Torsemide

What it is and how it works

Mechanism of Action Micropuncture studies in animals have shown that torsemide acts from within the lumen of the thick ascending portion of the loop of Henle, where it inhibits the Na + /K + /2Cl – -carrier system. Clinical pharmacology studies have confirmed this site of action in humans, and effects in other segments of the nephron have not been demonstrated. Diuretic activity thus correlates better with the rate of drug excretion in the urine than with the concentration in the blood. Torsemide increases the urinary excretion of sodium, chloride, and water, but it does not significantly alter glomerular filtration rate, renal plasma flow, or acid-base balance.

Indications

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. Edema Torsemide tablets are indicated for the treatment of edema associated with heart failure, renal disease or hepatic disease. Hypertension Torsemide tablets are indicated for 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. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including the class to which this drug principally belongs. There are no controlled trials demonstrating risk reduction with torsemide.

Dosage and administration (summary)

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.

Contraindications

Torsemide tablets are contraindicated in patients with known hypersensitivity to torsemide tablets or to povidone. Torsemide tablets are contraindicated in patients who are anuric. Torsemide tablets are contraindicated in patients with hepatic coma. Hypersensitivity to torsemide tablets or povidone, anuria, and hepatic coma.

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 (5.3 , 7.6) Hypotension and Worsening Renal Function Excessive diuresis may cause potentially symptomatic dehydration, blood volume reduction and hypotension and worsening renal function, including acute renal failure particularly in salt-depleted patients or those taking renin-angiotensin aldosterone inhibitors.

Pregnancy

Pregnancy Risk Summary There are no available data on use of torsemide in pregnant women and the risk of major birth defects or miscarriage. In pregnant rats and rabbits dosed, on a mg/m 2 basis, with 10 and 1.7 times a human dose of 20 mg/day, respectively, there was no fetotoxicity or teratogenicity.

Storage and supply

Product: 50090-7261 NDC: 50090-7261-0 90 TABLET in a BOTTLE

Source: Torsemide (Torsemide) — US FDA prescribing information, 2024-10-01, DailyMed. Summarised and shortened; the full label governs. Iranian registration, indications and labelling may differ.