TORSEMIDE

TORSEMIDE
(tor'se-mide)
Demadex
Classifications: electrolyte and water balance agent; loop diuretic;
Therapeutic: diuretic
; antihypertensive
Prototype: Furosemide
Pregnancy Category: B

Availability

5 mg, 10 mg, 20 mg, 100 mg tablets; 10 mg/mL injection

Action

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.

Therapeutic Effect

Long-acting potent sulfonamide "loop" diuretic and antihypertensive agent.

Uses

Management of edema associated with CHF, chronic kidney failure, hepatic cirrhosis; hypertension.

Contraindications

Hypersensitivity to torsemide or sulfonamides; anuria, fluid and electrolyte depletion states; acute MI; hepatic coma.

Cautious Use

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 10–20 mg once daily, may increase up to 200 mg/d as needed

Hepatic Cirrhosis
Adult: PO/IV 5–10 mg once daily administered with an aldosterone antagonist or potassium-sparing diuretic, may increase up to 40 mg/d as needed

Hypertension
Adult: PO 2.5–5 mg once daily, may increase to 10 mg/d if no response after 4–6 wk

Administration

  • Note: With hepatic cirrhosis, use an aldosterone antagonist concomitantly to prevent hypokalemia and metabolic alkalosis.
Oral
  • Be aware that oral and IV doses are therapeutically equivalent; patients may be switched between the two forms with no change in dosage.
Intravenous

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, insomnia. CV: Orthostatic hypotension. Endocrine: Hypokalemia, hyponatremia, hyperuricemia. GI: Nausea, diarrhea. Skin: Rash, pruritus. Body as a Whole: Muscle cramps, rhinitis.

Interactions

Drug: nsaids 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.

Pharmacokinetics

Absorption: Readily from GI tract. Onset: IV 10 min; PO 60 min. Peak: IV within 60 min; PO 60–120 min. Duration: 6–8 h. Metabolism: In liver (CYP system). Elimination: 80% in bile; 20% in urine. Half-Life: 210 min.

Nursing Implications

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 of therapy.
  • 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.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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