====== Torsemide (Demadex®) ======
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|^ Torsemide || Brand Names | Demadex® || Drug Class | Loop Diuretic || Primary Indications | Heart Failure; Edema; Hypertension (selected) || Blood Pressure Effect | ↓ preload, ↓ BP || Mortality Benefit | No (symptom relief) || Elimination | Hepatic & renal || Black Box Warning | Ototoxicity (high dose/rapid IV) || FDA Approval | 1993 |
===== Overview =====Torsemide is a loop diuretic that blocks NKCC2 in the thick ascending limb, producing potent diuresis. It has better oral bioavailability and longer duration than furosemide.
—-===== Mechanism of Action =====Primary Molecular Target * Na-K-2Cl cotransporter (NKCC2) in thick ascending limbSegment Effects * ↓ NaCl reabsorption in TAL * ↑ Ca2+ and Mg2+ excretion * Disrupts medullary concentrating gradientNet Physiologic Outcomes * Powerful diuresis * ↓ preload and congestion * Longer duration vs furosemide—-===== Indications ===== * Heart failure with congestion * Edema from CKD/cirrhosis * Hypertension with volume overload—-
===== Black Box Warning =====Risk of profound diuresis and electrolyte depletion; ototoxicity with high doses/rapid IV.
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===== Contraindications =====Absolute: * AnuriaRelative / Caution: * Hypovolemia * Severe electrolyte depletion * Gout
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===== Dosing =====Heart failure/edema: * PO: 10–20 mg daily (titrate) * Typical range: 10–200 mg/dayRenal adjustment: * Higher doses may be required in CKD
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===== Pharmacokinetics =====Absorption: * Oral/IVBioavailability: * ~80–90%Metabolism: * Hepatic (CYP2C9)Half-life: * ~3–4 hoursElimination: * Hepatic & renal
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===== Adverse Effects =====Common: * Hypokalemia * Hypomagnesemia * Hypotension * PolyuriaSerious: * Ototoxicity * AKI from overdiuresis * Hyponatremia
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===== Drug Interactions =====Increased risk: * Digoxin toxicity (via hypokalemia) * NSAIDs (↓ effect) * Lithium (↑ levels)Avoid combination: * Aminoglycosides (ototoxicity risk)
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===== Monitoring =====Labs: * Electrolytes (K+, Mg2+, Na+) * CreatinineVitals: * Blood pressure * WeightClinical: * Volume status * Hearing changes (high dose)
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===== Clinical Pearls ===== * More predictable absorption than furosemide * Longer duration (once-daily in many) * Useful in diuretic resistance
—-===== Comparison Within Class =====Compared to other loop diuretics: * Longer half-life than furosemide * Higher oral bioavailability * Less dose variability—-===== Related ===== * Loop Diuretics * Heart Failure * Diuretics