Torsemide
(tor′se-mide)
Demadex
Classification: ELECTROLYTE AND WATER BALANCE; LOOP DIURETIC
Therapeutic: DIURETIC; ANTIHYPERTENSIVE
Prototype: Furosemide
Pregnancy Category: B
AVAILABILITY
Tablet; solution for injection
ACTION & THERAPEUTIC EFFECT
Long-acting potent sulfonamide “loop” diuretic
that inhibits reabsorption of sodium and chloride primarily in the loop of
Henle and renal tubules. Binds to the sodium/potassium/chloride carrier in the
loop of Henle and in the renal tubules. Long-acting potent “loop”
diuretic and antihypertensive agent.
USES
Management of edema, hypertension.
CONTRAINDICATIONS
Hypersensitivity to torsemide or sulfonamides; anuria,
acute MI; hepatic coma.
CAUTIOUS USE
Renal impairment; ventricular arrhythmias; gout or
hyperuricemia; DM or history of pancreatitis; liver disease with cirrhosis and
ascites; fluid and electrolyte depletion; hearing impairment; pregnancy
(category B); lactation. Safety and efficacy in children have not been
established.
ROUTE & DOSAGE
Edema of HF, Chronic Renal Failure
Adult: PO/IV 10–20 mg once daily, may increase up to 200 mg/day as needed
Edema with Hepatic Cirrhosis
Adult: PO/IV 5–10 mg once daily administered with an aldosterone antagonist or
potassium-sparing diuretic, may increase up to 40 mg/day as needed
Hypertension
Adult: PO 5 mg once daily, may increase to 10 mg/day if no response after 4–6
wk
ADMINISTRATION
- Note: With hepatic cirrhosis, use an aldosterone
antagonist concomitantly to prevent hypokalemia and metabolic alkalosis.
Oral
- Be aware that oral and IV doses are therapeutically
equivalent; patients may be switched between the two forms with no change in
dosage.
Intravenous
PREPARE: Direct: Given undiluted.
ADMINISTER: Direct: Give slowly over 2 min.
- Store at 15°–30° C (59°–86° F).
ADVERSE EFFECTS (≥1%)
CNS: Headache, dizziness, fatigue, insomnia.
CV: Orthostatic hypotension, chest pain, ECG abnormality. Endocrine: Hypokalemia, hyponatremia, hyperuricemia. GI: Nausea, diarrhea. Skin:
Rash, pruritus. Body as a Whole: Muscle cramps, rhinitis.
INTERACTIONS
Drug: NSAIDs may reduce
diuretic effects. Also see furosemide for potential drug interactions such as
increased risk of digoxin toxicity due to hypokalemia, prolonged
neuromuscular blockade with NEUROMUSCULAR BLOCKING AGENTS, and decreased lithium elimination with increased toxicity. Herbal: Ginseng may decrease efficacy.
PHARMACOKINETICS
Absorption: Readily from GI tract. Onset: IV 10 min; PO 60 min. Peak: IV within 60 min; PO 60–120 min. Duration: 6–8 h. Metabolism:
In liver (CYP system). Elimination:
80% in bile; 20% in urine. Half-Life:
210 min.
NURSING IMPLICATIONS
Assessment & Drug Effects
- Monitor BP often and assess for orthostatic
hypotension; assess respiratory status for S&S of pulmonary edema.
- Monitor ECG, as electrolyte imbalances predispose
to cardiac arrhythmias.
- Monitor I&O with daily weights. Assess for
improvement in edema.
- Monitor diabetics for loss of glycemic control.
- Monitor coagulation parameters and lithium
levels in patients on concurrent anticoagulant and/or lithium therapy.
- Monitor lab tests: Periodic serum electrolytes,
uric acid, blood glucose, BUN, and creatinine.
Patient
& Family Education
- Check weight at least weekly and report abrupt
gains or losses to prescriber.
- Understand the risk of orthostatic hypotension.
- Report symptoms of hypokalemia (see Appendix F)
or hearing loss immediately to prescriber.
- Monitor blood glucose for loss of glycemic
control if diabetic.
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