemide clearance. Torsemide may affect the efficacy and safety of sensitive cyp2c9 substrates or of substrates with a narrow therapeutic range, such as warfarin or phenytoin.
• Cholestyramine: decreased exposure of torsemide.
• Organic anion drugs: may decrease diuretic activity of torsemide.
• Lithium: risk of lithium toxicity
• Renin-angiotensin inhibitors: increased risk of hypotension and renal impairment.
• Radiocontrast agents: increased risk of renal toxicity.
• Corticosteroids and ACTH: increased risk of hypokalemia.
• Symptomatic hypotension: advise patients receiving torsemide that lightheadedness can occur, especially during the first days of therapy, and that it should be reported to the prescribing physician. The patients should be told that if syncope occurs, torsemide should be discontinued until the physician has been consulted.
• All patients should be cautioned that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to an excessive fall in blood pressure, with the same consequences of lightheadedness and possible syncope
• Non-steroidal anti-inflammatory drugs (NSAID): advise patients to discuss with their physician before taking NSAID medications concomitantly.

Who is the manufacturer?

Pliva Hrvatska D.O.O. Zagreb, Croatia

Manufactured for: Teva Pharmaceuticals USA, Inc. North Wales, PA 19454

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