torsemide 5 mg tablet generic demadex

Uses

Edema

Torsemide is used for the management of edema associated with heart failure or hepatic or renal disease. Most experts state that all patients with symptomatic heart failure who have evidence for, or a history of, fluid retention generally should receive diuretic therapy in conjunction with moderate sodium restriction, an agent to inhibit the renin-angiotensin-aldosterone (RAA) system (e.g., angiotensin-converting enzyme [ACE] inhibitor, angiotensin II receptor antagonist, angiotensin receptor-neprilysin inhibitor [ARNI]), a β-adrenergic blocking agent (β-blocker), and in selected patients, an aldosterone antagonist. For additional information on the use of loop diuretics in the management of edema associated with heart failure, see Heart Failure under Uses: Edema, in , , and 40:28.08.

Hypertension

Torsemide also is used alone or in combination with other classes of antihypertensive agents for the management of hypertension. Because of established clinical benefits (e.g., reductions in overall mortality and in adverse cardiovascular, cerebrovascular, and renal outcomes), angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, calcium-channel blockers, and thiazide diuretics generally are considered the preferred drugs for the initial management of hypertension in adults. However, loop diuretics (e.g., furosemide, bumetanide, torsemide) may be particularly useful in patients with renal impairment (as an alternative to thiazide diuretics) or heart failure (for management of fluid retention). For additional information on the use of loop diuretics in the management of hypertension, see Uses: Hypertension, in 40:28.08.

Dosage and Administration

Administration

Torsemide usually is administered orally. Food decreases the rate but not the extent of GI absorption, and the manufacturers state that the drug may be administered without regard to meals.

Torsemide also may be given by IV injection when a rapid onset of diuresis is desired or when oral therapy is not practical. IV injections of torsemide should be administered slowly over 2 minutes (''bolus''); alternatively, the drug may be administered as a continuous IV infusion.

If torsemide injection is administered through an IV line, it is recommended that the IV line be flushed with 0.9% sodium chloride injection before and after the drug is administered. Because the pH of torsemide injection exceeds 8.3, flushing is necessary to avoid potential incompatibilities that may result from differences in pH.

For administration of torsemide as a continuous IV infusion, 200 mg of the drug may be diluted in 250 mL of 5% dextrose or 0.9% sodium chloride injection or in 500 mL of 0.45% sodium chloride injection; alternatively, 50 mg of torsemide may be diluted in 500 mL of 5% dextrose, 0.9% sodium chloride injection, or 0.45% sodium chloride injection. Following dilution in these solutions in plastic containers, the drug is stable for up to 24 hours at room temperature.

Dosage

The manufacturers state that since oral and IV doses of torsemide are therapeutically equivalent, torsemide dosage is identical for oral or IV administration.

For the management of fluid retention (e.g., edema) associated with heart failure, experts state that diuretics should be administered at a dosage sufficient to achieve optimal volume status and relieve congestion without inducing an excessively rapid reduction in intravascular volume, which could result in hypotension, renal dysfunction, or both.

Safety and efficacy of torsemide in children have not been established.

Edema

For the management of edema associated with heart failure, the usual initial adult oral or IV dosage of torsemide is 10-20 mg daily, given as a single dose. If the diuretic response is inadequate, dosage can be titrated upward by approximately doubling the daily dose until the desired response is attained. The manufacturers state that single doses exceeding 200 mg have not been adequately studied. Some experts recommend initiating torsemide at a low dosage (10-20 mg once daily) and increasing the dosage (maximum of 200 mg daily) until urine output increases and weight decreases, generally by 0.5-1 kg daily.

Hypertension

For the management of hypertension, the usual initial adult dosage of torsemide recommended by the manufacturers is 5 mg daily, given once daily. If a satisfactory lowering of blood pressure does not occur within 4-6 weeks, dosage of torsemide may be increased to 10 mg once daily. Some experts state that the usual dosage of torsemide is 2.5-10 mg daily. If a satisfactory lowering of blood pressure does not occur when 10 mg is administered daily, other antihypertensive agents should be added to the regimen.

Dosage in Renal and Hepatic Impairment

For the management of edema in patients with chronic renal failure, the usual initial adult oral or IV dosage of torsemide is 20 mg daily, given as a single dose. If the diuretic response is inadequate, dosage may be titrated upward by doubling the dose until desired response is attained. However, the manufacturers state that single doses exceeding 200 mg or chronic use in patients with renal impairment have not been adequately studied.

For the management of edema in patients with hepatic cirrhosis, torsemide is administered concomitantly with an aldosterone antagonist or a potassium-sparing diuretic; the usual initial adult oral or IV dosage of torsemide is 5-10 mg daily, given as a single dose. If the diuretic response to this initial dosage is inadequate, dosage may be titrated upward by doubling the dose until the desired response is attained. Single doses exceeding 40 mg have not been adequately studied in patients with hepatic cirrhosis.