Classifications: electrolyte and water balance agent; loop diuretic; Therapeutic: diuretic; antihypertensive
Pregnancy Category: B
5 mg, 10 mg, 20 mg, 100 mg tablets; 10 mg/mL injection
Long-acting potent sulfonamide "loop" diuretic that inhibits reabsorption of sodium and chloride primarily in the
loop of Henle and also in the proximal and distal renal tubules. Binds to the sodium/potassium/chloride carrier in the
loop of Henle and in the renal tubules.
Long-acting potent sulfonamide "loop" diuretic and antihypertensive agent.
Management of edema associated with CHF, chronic kidney failure, hepatic cirrhosis; hypertension.
Hypersensitivity to torsemide or sulfonamides; anuria, fluid and electrolyte depletion states; acute MI; hepatic coma.
Renal impairment; ventricular arrhythmias; concurrent use of other ototoxic drugs; gout or hyperuricemia; diabetes mellitus
or history of pancreatitis; liver disease; hearing impairment; pregnancy (category B); lactation.
Route & Dosage
|Edema of CHF, Chronic Kidney Failure
Adult: PO/IV 1020 mg once daily, may increase up to 200 mg/d as needed
Adult: PO/IV 510 mg once daily administered with an aldosterone antagonist or potassium-sparing diuretic, may increase up to 40
mg/d as needed
Adult: PO 2.55 mg once daily, may increase to 10 mg/d if no response after 46 wk
- Note: With hepatic cirrhosis, use an aldosterone antagonist concomitantly to prevent hypokalemia and metabolic alkalosis.
- Be aware that oral and IV doses are therapeutically equivalent; patients may be switched between the two forms with no change
PREPARE: Direct: Given undiluted.
ADMINISTER: Direct: Give slowly over 2 min.
INCOMPATIBILITIES Solution/additive: Dobutamine.
- Store at 15°30° C (59°86° F).
Adverse Effects (≥1%)CNS:
Headache, dizziness, fatigue
Orthostatic hypotension. Endocrine: Hypokalemia,
hyponatremia, hyperuricemia. GI:
Rash, pruritus. Body as a Whole:
Muscle cramps, rhinitis.
s may reduce diuretic effects. Also see furosemide
for potential drug interactions such as increased risk of digoxin toxicity
due to hypokalemia, prolonged neuromuscular blockade with neuromuscular blocking agents
, and decreased lithium
elimination with increased toxicity
. Herbal: Ginseng
may decrease efficacy
Readily from GI tract. Onset: IV
10 min; PO 60 min. Peak: IV
within 60 min; PO 60120 min. Duration:
68 h. Metabolism:
In liver (CYP system). Elimination:
80% in bile; 20% in urine. Half-Life:
Assessment & Drug Effects
- Monitor BP often and assess for orthostatic hypotension; assess respiratory status for S&S of pulmonary edema.
- Monitor ECG, as electrolyte imbalances predispose to cardiac arrhythmias.
- Lab tests: Monitor serum electrolytes, uric acid, blood glucose, BUN, and creatinine periodically throughout the course
- Monitor I & O with daily weights. Assess for improvement in edema.
- Monitor diabetics for loss of glycemic control.
- Monitor coagulation parameters and lithium levels in patients on concurrent anticoagulant and/or lithium therapy.
Patient & Family Education
- Check weight at least weekly and report abrupt gains or losses to physician.
- Understand the risk of orthostatic hypotension.
- Report symptoms of hypokalemia (see Appendix F) or hearing loss immediately to physician.
- Monitor blood glucose for loss of glycemic control if diabetic.