Torasemide


Generic Medicine Info
Indications and Dosage
Intravenous
Hypertension
Adult: As monotherapy or in combination with other antihypertensive agents: In cases when oral administration is not possible or when rapid onset of diuresis is desired: Initially, 5 mg once daily via bolus inj over 2 minutes or as a continuous infusion. If reduction in blood pressure is not achieved within 4-6 weeks, dosage may be increased to 10 mg once daily. Flush the line with 0.9% NaCl before and after administration.

Intravenous
Oedema
Adult: For the treatment of cases associated with CHF: 10-20 mg once daily. Max: 200 mg daily. For cases associated with chronic renal failure: 20 mg once daily. For cases associated with hepatic cirrhosis: In combination with an aldosterone antagonist or a K-sparing diuretic: 5-10 mg once daily. Max: 40 mg. Doses are to be given via bolus inj over 2 minutes or as a continuous infusion. Dosage is individualised and gradually increased until desired diuretic response is attained. Flush the line with 0.9% NaCl before and after administration.

Oral
Hypertension
Adult: As monotherapy or in combination with other antihypertensive agents: Initially, 2.5 mg once daily. Dosage may be increased to 5 mg once daily as necessary. Alternatively, initial dose of 5 mg may be given; if reduction in blood pressure is not achieved within 4-6 weeks, dosage may be increased to 10 mg once daily. Dosage recommendation may vary among countries or individual products. Refer to specific product guidelines.

Oral
Oedema
Adult: For the treatment of cases associated with CHF: 10-20 mg once daily. Max: 200 mg daily. For cases associated with chronic renal failure: 20 mg once daily. For cases associated with hepatic cirrhosis: In combination with an aldosterone antagonist or a K-sparing diuretic: 5-10 mg once daily. Max: 40 mg. Dosage is individualised and gradually increased until desired diuretic response is attained. Dosage recommendation may vary among countries or individual products. Refer to specific product guidelines.
Administration
May be taken with or without food.
Reconstitution
Dilute 50 mg in 500 mL 5% dextrose in water, 0.9% NaCl, or 0.45% NaCl. Alternatively, dilute 200 mg in 250 mL 5% dextrose in water, 0.9% NaCl, or 500 mL 0.45% NaCl.
Contraindications
Hypersensitivity to sulfonamide derived drugs. Anuria; hepatic coma and pre-coma.
Special Precautions
Patient with difficulty in micturition including prostatic hypertrophy, hyperuricaemia, gout, diabetes mellitus, cardiac arrhytmias (e.g. sino-atrial-block, 2nd or 3rd degree atrioventricular block). Patient with CV disease (particularly those receiving cardiac glycosides); liver cirrhosis and ascites (IV). Patient undergoing surgery; avoid use in the immediate postoperative period after bariatric surgery. Not recommended for the initial treatment of hypertension. Not for use in the treatment of hypertension in patients with Addison's disease. Renal and hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Fluid loss, dehydration, electrolyte abnormalities (e.g. hypokalaemia, hyponatraemia, hypomagnesaemia, hypocalcaemia, hypochloraemic alkalosis), hyperuricaemia, increased blood glucose levels, hyperglycaemia; nephrotoxicity, oliguria, azotaemia, reversible increase in BUN and creatinine; tinnitus and hearing loss (reversible). Rarely, gout.
Gastrointestinal disorders: Nausea, vomiting, dyspepsia, diarrhoea, constipation, anorexia, abdominal pain.
General disorders and administration site conditions: Asthenia, fatigue.
Immune system disorders: Serious skin reactions (e.g. Stevens-Johnson syndrome, toxic epidermal necrolysis).
Investigations: Increased blood uric acid, blood glucose, and lipids (including triglycerides, cholesterol).
Metabolism and nutrition disorders: Metabolic alkalosis.
Musculoskeletal and connective tissue disorders: Muscle spasms.
Nervous system disorders: Headache, dizziness, nervousness.
Renal and urinary disorders: Polyuria.
Patient Counseling Information
This drug may cause dizziness, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor serum electrolytes, renal function, uric acid, serum glucose, lipids, CBC, blood pressure, volume status, and diuretic effect periodically.
Overdosage
Symptoms: Diuresis resulting to loss of fluid and electrolytes which may lead to dehydration, somnolence, hyponatremia, hypokalaemia, hypovolaemia, hypotension, hypochloremic alkalosis, hemoconcentration, circulatory collapse. Management: Fluid and electrolyte replacement.
Drug Interactions
May enhance the adverse/toxic (nephrotoxicity/ototoxicity) effect of aminoglycosides. May increase the nephrotoxic effect of cephalosporins and cisplatin. May increase serum concentrations and the cardio-and neurotoxic effect of lithium. May increase the hypokalaemic effect of corticosteroids and laxatives. May enhance the hypotensive effect of ACE inhibitors. May diminish the therapeutic efficacy of antidiabetic agents. May potentiate the therapeutic effect of theophylline and curare-containing muscle relaxants. May increase the risk of salicylate toxicity. Decreased renal clearance of spironolactone. NSAIDs (e.g. indomethacin) and probenecid may decrease the therapeutic efficacy of torasemide. May decrease the arterial responsiveness to pressor agents (e.g. epinepherine, norephinephrine).
Lab Interference
May lead to false-negative aldosterone/renin ratio (ARR).
Action
Description: Torasemide is a loop diuretic. It inhibits Na and Cl ion reabsorption in the ascending loop of Henle and distal renal tubule, interfering with the chloride-binding cotransport system, thereby increasing the excretion of water, Na, Cl, Mg and Ca. It does not affect GFR, renal plasma flow, or acid-base balance.
Synonym: torsemide.
Onset: Diuresis: Within 1 hour (oral); within 10 minutes (IV).
Duration: Diuresis: Approx 6-8 hours (oral/IV).
Pharmacokinetics:
Absorption: Rapidly and completely absorbed from the gastrointestinal tract. Bioavailability: Approx 80%. Time to peak plasma concentration: Within 1 hour; delayed with food approx 0.5 hour.
Distribution: Volume of distribution: 12-15 L. Plasma protein binding: >99%.
Metabolism: Metabolised in the liver primarily by CYP2C9 and to a minor extent by CYP2C8 and CYP2C18.
Excretion: Via urine (21%). Elimination half-life: 3-4 hours.
Chemical Structure

Chemical Structure Image
Torasemide

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 41781, Torsemide. https://pubchem.ncbi.nlm.nih.gov/compound/Torsemide. Accessed July 29, 2021.

Storage
Store between 15-30°C. Solution for inj: Do not freeze. Diluted solutions are stable for 24 hours at room temperature.
MIMS Class
Diuretics
ATC Classification
C03CA04 - torasemide ; Belongs to the class of high-ceiling sulfonamide diuretics.
References
Anon. Torasemide (Torsemide). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 29/06/2021.

Anon. Torsemide. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 29/06/2021.

Buckingham R (ed). Torasemide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 29/06/2021.

Joint Formulary Committee. Torasemide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 29/06/2021.

Torasemide 5 mg Tablets (Teva UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 29/06/2021.

Torem 5 mg Tablets (Mylan Products Ltd.). MHRA. https://products.mhra.gov.uk. Accessed 29/06/2021.

Torsemide Injection, Solution (American Regent, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 29/06/2021.

Torsemide Tablet (Aurobindo Pharma Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 29/06/2021.

Disclaimer: This information is independently developed by MIMS based on Torasemide from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 MIMS. All rights reserved. Powered by MIMS.com
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