Torsemide 10mg Tablets
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 B
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 helps to reduce swelling (edema) and lower high blood pressure. It works by making your kidneys remove more fluid from your body.
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 feeling well.
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 dose, skip the missed dose and resume your regular 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 feeling well.
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 dose, skip the missed dose and resume your regular 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 a day in the morning to avoid nighttime urination.
- Do not stop taking torsemide without consulting your doctor, even if you feel better.
- Follow your doctor's recommendations for a low-salt (low-sodium) diet.
- 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.
- Avoid excessive alcohol intake, as it can worsen dizziness or dehydration.
- Be cautious when standing up quickly to avoid dizziness or lightheadedness (orthostatic hypotension).
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
Edema (CHF, renal, hepatic): 10-20 mg orally once daily. Hypertension: 5 mg orally once daily.
Dose Range:
5 - 200 mg
Condition-Specific Dosing:
Edema (CHF, renal, hepatic):
Initial: 10-20 mg PO once daily. May increase by 20 mg increments up to 200 mg PO once daily if needed.
Hypertension:
Initial: 5 mg PO once daily. If response is inadequate after 4-6 weeks, increase to 10 mg PO once daily. Doses >10 mg are not recommended for hypertension.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established (limited data, generally not recommended for routine use)
Adolescent:
Not established (limited data, generally not recommended for routine use)
Dose Adjustments
Renal Impairment:
Mild:
No adjustment typically needed.
Moderate:
No adjustment typically needed, but monitor closely. Higher doses may be required for diuretic effect in severe renal impairment.
Severe:
No specific dose reduction, but higher doses (e.g., 20-200 mg/day) may be required to achieve desired diuresis. Monitor closely for fluid and electrolyte balance.
Dialysis:
Not significantly dialyzable. No specific dose adjustment for patients on dialysis, but monitor fluid status and electrolytes carefully.
Hepatic Impairment:
Mild:
No specific adjustment, but monitor closely.
Moderate:
Use with caution. Lower initial doses may be considered. Increased risk of electrolyte imbalances and hepatic encephalopathy.
Severe:
Use with extreme caution. Lower initial doses and careful titration are recommended. Increased risk of hepatic encephalopathy and hepatorenal syndrome.
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:
Approximately 80-90%
Tmax:
Approximately 1 hour
FoodEffect:
Food may delay Tmax but does not significantly affect the extent of absorption (AUC).
Distribution:
Vd:
Approximately 12-15 L
ProteinBinding:
Greater than 95% (primarily to albumin)
CnssPenetration:
Limited
Elimination:
HalfLife:
Approximately 3.5 hours
Clearance:
Total body clearance approximately 40 mL/min
ExcretionRoute:
Renal (primarily as unchanged drug and metabolites)
Unchanged:
Approximately 20-25%
Pharmacodynamics
OnsetOfAction:
Within 1 hour (oral)
PeakEffect:
1-2 hours
DurationOfAction:
Approximately 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 or seek immediate 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 very 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
If you have questions or concerns about side effects, 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 or seek immediate 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 very 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
If you have questions or concerns about side effects, 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:
- Signs of dehydration: severe thirst, very dry mouth, decreased urination, dark urine, extreme weakness, dizziness, fainting.
- Signs of electrolyte imbalance: muscle cramps or weakness, irregular heartbeat, confusion, unusual tiredness.
- Signs of low blood pressure: severe dizziness, lightheadedness, fainting.
- Signs of kidney problems: swelling in feet or ankles, unusual tiredness, nausea, decreased urination.
- Signs of liver problems (rare): yellowing of skin or eyes (jaundice), dark urine, severe stomach pain, nausea, vomiting.
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. Describe the allergic reaction you experienced, including the symptoms that occurred.
If you have difficulty urinating or are unable to pass urine.
If you have liver disease, as this may affect the medication's efficacy or increase the risk of side effects.
If you are taking any medications that can increase the risk of hearing problems. There are numerous drugs that can cause this interaction, so it is crucial to consult your doctor or pharmacist if you are unsure.
To avoid potential interactions, provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Natural products and vitamins you are using
* Any health problems you have
This information will help your doctor determine whether it is safe to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor to ensure your safety.
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. Describe the allergic reaction you experienced, including the symptoms that occurred.
If you have difficulty urinating or are unable to pass urine.
If you have liver disease, as this may affect the medication's efficacy or increase the risk of side effects.
If you are taking any medications that can increase the risk of hearing problems. There are numerous drugs that can cause this interaction, so it is crucial to consult your doctor or pharmacist if you are unsure.
To avoid potential interactions, provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Natural products and vitamins you are using
* Any health problems you have
This information will help your doctor determine whether it is safe to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor to ensure your safety.
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 navigating stairs.
If you have diabetes (high blood sugar), closely monitor your blood sugar levels as advised by your healthcare provider. Regularly check your blood pressure as directed, and undergo blood tests as scheduled by your doctor. Discuss any concerns or questions with your doctor.
If you are on a low-salt or salt-free diet, consult with your doctor. Additionally, 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 aids.
This medication is a potent diuretic, which can lead to excessive loss of water and electrolytes (including potassium) in the blood, resulting in severe health issues. Your doctor will closely monitor you and adjust the dosage as needed to meet your body's requirements. You may need supplemental potassium; 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 potential for gout attacks.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor to discuss the 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 navigating stairs.
If you have diabetes (high blood sugar), closely monitor your blood sugar levels as advised by your healthcare provider. Regularly check your blood pressure as directed, and undergo blood tests as scheduled by your doctor. Discuss any concerns or questions with your doctor.
If you are on a low-salt or salt-free diet, consult with your doctor. Additionally, 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 aids.
This medication is a potent diuretic, which can lead to excessive loss of water and electrolytes (including potassium) in the blood, resulting in severe health issues. Your doctor will closely monitor you and adjust the dosage as needed to meet your body's requirements. You may need supplemental potassium; 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 potential for gout attacks.
If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor to discuss the benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe dehydration
- Profound hypotension (very low blood pressure)
- Electrolyte imbalances (especially hypokalemia, hyponatremia)
- Dizziness
- Fainting
- Confusion
- Muscle weakness or cramps
What to Do:
In case of suspected overdose, seek immediate medical attention or call a poison control center (1-800-222-1222). Treatment is supportive, focusing on fluid and electrolyte replacement.
Drug Interactions
Major Interactions
- Aminoglycosides (increased risk of ototoxicity)
- Cisplatin (increased risk of ototoxicity)
- Lithium (decreased renal clearance of lithium, leading to increased lithium levels and toxicity)
- NSAIDs (may reduce diuretic and antihypertensive effects of torsemide)
- Digoxin (increased risk of digitalis toxicity due to hypokalemia)
- Other antihypertensives (additive hypotensive effects)
Moderate Interactions
- Corticosteroids (increased risk of hypokalemia)
- Amphotericin B (increased risk of hypokalemia)
- Sucralfate (may reduce absorption of torsemide; administer torsemide 2 hours before sucralfate)
- Probenecid (may reduce diuretic effect of torsemide)
- Warfarin (potential for altered anticoagulant effect, monitor INR)
- Phenytoin (may reduce diuretic effect of torsemide)
Minor Interactions
- Cholestyramine (may reduce absorption of torsemide; administer torsemide 2 hours before cholestyramine)
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, which can influence dosing and risk of adverse effects.
Timing: Prior to initiation of therapy.
Blood Pressure
Rationale: To establish baseline and monitor for hypotensive effects.
Timing: Prior to initiation of therapy.
Fluid Status and Body Weight
Rationale: To assess baseline hydration status and monitor for efficacy 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 periodically 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 periodically as clinically indicated, especially in patients with pre-existing renal impairment or those on concomitant nephrotoxic drugs.
Target: Within patient's baseline range
Action Threshold: Significant increase from baseline (e.g., >25-50% increase in creatinine) or signs of acute kidney injury.
Blood Pressure (Orthostatic)
Frequency: Regularly, especially during dose titration.
Target: Individualized based on patient's condition
Action Threshold: Symptomatic hypotension or significant orthostatic drop (>20 mmHg systolic or >10 mmHg diastolic).
Body Weight
Frequency: Daily (for edema management) or weekly (for hypertension).
Target: Goal weight or stable weight without excessive fluid retention.
Action Threshold: Rapid weight loss (>2-3 lbs/day) or gain, indicating over-diuresis or inadequate diuresis.
Fluid Status (Edema, Lung Sounds, JVD)
Frequency: Daily (for edema management) or regularly.
Target: Resolution of edema, clear lung sounds, normal JVD.
Action Threshold: Persistent or worsening edema, new or worsening crackles, signs of dehydration (dry mucous membranes, decreased skin turgor).
Symptom Monitoring
- Dizziness
- Lightheadedness
- Weakness
- Muscle cramps
- Dry mouth
- Excessive thirst
- Nausea
- Vomiting
- Fatigue
- Changes in urination frequency or volume
- Signs of gout (joint pain, swelling)
- Signs of hearing impairment (rare)
Special Patient Groups
Pregnancy
Torsemide is classified as Pregnancy Category B. Studies in animals have shown no evidence of impaired fertility or harm to the fetus. However, there are no adequate and well-controlled studies in pregnant women. Use during pregnancy only if clearly needed and the potential benefit outweighs the potential risk to the fetus.
Trimester-Specific Risks:
First Trimester:
Limited human data, animal studies show no teratogenicity. Use with caution.
Second Trimester:
Use with caution, monitor fluid and electrolyte balance.
Third Trimester:
Use with caution, monitor for potential effects on fetal fluid and electrolyte balance, and neonatal jaundice.
Lactation
Torsemide is excreted in the milk of lactating rats. It is not known whether torsemide is excreted in human milk. Due to the potential for serious adverse reactions in nursing infants, 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:
L3 (Moderately Safe - limited human data, potential for adverse effects on infant or milk production; weigh risk vs. benefit).
Pediatric Use
Safety and effectiveness in pediatric patients have not been established. Use is generally not recommended due to limited data and potential for adverse effects, especially electrolyte imbalances and dehydration.
Geriatric Use
No overall differences in safety or effectiveness have been observed between elderly and younger patients. However, elderly patients may be more sensitive to the effects of diuretics, particularly fluid and electrolyte disturbances and hypotension. Start with lower doses and titrate carefully, monitoring closely for adverse effects.
Clinical Information
Clinical Pearls
- Torsemide has a longer duration of action and higher oral bioavailability compared to furosemide, allowing for once-daily dosing.
- Less ototoxicity reported with torsemide compared to furosemide, especially at higher doses or in patients with renal impairment.
- Effective in patients with impaired renal function where thiazide diuretics may be less effective.
- Patients should be advised to take torsemide in the morning to prevent nocturia (nighttime urination).
- Monitor for signs of gout, as loop diuretics can increase uric acid levels.
Alternative Therapies
- Other loop diuretics (e.g., Furosemide, Bumetanide, Ethacrynic acid)
- Thiazide diuretics (e.g., Hydrochlorothiazide, Chlorthalidone) for milder edema or hypertension
- Potassium-sparing diuretics (e.g., Spironolactone, Amiloride, Triamterene) often used in combination with loop diuretics to mitigate potassium loss
- Aldosterone antagonists (e.g., Spironolactone, Eplerenone) for heart failure with reduced ejection fraction
Cost & Coverage
Average Cost:
Varies, typically $10-$50 per 30 tablets (10mg)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to 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 seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.