Torasemide
Torasemide Uses, Dosage, Side Effects, Food Interaction and all others data.
Torasemide inhibits the Na+/K+/2CI- carrier system (via interference of the chloride binding site) in the lumen of the thick ascending portion of the loop of Henle, resulting in a decrease in reabsorption of sodium and chloride. This results in an increase in the rate of delivery of tubular fluid and electrolytes to the distal sites of hydrogen and potassium ion secretion, while plasma volume contraction increases aldosterone production. The increased delivery and high aldosterone levels promote sodium reabsorption at the distal tubules, and By increasing the delivery of sodium to the distal renal tubule, torasemide indirectly increases potassium excretion via the sodium-potassium exchange mechanism. Torasemide's effects in other segments of the nephron have not been demonstrated. Thus torasemide increases the urinary excretion of sodium, chloride, and water, but it does not significantly alter glomerular filtration rate, renal plasma flow, or acid-base balance. Torasemide's effects as a antihypertensive are due to its diuretic actions. By reducing extracellular and plasma fluid volume, blood pressure is reduced temporarily, and cardiac output also decreases.
It is widely known that administration of torasemide can attenuate renal injury and reduce the severity of acute renal failure. This effect is obtained by increasing urine output and hence, facilitating fluid, acid-base and potassium control. This effect is obtained by the increase in the excretion of urinary sodium and chloride.
Several reports have indicated that torasemide presents a long-lasting diuresis and less potassium excretion which can be explained by the effect that torasemide has on the renin-angiotensin-aldosterone system. This effect is very similar to the effect observed with the administration of combination therapy with furosemide and spironolactone and it is characterized by a decrease in plasma brain natriuretic peptide and improved measurements of left ventricular function.
Above the aforementioned effect, torasemide presents a dual effect .in which the inhibition of aldosterone which donates torasemide with a potassium-sparing action.
| Trade Name | Torasemide |
| Generic | Torasemide |
| Torasemide Other Names | Torasemida, Torasemide, Torasémide, Torasemidum, Torsemide |
| Type | |
| Formula | C16H20N4O3S |
| Weight | Average: 348.42 Monoisotopic: 348.125611216 |
| Protein binding | Torasemide is found to be highly bound to plasma proteins, representing over 99% of the administered dose. |
| Groups | Approved |
| Therapeutic Class | Loop diuretics |
| Manufacturer | |
| Available Country | |
| Last Updated: | September 19, 2023 at 7:00 am |
Uses
Torasemide is used for the management of edema of cardiac, renal and hepatic origin.The management of hypertension, as a sole therapeutic agent or in combination with other classes of antihypertensive agents.
Torasemide is also used to associated treatment for these conditions: Edema, High Blood Pressure (Hypertension)
How Torasemide works
As mentioned above, torasemide is part of the loop diuretics and thus, it acts by reducing the oxygen demand in the medullary thick ascending loop of Henle by inhibiting the Na+/K+/Cl- pump on the luminal cell membrane surface. This action is obtained by the binding of torasemide to a chloride ion-binding site of the transport molecule.
Torasemide is known to have an effect in the renin-angiotensin-aldosterone system by inhibiting the downstream cascade after the activation of angiotensin II. This inhibition will produce a secondary effect marked by the reduction of the expression of aldosterone synthase, TGF-B1 and thromboxane A2 and a reduction on the aldosterone receptor binding.
Dosage
Torasemide dosage
Congestive heart failure: The usual initial oral dose is 10 mg or 20 mg once daily. If the diuretic response is inadequate, the dose should be titrated upward by approximately doubling until the desired diuretic response is obtained. Single doses higher than 200 mg have not been adequately studied.
Chronic renal failure: The usual initial oral dose is 20 mg once daily. lf the diuretic response is inadequate, the dose should be titrated upward by approximately doubling until the desired diuretic response is obtained. Single doses higher than 200mg have not been adequately studied.
Hepatic cirrhosis: The usual initial oral dose is 5 mg or 10 mg once daily, administered together with an aldosterone antagonist or a potassium sparing diuretic. If the diuretic response is inadequate, the dose should be titrated upward by approximately doubling until the desired diuretic response is obtained. Single doses higher than 40 mg have not been adequately studied. Chronic use of any diuretic in hepatic disease has not been studied in adequate and well-controlled trials.
Hypertension: The usual initial oral dose is 2.5-5 mg once daily. If the 5 mg dose does not provide adequate reduction of blood pressure within 4 to 6 weeks, the dose may be increased to 10 mg once daily. If the response to 10 mg is insufficient, an additional antihypertensive should be added to the treatment regimen.
Side Effects
Usually torasemide is well tolerated. However, a few side effects like dry mouth, dizziness, tiredness, skin rash, diarrhea, constipation, nausea, vomiting, orthostatic hypotention and muscle cramp may occur. All side effects usually are mild and transient.
Toxicity
The oral LD50 of torasemide in the rat is 5 g/kg. When overdose occurs, there is a marked diuresis with the danger of loss of fluid and electrolytes which has been seen to lead to somnolence, confusion, hypotension, hyponatremia, hypokalemia, hypochloremic alkalosis, hemoconcentration dehydration and circulatory collapse. This effects can include some gastrointestinal disturbances.
There is no increase in tumor incidence with torasemide and it is proven to not be mutagenic, not fetotoxic or teratogenic.
Precaution
Precautions should be taken while torasemide is administered in the conditions like diabetes, gout, hypotension and liver failure.
Interaction
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.
Food Interaction
- Take with or without food. Food delays the Cmax by 30 minutes but does not impact efficacy.
Volume of Distribution
The volume of distribution of torasemide is 0.2 L/kg.
Elimination Route
Torasemide is the diuretic with the highest oral bioavailability even in advanced stages of chronic kidney disease. This bioavailability tends to be higher than 80% regardless of the patient condition. The maximal serum concentration is reported to be of 1 hour and the absorption parameters are not affected by its use concomitantly with food.
Half Life
The average half-life of torasemide is 3.5 hours.
Clearance
The clearance rate of torasemide is considerably reduced by the presence of renal disorders.
Elimination Route
Torasemide is mainly hepatically processed and excreted in the feces from which about 70-80% of the administered dose is excreted by this pathway. On the other hand, about 20-30% of the administered dose is found in the urine.
Pregnancy & Breastfeeding use
Pregnancy: Adequate and well controlled studies of torasemide have not been carried out in pregnant woman. Because animal reproduction studies are not always predictive of human response, torasemide can be used during pregnancy only if clearly needed.
Nursing Mother: lt is not known whether torasemide is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when torasemide is administered to a nursing mother.
Contraindication
Torasemide is contraindicated in patients with known hypersensitivity to torasemide and other sulfonyl ureas. It is also contraindicated in patients who are anuric.
Special Warning
Use in children: Safety and efficacy of torasemide in children have not been established.
Acute Overdose
There is no human experience of overdoses of torasemide, but the signs and symptoms of overdosage can be anticipated to be those of excessive pharmacological effect: dehydration, hypovolemia, hypotension and hypokalemia. Treatment of overdose should consist of fluid and electrolyte supplement.
Storage Condition
Store Torasemide at room temperature less than 30° C and keep in cool and dry place, away from moisture and sunlight. Keep the medicine out of the reach of children.
Innovators Monograph
You find simplified version here Torasemide
Torasemide contains Torasemide see full prescribing information from innovator Torasemide Monograph, Torasemide MSDS, Torasemide FDA label
FAQ
What is Torasemide used for?
Torasemide is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, or liver disease. Torasemide is in a class of medications called diuretics.
How safe is Torasemide?
Do not take more or less of it or take it more often than prescribed by your doctor. Torasemide controls high blood pressure and edema but does not cure these conditions. Continue to take Torasemide even if you feel well. Do not stop taking Torasemide without talking to your doctor.
how does Torasemide work?
Torasemide is in a class of medications called diuretics. It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.
What are the common side effects of Torasemide?
Common side effects of Torasemide include:
- Constipation
- Cough
- Decreased sex drive
- Diarrhea
- Difficulty having an orgasm
- Dizziness
- Electrolyte imbalance
- Excessive or increased urination
- Headache
- Impotence
- Indigestion/heartburn
- Insomnia
- Joint pain
- Nausea
- Nervousness
- Runny or stuffy nose
- Stomach upset
Is Torasemide safe during pregnancy?
Use is considered contraindicated and should be used during pregnancy only if clearly needed.
Is Torasemide safe during breastfeeding?
Because little information is available on the use of Torasemide during breastfeeding and because intense diuresis might decrease lactation, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Low doses of Torasemide may not suppress lactation.
Can I drink alcohol with Torasemide?
You should limit the amount of alcohol you drink while you are taking Torasemide. Torasemide can cause dizziness, lightheadedness, or fainting, especially when you stand up quickly from a lying or sitting position. Drinking alcohol can make these side effects worse.
When is the best time to take Torasemide?
Torasemide take by mouth as directed by your doctor, with or without food, usually once daily. It is best to avoid taking this medication within 4 hours of your bedtime to prevent having to get up to urinate.
Is Torasemide bad for my kidneys?
bran may causes kidney problems,Torasemide should be used very cautiously in patients with renal disease.
Does Torasemide cause weight gain?
The lack of weight gain in the Torasemide group was associated with a higher percentage of patients who showed no change or an improvement in peripheral edema status than in placebo patients .
How much Torasemide can I take in a day?
Adults at first, 20 milligrams once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 200 mg per day. Children use and dose must be determined by your doctor.
Can I take too much Torasemide?
Overdose symptoms may include dehydration, an electrolyte imbalance such as low levels of potassium, magnesium, or sodium in your blood, or low blood pressure and fainting.
Does Torasemide cause insomnia?
Torasemide may causes insomnia with other side effects are muscle pain, fluid retention (edema), and. nervousness.
Should Torasemide be taken with food?
You may take Torasemide with or without food. If it upsets your stomach, take it with food or milk. Do not take your medicine more often than directed.
Is Torasemide hazardous?
May be harmful by inhalation, ingestion, or skin absorption. May cause skin or respiratory system irritation.
When should I stop taking Torasemide?
You may be able to stop taking Torasemide a diuretic used to treat edema , when your edema improves. Do not stop taking Torasemide without talking to your doctor.
Does Torasemide cause sun sensitivity?
This medicine may make your skin more sensitive to the sun and may cause you to sunburn more easily.
What happens when I stop taking Torasemide?
Suddenly can cause your blood pressure to spike. This may increase your risk of a heart attack or stroke. If you have heart failure, liver disease, or kidney disease, you may also have fluid buildup if you stop taking Torasemide suddenly.
How long does torsemide stay in my body?
In normal subjects the elimination half-life of Torasemide is approximately 3.5 hours. Torasemide is cleared from the circulation by both hepatic metabolismand excretion into the urine.
