Torasemide

Indications
 Oral
Hypertension
Adult: 2.5-5 mg once daily. Max: 5 mg daily.
Oral
Oedema in patients with hepatic cirrhosis
Adult: Initially, 5-10 mg once daily, given together with an aldosterone antagonist or a potassium-sparing diuretic, titrated upwards until the desired diuretic response is obtained. Max: 40 mg daily.
Oral
Oedema
Adult: 5 mg once daily, increased to 20 mg once daily if necessary. Max: 40 mg/day.
Intravenous
Oedema
Adult: 10-20 mg daily as IV inj slowly over 2 min. Max: 200 mg daily.
Contraindications
 Hypersensitivity to sulfonylureas, renal failure with anuria, hepatic coma and pre-coma, hypotension, cardiac arrhythmias. Pregnancy and lactation.
Warnings / Precautions
 Risk of hyperuricaemia, gout and DM. Correct electrolyte distubances and disorders of micturition before treatment. Monitor electrolyte balance, glucose, uric acid, creatinine and lipids regularly. May impair ability to drive or operate machinery.
Adverse Reactions
 Electrolyte disturbances e.g. hypokalaemia, dehydration, dry mouth, headache, dizziness, hypotension, weakness, drowsiness, confusional states, loss of appetite, cramps, increased serum uric acid, glucose, lipids, urea and creatinine, increase in LFT, metabolic alkalosis, tinnitus and hearing loss.
Overdose Reactions
 Symptoms: Marked diuresis with severe dehydration and electrolytes disturbances. Somnolence, confusion, hypotension, circulatory collapse and GI disturbances. Management: Reduce or stop torasemide. There is no antidote and treatment involves simultaneous replacement of fluid and electrolytes. Haemodialysis unlikely to be useful.
Drug Interactions
 Increased risk of severe hypokalaemia with amphotercin B, corticosteroids, carbenoxolone, hypokalaemia-causing medications. Increased risk of lithium toxicity. Increased potential for ototoxicity and nephrotoxicity with nephrotoxic or ototoxic medications e.g. aminoglycosides. High dose salicylates may increase the risk of salicylate toxicity. Increased risk of toxicity with digoxin. Reduced diuretic effect with NSAIDs. Increased risk of hypotension with antihypertensives.
See Below for More torasemide Drug Interactions
Mechanism of Actions
 Torasemide, a sulfonylurea loop diuretic, acts from within the lumen of the thick ascending portion of the loop of Henle, where it inhibits the Na+/K+/2CI--carrier system.
Onset: Diuresis: Oral: Within 1 hr; IV: Within 10 min.
Duration: Diuresis: Oral and IV: 8 hr.
Absorption: Absorbed rapidly and almost completely (oral). Peak serum levels after 1-2 hr. Food decreases rate but not extent of absorption.
Distribution: Protein-binding: >99%. Apparent distribution volume: 16 L.
Metabolism: Metabolised by the cytochrome P450 isoenzyme CYP2C9. Elimination half-life: 3.5 hr.
Excretion: Excreted by urine as unchanged drug (24%) and metabolites.
Administration
 May be taken with or without food.
ATC Classification
 C03CA04 - torasemide ; Belongs to the class of high-ceiling sulfonamide diuretics.
Available As
  • Torasemide 10 mg
  • Torasemide 100 mg
  • Torasemide 1000 mg
  • Torasemide 20 mg
  • Torasemide 2000 mg
  • Torasemide 250 mg
  • Torasemide 40 mg
  • Torasemide 5 mg
  • Torasemide 500 mg

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