Torsemide 100mg (hundred Mg) Tablet
It is used to get rid of extra fluid. It is used to treat high blood pressure.
Drug Class
Diuretic
Pharmacologic Class
Loop Diuretic
Pregnancy Category
Category C
FDA Approved
Dec 1993
DEA Schedule
Not Controlled
Overview
What is this medicine?
Torsemide is a 'water pill' (diuretic) that helps your body get rid of extra salt and water. This can help lower your blood pressure and reduce swelling (edema) caused by conditions like heart failure, kidney disease, or liver disease.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. This medication may increase your urine production, so try to avoid taking it too close to bedtime to minimize sleep disturbances.
Continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel better. If you are also taking cholestyramine, consult with your pharmacist about the best way to take these medications together.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you have questions about disposing of your medication, consult with your pharmacist. You may also want to check if there are any drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it is close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. This medication may increase your urine production, so try to avoid taking it too close to bedtime to minimize sleep disturbances.
Continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel better. If you are also taking cholestyramine, consult with your pharmacist about the best way to take these medications together.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, avoiding the bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you have questions about disposing of your medication, consult with your pharmacist. You may also want to check if there are any drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it is close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Take torsemide exactly as prescribed, usually once daily in the morning to avoid nighttime urination.
- Do not stop taking this medication without talking to your doctor.
- Monitor your weight daily and report any sudden changes (e.g., gain or loss of more than 2-3 pounds in a day) to your doctor.
- Follow your doctor's recommendations for salt intake and fluid restriction.
- Avoid standing up too quickly, especially from a sitting or lying position, to prevent dizziness or lightheadedness.
- Limit alcohol intake, as it can increase the risk of dizziness and dehydration.
- Discuss any over-the-counter medications, supplements, or herbal products with your doctor or pharmacist before taking them, especially NSAIDs (like ibuprofen) which can reduce torsemide's effect.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
For severe edema: 100 mg orally once daily. Dosing is highly individualized based on patient response and indication.
Dose Range:
5 - 200 mg
Condition-Specific Dosing:
Edema (CHF):
Initial 10-20 mg PO once daily, titrate up to 200 mg/day if needed.
Edema (Renal Disease):
Initial 20 mg PO once daily, titrate up to 200 mg/day if needed.
Edema (Hepatic Cirrhosis):
Initial 5-10 mg PO once daily, titrate up to 40 mg/day (usually with an aldosterone antagonist).
Hypertension:
Initial 5 mg PO once daily, may increase to 10 mg/day if needed.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established (limited data, generally not recommended)
Adolescent:
Not established (limited data, generally not recommended)
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment needed, but monitor closely.
Moderate:
No specific adjustment needed, but monitor closely. May require higher doses for efficacy.
Severe:
No specific adjustment needed, but monitor closely. Doses up to 200 mg/day may be used. Monitor for fluid and electrolyte imbalances.
Dialysis:
Torsemide is not significantly removed by hemodialysis. Dosing should be based on residual renal function and fluid status. Monitor closely.
Hepatic Impairment:
Mild:
Use with caution, monitor electrolytes and fluid balance.
Moderate:
Use with caution, lower initial doses (e.g., 5-10 mg/day), and monitor electrolytes and fluid balance closely. Max 40 mg/day when used with an aldosterone antagonist.
Severe:
Use with caution, lower initial doses, and monitor electrolytes and fluid balance closely. Increased risk of hepatic encephalopathy. Max 40 mg/day when used with an aldosterone antagonist.
Pharmacology
Mechanism of Action
Torsemide is a loop diuretic that acts on the thick ascending limb of the loop of Henle, where it inhibits the Na+/K+/2Cl- cotransport system. This inhibition leads to increased excretion of sodium, chloride, and water, as well as potassium, calcium, and magnesium.
Pharmacokinetics
Absorption:
Bioavailability:
80-90%
Tmax:
1-2 hours
FoodEffect:
Food delays the time to peak concentration (Tmax) but does not affect the extent of absorption (AUC).
Distribution:
Vd:
12-15 L
ProteinBinding:
>95%
CnssPenetration:
Limited
Elimination:
HalfLife:
3.5 hours (in subjects with normal renal and hepatic function)
Clearance:
Approximately 40 mL/min (renal clearance) and 10 mL/min (hepatic clearance)
ExcretionRoute:
Renal (unchanged drug and metabolites), Fecal (metabolites)
Unchanged:
Approximately 20-25%
Pharmacodynamics
OnsetOfAction:
Within 1 hour (oral)
PeakEffect:
1-2 hours
DurationOfAction:
6-8 hours
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of fluid and electrolyte problems, including:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Fast or abnormal heartbeat
+ Severe dizziness or fainting
+ Increased thirst
+ Seizures
+ Feeling extremely tired or weak
+ Decreased appetite
+ Unable to pass urine or changes in urine output
+ Dry mouth
+ Dry eyes
+ Severe stomach upset or vomiting
Signs of high blood sugar, such as:
+ Confusion
+ Feeling sleepy
+ Unusual thirst or hunger
+ Frequent urination
+ Flushing
+ Rapid breathing
+ Fruity-smelling breath
Signs of kidney problems, including:
+ Unable to pass urine
+ Changes in urine output
+ Blood in the urine
+ Sudden weight gain
Severe dizziness or fainting
Ringing in the ears (tinnitus)
* Hearing loss, which is rare but may occur, especially in people with kidney problems or those taking high doses of this medication. If you experience hearing problems, contact your doctor immediately.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any side effects that bother you or persist, contact your doctor for guidance.
Reporting Side Effects
This is not an exhaustive list of potential side effects. If you have questions or concerns, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of fluid and electrolyte problems, including:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Fast or abnormal heartbeat
+ Severe dizziness or fainting
+ Increased thirst
+ Seizures
+ Feeling extremely tired or weak
+ Decreased appetite
+ Unable to pass urine or changes in urine output
+ Dry mouth
+ Dry eyes
+ Severe stomach upset or vomiting
Signs of high blood sugar, such as:
+ Confusion
+ Feeling sleepy
+ Unusual thirst or hunger
+ Frequent urination
+ Flushing
+ Rapid breathing
+ Fruity-smelling breath
Signs of kidney problems, including:
+ Unable to pass urine
+ Changes in urine output
+ Blood in the urine
+ Sudden weight gain
Severe dizziness or fainting
Ringing in the ears (tinnitus)
* Hearing loss, which is rare but may occur, especially in people with kidney problems or those taking high doses of this medication. If you experience hearing problems, contact your doctor immediately.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any side effects that bother you or persist, contact your doctor for guidance.
Reporting Side Effects
This is not an exhaustive list of potential side effects. If you have questions or concerns, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness, lightheadedness, or fainting
- Muscle cramps, weakness, or spasms
- Irregular or fast heartbeat
- Excessive thirst or dry mouth
- Nausea or vomiting that is severe or persistent
- Unusual tiredness or confusion
- Decreased urination or no urination
- Yellowing of skin or eyes (jaundice), dark urine, or severe stomach pain (signs of liver problems, rare)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you have difficulty urinating.
If you have liver disease.
If you are taking any medications that may increase the risk of hearing problems. There are numerous drugs that can cause this issue, so consult your doctor or pharmacist if you are unsure.
To avoid potential interactions, it is crucial to disclose all of your medications, including:
Prescription and over-the-counter (OTC) drugs
Natural products
* Vitamins
Additionally, inform your doctor about any existing health problems. This information will help your doctor determine whether it is safe to take this medication with your other medications and health conditions.
Remember, do not start, stop, or change the dose of any medication without first consulting your doctor.
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you have difficulty urinating.
If you have liver disease.
If you are taking any medications that may increase the risk of hearing problems. There are numerous drugs that can cause this issue, so consult your doctor or pharmacist if you are unsure.
To avoid potential interactions, it is crucial to disclose all of your medications, including:
Prescription and over-the-counter (OTC) drugs
Natural products
* Vitamins
Additionally, inform your doctor about any existing health problems. This information will help your doctor determine whether it is safe to take this medication with your other medications and health conditions.
Remember, do not start, stop, or change the dose of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
When starting this medication, avoid driving and other activities that require alertness until you understand how it affects you. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and exercise caution when climbing stairs.
If you have diabetes, closely monitor your blood sugar levels as directed by your healthcare provider. Additionally, check your blood pressure as instructed and undergo blood tests as recommended by your doctor. Discuss any concerns or questions with your doctor.
If you follow a low-sodium or sodium-free diet, consult with your doctor. Furthermore, if you have high blood pressure and are taking this medication, talk to your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or supplements.
This medication is a potent diuretic, which can lead to excessive loss of water and electrolytes (including potassium) in the blood, potentially causing severe health issues. Your doctor will closely monitor you and adjust the dosage as needed to meet your individual requirements. You may require additional potassium supplements; discuss this with your doctor.
Notify your doctor if you experience excessive sweating, fluid loss, vomiting, or diarrhea, as these conditions can lead to low blood pressure. Be aware of the possibility of gout attacks and inform your doctor if you experience any symptoms.
If you are pregnant, plan to become pregnant, or are breastfeeding, consult with your doctor to discuss the potential benefits and risks of this medication to both you and your baby.
When starting this medication, avoid driving and other activities that require alertness until you understand how it affects you. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and exercise caution when climbing stairs.
If you have diabetes, closely monitor your blood sugar levels as directed by your healthcare provider. Additionally, check your blood pressure as instructed and undergo blood tests as recommended by your doctor. Discuss any concerns or questions with your doctor.
If you follow a low-sodium or sodium-free diet, consult with your doctor. Furthermore, if you have high blood pressure and are taking this medication, talk to your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or supplements.
This medication is a potent diuretic, which can lead to excessive loss of water and electrolytes (including potassium) in the blood, potentially causing severe health issues. Your doctor will closely monitor you and adjust the dosage as needed to meet your individual requirements. You may require additional potassium supplements; discuss this with your doctor.
Notify your doctor if you experience excessive sweating, fluid loss, vomiting, or diarrhea, as these conditions can lead to low blood pressure. Be aware of the possibility of gout attacks and inform your doctor if you experience any symptoms.
If you are pregnant, plan to become pregnant, or are breastfeeding, consult with your doctor to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Profound diuresis (excessive urination)
- Dehydration
- Electrolyte depletion (especially hypokalemia, hyponatremia)
- Hypotension (low blood pressure)
- Circulatory collapse
- Thrombosis and embolism (due to hemoconcentration)
What to Do:
In case of suspected overdose, seek immediate medical attention or call a poison control center. In the US, call 1-800-222-1222. Treatment is supportive, focusing on fluid and electrolyte replacement and blood pressure support.
Drug Interactions
Major Interactions
- Aminoglycosides (increased ototoxicity)
- Cisplatin (increased ototoxicity)
- Lithium (increased lithium levels and toxicity due to decreased renal clearance)
- NSAIDs (e.g., ibuprofen, naproxen; may reduce diuretic and antihypertensive effects, increase risk of renal dysfunction)
- ACE inhibitors/ARBs (increased risk of severe hypotension and renal dysfunction, especially with initial doses)
- Digoxin (increased risk of digitalis toxicity due to hypokalemia)
Moderate Interactions
- Corticosteroids (increased risk of hypokalemia)
- Amphotericin B (increased risk of hypokalemia)
- Neuromuscular blockers (potentiated effect due to electrolyte disturbances)
- Antihypertensives (additive hypotensive effects)
- Probenecid (may decrease torsemide's diuretic effect)
- Cholestyramine (may decrease torsemide absorption)
Minor Interactions
- Oral hypoglycemics (may decrease their effectiveness)
Monitoring
Baseline Monitoring
Serum Electrolytes (Sodium, Potassium, Magnesium, Calcium)
Rationale: To establish baseline levels and identify pre-existing imbalances, as torsemide can cause electrolyte disturbances.
Timing: Prior to initiation of therapy.
Renal Function (BUN, Serum Creatinine, eGFR)
Rationale: To assess baseline kidney function and guide dosing, as well as monitor for potential renal impairment.
Timing: Prior to initiation of therapy.
Blood Pressure
Rationale: To establish baseline and monitor for hypotensive effects.
Timing: Prior to initiation of therapy.
Weight and Fluid Status
Rationale: To establish baseline and monitor for efficacy (fluid removal) and signs of dehydration.
Timing: Prior to initiation of therapy.
Routine Monitoring
Serum Electrolytes (Potassium, Sodium)
Frequency: Weekly for the first few weeks, then monthly or as clinically indicated.
Target: Potassium: 3.5-5.0 mEq/L; Sodium: 135-145 mEq/L
Action Threshold: Potassium < 3.0 mEq/L or > 5.5 mEq/L; Sodium < 130 mEq/L or > 150 mEq/L (requires intervention)
Renal Function (BUN, Serum Creatinine)
Frequency: Monthly or as clinically indicated, especially with dose changes or concomitant nephrotoxic drugs.
Target: Within patient's baseline range
Action Threshold: Significant increase in creatinine (>25% from baseline or >0.5 mg/dL absolute increase) or BUN.
Blood Pressure
Frequency: Daily initially, then regularly as part of routine care.
Target: Individualized based on patient's condition (e.g., <130/80 mmHg for hypertension)
Action Threshold: Symptomatic hypotension (e.g., dizziness, syncope) or systolic BP <90 mmHg.
Weight
Frequency: Daily (for acute fluid management) or weekly (for chronic management).
Target: Target dry weight or stable weight without signs of fluid overload.
Action Threshold: Rapid weight loss (>2-3 lbs/day) or signs of dehydration.
Symptom Monitoring
- Dizziness or lightheadedness (especially upon standing)
- Muscle cramps or weakness
- Irregular heartbeat or palpitations
- Excessive thirst or dry mouth
- Nausea or vomiting
- Unusual fatigue or lethargy
- Signs of dehydration (decreased urination, sunken eyes, dry skin)
- Signs of hepatic encephalopathy (in patients with liver disease: confusion, asterixis)
Special Patient Groups
Pregnancy
Category C. Torsemide should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Animal studies have shown adverse effects at high doses. There are no adequate and well-controlled studies in pregnant women.
Trimester-Specific Risks:
First Trimester:
Potential for fetal harm, though human data are limited. Avoid if possible.
Second Trimester:
Risk of electrolyte imbalance and volume depletion in the mother, which could affect fetal perfusion. Use with caution.
Third Trimester:
Risk of electrolyte imbalance and volume depletion in the mother, which could affect fetal perfusion. May also cause fetal/neonatal jaundice, thrombocytopenia, and other adverse reactions observed in adults.
Lactation
Torsemide is excreted in breast milk. Due to the potential for serious adverse reactions in the nursing infant (e.g., electrolyte disturbances, dehydration), a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Infant Risk:
Risk L3 (Moderately Safe) - Excreted in human milk; monitor infant for dehydration, electrolyte imbalance, and weight loss. Consider alternative if possible, especially in preterm or unstable infants.
Pediatric Use
Safety and effectiveness in pediatric patients have not been established. Use is generally not recommended due to limited data and potential for serious electrolyte disturbances.
Geriatric Use
Elderly patients may be more susceptible to the hypotensive and electrolyte-depleting effects of torsemide. Start with lower doses and titrate slowly. Monitor fluid and electrolyte status closely. Renal function often declines with age, which may affect drug elimination.
Clinical Information
Clinical Pearls
- Torsemide has a more predictable and complete oral absorption compared to furosemide, making it a good choice for patients with variable GI absorption.
- It has a longer duration of action than furosemide, allowing for once-daily dosing.
- Torsemide is often preferred in patients with chronic kidney disease (CKD) as it maintains its diuretic efficacy even at lower GFRs where thiazide diuretics may become ineffective.
- Unlike furosemide, torsemide has a minor active metabolite (M5), but its contribution to overall diuretic effect is minimal.
- Always monitor for signs of dehydration and electrolyte imbalance, especially hypokalemia, which can be life-threatening.
- For patients with hepatic cirrhosis, torsemide should be used with caution and typically in combination with an aldosterone antagonist to prevent hypokalemia and minimize the risk of hepatic encephalopathy.
Alternative Therapies
- Furosemide (another loop diuretic)
- Bumetanide (another loop diuretic)
- Ethacrynic acid (another loop diuretic, used in sulfa-allergic patients)
- Hydrochlorothiazide (thiazide diuretic, less potent)
- Chlorthalidone (thiazide-like diuretic, longer acting)
- Spironolactone (aldosterone antagonist, potassium-sparing diuretic)
- Eplerenone (selective aldosterone antagonist, potassium-sparing diuretic)
- Metolazone (thiazide-like diuretic, often used in combination with loop diuretics for refractory edema)
Cost & Coverage
Average Cost:
Varies widely, typically $10-$50 per 30 tablets (generic 100mg)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (Generic)
General Drug Facts
If your symptoms or health condition do not improve or worsen over time, it is essential to contact your doctor for further evaluation and guidance. To ensure your safety and the effectiveness of your treatment, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it is a good idea to consult with your pharmacist to determine if this applies to your prescription. If you have any questions or concerns about your medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide detailed information about the medication taken, including the dosage, time of ingestion, and any other relevant details.