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Drugs, Supplies and Delivery
Torsemide
Torsemide is a potent loop diuretic commonly used to manage conditions associated with fluid overload, such as heart failure, hypertension, and renal impairment. It is known for its predictable pharmacokinetics and bioavailability, making it a reliable alternative to other loop diuretics like furosemide. This article synthesizes information from the British National Formulary (BNF), Lippincott Textbook of Pharmacology, and Lange Basic & Clinical Pharmacology to provide a detailed overview of torsemide, including its mechanism, uses, dosing, side effects, precautions, and drug interactions.
Torsemide inhibits the Na-K-2Cl symporter in the thick ascending limb of the loop of Henle in the kidney. By blocking this transporter, it prevents the reabsorption of sodium, chloride, and potassium, leading to:
- Increased excretion of sodium and water, reducing fluid overload and edema.
- Secondary effects such as vasodilation and reduced preload, which are beneficial in heart failure and hypertension (Lippincott, Lange).
Torsemide has a longer duration of action compared to furosemide and is less dependent on renal function for its effects, making it suitable for patients with renal impairment (BNF).
- Heart Failure:
- Reduces fluid overload and alleviates symptoms like dyspnea and edema (BNF).
- Hypertension:
- Used as an adjunct to other antihypertensive agents, particularly in patients with fluid retention (Lippincott).
- Renal Impairment:
- Effective in managing edema associated with chronic kidney disease (CKD) (Lange).
- Hepatic Cirrhosis:
- Used to treat ascites and edema in patients with liver disease (BNF).
- Heart Failure:
- Initial dose: 10–20 mg once daily, titrated to response (max 200 mg/day) (BNF).
- Hypertension:
- Initial dose: 5 mg once daily, increased to 10 mg once daily if needed (Lippincott).
- Renal Impairment:
- Dose adjustment may not be necessary, but monitor renal function closely (Lange).
- Hepatic Cirrhosis:
- Initial dose: 5–10 mg once daily, titrated to response (BNF).
Administration:
- Can be taken with or without food.
- Administer in the morning to avoid nocturia (Lippincott).
- Common: Electrolyte imbalances (hypokalemia, hyponatremia, hypomagnesemia), dehydration, and dizziness (Lange).
- Serious: Ototoxicity (rare), acute kidney injury, and severe hypotension (BNF).
- Electrolyte Imbalances: Monitor potassium, sodium, and magnesium levels regularly (Lippincott).
- Renal Impairment: Use with caution in severe renal failure; monitor renal function (Lange).
- Pregnancy: Use only if benefits outweigh risks; limited data available (BNF).
- Allergy to Sulfonamides: Contraindicated in patients with sulfonamide hypersensitivity (Lippincott).
- Other Diuretics: Increased risk of electrolyte imbalances and dehydration (Lange).
- ACE Inhibitors/ARBs: Increased risk of hyperkalemia and renal dysfunction (BNF).
- Digoxin: Hypokalemia may increase the risk of digoxin toxicity (Lippincott).
- NSAIDs: May reduce diuretic efficacy and worsen renal function (Lange).
Torsemide is the generic name for this medication. It is marketed under the brand name Demadex® in some regions. Generic versions are widely available, making it an affordable option for patients
