Formulary
Torasemide: Indications, Dosing, Side Effects and Interactions
For all loop diuretics Loop diuretics inhibit reabsorption from the ascending limb of the loop of Henl in the renal tubule and are powerful diuretics.
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Torasemide: Indications, Dosing, Side Effects and Interactions
For all loop diuretics Loop diuretics inhibit reabsorption from the ascending limb of the loop of Henl in the renal tubule and are powerful diuretics.
Drug action
For all loop diuretics Loop diuretics inhibit reabsorption from the ascending limb of the loop of Henl in the renal tubule and are powerful diuretics.
Indications and dose
**Oedema**
- **Adult** (By Mouth): 5 mg once daily, to be taken preferably in the morning, then increased if necessary to 20 mg once daily; maximum 40 mg per day.
**Hypertension**
- **Adult** (By Mouth): 2.5 mg daily, then increased if necessary to 5 mg once daily.
Cautions
For all loop diuretics Can exacerbate diabetes (but hyperglycaemia less likely than with thiazides); can excacerbate gout; hypotension should be corrected before initiation of treatment; hypovolaemia should be corrected before initiation of treatment; urinary retention can occur in prostatic hyperplasia Cautions, further information Elderly Lower initial doses of diuretics may be necessary in the elderly because they are particularly susceptible to the side-effects. The dose should then be adjusted according to renal function. M Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: as a first-line treatment for hypertension (safer, more effective alternatives available) for treatment of hypertension with concurrent urinary incontinence (may exacerbate incontinence) for dependent ankle oedema without evidence of heart failure, liver failure, nephrotic syndrome, or renal failure (leg elevation and/or compression hosiery usually more appropriate) Potassium loss Hypokalaemia can occur with loop diuretics. Hypokalaemia is dangerous in severe cardiovascular disease and in patients also being treated with cardiac glycosides. Often the use of potassium-sparing diuretics avoids the need to take potassium supplements. In hepatic impairment, hypokalaemia caused by diuretics can precipitate encephalopathy. Urinary retention If there is an enlarged prostate, urinary retention can occur, although this is less likely if small doses and less potent diuretics are used initially; manufacturer advises adequate urinary output should be established before initiating treatment.
Contraindications
For all loop diuretics Anuria; comatose and precomatose states associated with liver cirrhosis; renal failure due to nephrotoxic or hepatotoxic drugs; severe hypokalaemia; severe hyponatraemia
Side effects
For all loop diuretics Common or very common Dizziness; electrolyte imbalance; fatigue; headache; metabolic alkalosis; muscle spasms; nausea Uncommon Diarrhoea Rare or very rare Bone marrow depression; photosensitivity reaction Frequency not known Deafness (more common in renal impairment); leucopenia; paraesthesia; rash; severe cutaneous adverse reactions (SCARs); thrombocytopenia; tinnitus (more common with rapid intravenous administration, and in renal impairment); vomiting Side-effects For torasemide Common or very common Asthenia; gastrointestinal disorder Uncommon Bladder dilation; urinary retention Rare or very rare Allergic dermatitis Frequency not known Anaemia; cerebral ischaemia; confusion; dry mouth; embolism; ischaemic heart disease; myocardial infarction; pancreatitis; syncope; visual impairment
Interactions
**Severe interactions:**
- Combination of loop diuretics with ACE inhibitors or AT2 antagonists may cause severe hypotension.
**Other interactions (10):**
- As with other diuretics, the effect of antihypertensive drugs given concomitantly may be potentiated.
- Torasemide, especially at high doses, may potentiate the phototoxicity and nephrotoxic effects of aminoglycoside antibiotics, cytostatic platinum derivatives the nephrotoxic effects of...
- Torasemide is a substrate for Cytochrome P450 CYP2C8 and CYP2C9.
- The antihypertensive and diuretic effects of loop diuretics appear to be reduced by NSAIDs.
- Diuretics may increase the risk of NSAID-induced acute renal failure.
- Probenecid may reduce the diuretic effect of torasemide.
Pregnancy
Manufacturer advises avoid-toxicity in animal studies.
Breast feeding
Manufacturer advises avoid-no information available.
Hepatic impairment
For all loop diuretics Hypokalaemia induced by loop diuretics may precipitate hepatic encephalopathy and coma-potassium-sparing diuretics can be used to prevent this. Diuretics can increase the risk of hypomagnesaemia in alcoholic cirrhosis, leading to arrhythmias.
Renal impairment
For all loop diuretics High doses or rapid intravenous administration can cause tinnitus and deafness. Dose adjustments High doses of loop diuretics may occasionally be needed in renal impairment.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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