Torsemide 5mg 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 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 the frequency of urination, 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 to determine 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 the best way to dispose 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 a 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 the frequency of urination, 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 to determine 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 the best way to dispose 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 a 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 talking to your doctor, even if you feel better.
- Follow your doctor's recommendations for diet, especially regarding salt intake. A low-sodium diet is often recommended.
- Your doctor may recommend potassium-rich foods or a potassium supplement to prevent low potassium levels.
- 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 standing up too quickly from a sitting or lying position to prevent dizziness or lightheadedness.
- Limit alcohol consumption as it can increase the risk of dizziness and dehydration.
- Stay hydrated as advised by your doctor; do not restrict fluid intake unless specifically instructed.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
For edema: 5 mg to 20 mg orally once daily. For hypertension: 2.5 mg to 5 mg orally once daily.
Dose Range:
2.5 - 200 mg
Condition-Specific Dosing:
Edema (CHF, renal, hepatic):
Initial: 5 mg to 20 mg orally once daily. May be increased by 20 mg increments up to 200 mg once daily if needed.
Hypertension:
Initial: 2.5 mg to 5 mg orally once daily. If response is inadequate after 4-6 weeks, dose may be increased to 10 mg once daily. Doses above 10 mg generally do not provide additional benefit.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Not established
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment needed.
Moderate:
No specific adjustment needed, but monitor closely.
Severe:
For patients with severe renal failure (CrCl < 20 mL/min), higher doses (e.g., 20 mg to 200 mg daily) may be required to achieve desired diuresis. Monitor closely for electrolyte imbalances.
Dialysis:
Torsemide is not significantly removed by hemodialysis. Dosing should be based on residual renal function and clinical response.
Hepatic Impairment:
Mild:
No specific adjustment needed.
Moderate:
Use with caution. Reduced clearance and increased half-life may occur. Initiate at lower doses and titrate slowly with close monitoring of fluid and electrolyte balance.
Severe:
Use with caution. Reduced clearance and increased half-life may occur. Initiate at lower doses and titrate slowly with close monitoring of fluid and electrolyte balance. Risk of hepatic encephalopathy.
Pharmacology
Mechanism of Action
Torsemide is a loop diuretic that acts on the thick ascending limb of the loop of Henle. It inhibits the Na+/K+/2Cl- cotransport system, thereby decreasing the reabsorption of sodium, potassium, and chloride ions. This leads to increased excretion of water, sodium, chloride, and potassium, resulting in diuresis and natriuresis.
Pharmacokinetics
Absorption:
Bioavailability:
80-90%
Tmax:
1 hour
FoodEffect:
Food may delay Tmax but does not significantly affect the extent of absorption (AUC).
Distribution:
Vd:
12-18 L
ProteinBinding:
>95%
CnssPenetration:
Limited
Elimination:
HalfLife:
3.5 hours (in healthy subjects)
Clearance:
Not available (variable)
ExcretionRoute:
Renal (primarily as metabolites, some unchanged drug)
Unchanged:
20-25%
Pharmacodynamics
OnsetOfAction:
Within 1 hour (oral)
PeakEffect:
1-2 hours (oral)
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 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 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
* Hearing loss (although rare, this may occur, especially in people with kidney problems or those taking high doses of this medication)
If you experience any hearing problems, such as hearing loss, 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 have mild ones, it's essential to contact your doctor or seek medical help if you have any symptoms that bother you or persist.
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor.
To report side effects, you can contact the FDA at 1-800-332-1088 or visit their website 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 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
* Hearing loss (although rare, this may occur, especially in people with kidney problems or those taking high doses of this medication)
If you experience any hearing problems, such as hearing loss, 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 have mild ones, it's essential to contact your doctor or seek medical help if you have any symptoms that bother you or persist.
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor.
To report side effects, you can contact the FDA at 1-800-332-1088 or visit their website at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or fainting
- Muscle cramps or weakness
- Unusual tiredness or weakness
- Irregular heartbeat
- Nausea or vomiting that doesn't go away
- Excessive thirst or dry mouth
- Decreased urination or no urination
- Signs of allergic reaction (rash, itching, swelling, severe dizziness, trouble breathing)
- Hearing problems or ringing in the ears
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 metabolism and increase the risk of adverse effects.
If you are taking any medications that can increase the risk of hearing problems, such as ototoxic agents. There are numerous medications that can cause hearing issues, so it is crucial to consult your doctor or pharmacist if you are unsure.
To minimize potential interactions and ensure safe use, provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Natural products, including herbal supplements
Vitamins and other dietary supplements
Existing health problems, including medical conditions and previous illnesses
Carefully review your medication regimen with your doctor to confirm that it is safe to take this medication with your other medications and health conditions. Do not initiate, discontinue, or modify 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. 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 metabolism and increase the risk of adverse effects.
If you are taking any medications that can increase the risk of hearing problems, such as ototoxic agents. There are numerous medications that can cause hearing issues, so it is crucial to consult your doctor or pharmacist if you are unsure.
To minimize potential interactions and ensure safe use, provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Natural products, including herbal supplements
Vitamins and other dietary supplements
Existing health problems, including medical conditions and previous illnesses
Carefully review your medication regimen with your doctor to confirm that it is safe to take this medication with your other medications and health conditions. Do not initiate, discontinue, or modify 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, consult 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; 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 report any symptoms to your doctor.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform 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, consult 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; 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 report any symptoms to your doctor.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform 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)
- Severe dehydration
- Significant electrolyte depletion (especially hypokalemia, hyponatremia)
- Hypotension (low blood pressure)
- Dizziness
- Fainting
- Confusion
- Circulatory collapse
What to Do:
In case of suspected overdose, seek immediate medical attention. Call 911 or your local poison control center (1-800-222-1222 in the US). Management is primarily supportive, focusing on fluid and electrolyte replacement and blood pressure support.
Drug Interactions
Major Interactions
- Aminoglycosides (e.g., gentamicin, amikacin): Increased risk of ototoxicity and nephrotoxicity.
- Cisplatin: Increased risk of ototoxicity and nephrotoxicity.
- Lithium: Decreased renal clearance of lithium, leading to increased serum lithium levels and potential toxicity.
- Digoxin: Increased risk of digitalis toxicity due to electrolyte imbalances (hypokalemia, hypomagnesemia) caused by torsemide.
- NSAIDs (e.g., ibuprofen, naproxen): May reduce the diuretic, natriuretic, and antihypertensive effects of torsemide.
Moderate Interactions
- Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers): Additive hypotensive effects, increased risk of orthostatic hypotension.
- Corticosteroids (e.g., prednisone): Increased risk of hypokalemia.
- Amphotericin B: Increased risk of hypokalemia.
- Probenecid: May reduce the diuretic effect of torsemide by inhibiting its tubular secretion.
- Sucralfate: May reduce the absorption of torsemide; administer torsemide at least 2 hours before sucralfate.
- Cholestyramine: May reduce the absorption of torsemide; administer torsemide at least 2 hours before or 4-6 hours after cholestyramine.
Minor Interactions
- Oral hypoglycemics: May decrease the hypoglycemic effect due to torsemide's potential to cause hyperglycemia (rare).
Monitoring
Baseline Monitoring
Serum Electrolytes (Sodium, Potassium, Chloride, 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 influences dosing and risk of adverse effects.
Timing: Prior to initiation of therapy.
Blood Pressure
Rationale: To establish baseline and monitor for hypotensive effects, especially in hypertensive patients.
Timing: Prior to initiation of therapy.
Fluid Status (Weight, Edema)
Rationale: To establish baseline and monitor therapeutic response and signs of dehydration.
Timing: Prior to initiation of therapy.
Routine Monitoring
Serum Electrolytes (Potassium, Sodium, Magnesium)
Frequency: Weekly initially, then monthly or as clinically indicated, especially after dose changes or in patients with renal/hepatic impairment.
Target: Potassium: 3.5-5.0 mEq/L; Sodium: 135-145 mEq/L; Magnesium: 1.7-2.2 mg/dL
Action Threshold: Potassium < 3.0 mEq/L or > 5.5 mEq/L; Sodium < 130 mEq/L or > 150 mEq/L; Magnesium < 1.5 mg/dL. Requires intervention (supplementation, dose adjustment, or discontinuation).
Renal Function (BUN, Serum Creatinine)
Frequency: Monthly or as clinically indicated, especially in patients with pre-existing renal impairment or those on concomitant nephrotoxic drugs.
Target: Within patient's baseline or normal limits.
Action Threshold: Significant increase in BUN/Creatinine (e.g., >25% above baseline or rapidly rising). Requires investigation and potential dose adjustment.
Blood Pressure (Orthostatic and Supine)
Frequency: Daily or as clinically indicated, especially during initial titration.
Target: Individualized based on treatment goals.
Action Threshold: Symptomatic hypotension or significant orthostatic drop (>20 mmHg systolic or >10 mmHg diastolic).
Body Weight
Frequency: Daily (for acute fluid management) or weekly (for chronic management).
Target: Goal weight or stable weight without signs of fluid overload.
Action Threshold: Rapid weight loss (>2-3 lbs/day) or signs of dehydration.
Fluid Status (Edema, Lung Sounds, Urine Output)
Frequency: Daily or as clinically indicated.
Target: Resolution of edema, clear lung sounds, adequate urine output.
Action Threshold: Persistent edema, worsening dyspnea, or oliguria/anuria.
Symptom Monitoring
- Dizziness
- Lightheadedness
- Muscle cramps or weakness
- Nausea
- Vomiting
- Excessive thirst
- Dry mouth
- Unusual tiredness or weakness
- Irregular heartbeat
- Confusion
- Decreased urination
Special Patient Groups
Pregnancy
Torsemide is Pregnancy Category B. Animal studies have not shown 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.
Second Trimester:
Limited human data, generally considered low risk if clinically indicated.
Third Trimester:
May reduce placental perfusion and cause fetal electrolyte disturbances (e.g., hypokalemia, hyponatremia). Use with caution.
Lactation
It is not known whether torsemide is excreted in human milk. Due to the potential for serious adverse reactions in nursing infants (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 cannot be ruled out. Potential for electrolyte imbalance and dehydration in the infant. Monitor infant for signs of dehydration or electrolyte disturbances.
Pediatric Use
Safety and effectiveness in pediatric patients have not been established. Use is generally not recommended.
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 regarding fluid and electrolyte imbalances and orthostatic hypotension. Initiate therapy at the lower end of the dosing range and titrate slowly with close monitoring.
Clinical Information
Clinical Pearls
- Torsemide has a longer duration of action and higher oral bioavailability compared to furosemide, making it a good option for once-daily dosing.
- It is generally considered more potent than furosemide on a milligram-to-milligram basis (e.g., 10 mg torsemide is roughly equivalent to 40 mg furosemide).
- Unlike furosemide, torsemide's absorption is not significantly affected by food, allowing for more flexible administration.
- Effective in patients with impaired renal function, often requiring higher doses in severe renal failure.
- Patients should be advised to take the dose in the morning to prevent nocturia (nighttime urination).
Alternative Therapies
- Furosemide (another loop diuretic)
- Bumetanide (another loop diuretic)
- Ethacrynic acid (another loop diuretic, used in sulfa-allergic patients)
- Hydrochlorothiazide (thiazide diuretic, for hypertension or mild edema)
- Chlorthalidone (thiazide-like diuretic, for hypertension)
- Metolazone (thiazide-like diuretic, often used in combination with loop diuretics for refractory edema)
Cost & Coverage
Average Cost:
$10 - $30 per 30 tablets (5mg generic)
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 your 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.