Names and pronunciation
(tor′suh-mide) Demadex
Source page 1317
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Individual generic drug information
Extracted information for torsemide only.
(tor′suh-mide) Demadex
Source page 1317
Func. class.: Loop diuretic
Source page 1317
Chem. class.: Sulfonamide derivative
Source page 1317
ACTION: Acts on loop of Henle by inhibiting absorption of chloride, sodium, water
Source page 1318
USES: Treatment of hypertension and edema with HF, ascites
Source page 1318
Extracted information for torsemide only.
CONTRAINDICATIONS: Infants, hypersensitivity to sulfonamides, anuria Precautions: Pregnancy, breastfeeding, diabetes mellitus, dehydration, severe renal disease, electrolyte depletion, hypovolemia, syncope, ventricular dysrhythmias
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SIDE EFFECTS CNS: Headache, dizziness, asthenia, insomnia, nervousness CV: Orthostatic hypotension, chest pain, ECG changes, circulatory collapse, ven- tricular tachycardia, edema EENT: Loss of hearing, ear pain, tinnitus, blurred vision ELECT: Hypokalemia, hypochloremic alkalosis, hyponatremia, metabolic alkalosis ENDO: Hyperglycemia, hyperuricemia GI: Nausea, diarrhea, dyspepsia, cramps, constipation GU: Polyuria, renal failure, glycosuria INTEG: Rash, photosensitivity, pruritus MS: Cramps, stiffness RESP: Rhinitis, cough increase
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INTERACTIONS Increase: toxicity—lithium, nondepolar- izing skeletal muscle relaxants, digoxin Increase: action of antihypertensives, oral anticoagulants, nitrates; cautious use Increase: ototoxicity—aminoglycosides, CISplatin, vancomycin; cautious use Decrease: antihypertensive effect of torsemide—indomethacin, carBAMaze- pine, PHENobarbital, phenytoin, rifAMPin, NSAIDs Decrease: hypoglycemic effect—antidia- betics; monitor blood glucose levels often Drug/Herb • Severe photosensitivity: St. John’s wort Drug/Lab Test Increase: BUN, creatinine, uric acid, blood glucose, cholesterol Decrease: potassium, magnesium, chlo- ride sodium
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TREATMENT OF OVERDOSE: Lavage if taken orally; monitor electrolytes; administer dextrose in saline; monitor hydration, CV, renal status HIGH ALERT
Source page 1319
Extracted information for torsemide only.
DOSAGE AND ROUTES HF diuresis • Adult: PO 10-20 mg/day, may increase as needed, max 200 mg/day Diuresis in chronic renal failure • Adult: PO 20 mg/day, may increase to 200 mg/day Hepatic cirrhosis • Adult: PO 5-10 mg/day, may increase as needed, max 40 mg/day Hypertension • Adult: PO 5mg/day, after 4-6 weeks may increase to 10mg/day
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Available forms: Tabs 5, 10, 20, 100 mg
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Administer: PO route • In AM to avoid interference with sleep if using product as diuretic • With food or milk if nausea occurs; absorption may be decreased slightly
Source page 1318
Extracted information for torsemide only.
Assess: • Heart failure: B/P lying, standing; pos- tural hypotension may occur; weight, I&O daily to determine fluid loss; effect of product may be decreased if used daily • Hearing when giving high doses • Sulfa allergy: determine before using product • Electrolytes: potassium, sodium, chlo- rine; include blood glucose, CBC, blood pH, ABGs, uric acid; calcium, magnesium, potassium supplements may be required • Blood glucose of diabetic patients, gly- cosuria • Renal failure: monitor urinalysis, BUN, CCr • Hyperuricemia: exacerbation of gout may occur • Metabolic alkalosis: drowsiness, rest- lessness • Hypokalemia: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness • Rashes, temperature elevation daily • Confusion, especially in geriatric pa- tients; take safety precautions if needed • Pregnancy/breastfeeding: use only if clearly needed, no well-controlled stud- ies; cautious use in breastfeeding • Beers: use with caution in older adults; may exacerbate or cause SIADH or hypona- tremia; monitor sodium levels frequently
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Evaluate: • Therapeutic response: improvement in edema of feet, legs, sacral area daily if medication is being used with HF
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To rise slowly from lying, sitting position • To recognize adverse reactions: muscle cramps, weakness, nausea, dizziness, tin- nitus • To take with food or milk for GI symp- toms; to limit alcohol use • To take early during the day to prevent nocturia • To use sunscreen, protective clothing to prevent sunburn • To notify prescriber if pregnancy is planned or suspected • To report tinnitus immediately; may indicate toxicity • Not to use any OTC medications, herbal products before approved by pre- scriber
Source page 1319
Extracted information for torsemide only.
PHARMACOKINETICS PO: Rapidly absorbed; duration 6 hr; excreted in breast milk; crosses placenta; half-life 3.5 hr; protein binding 97%-99%, cleared through hepatic metabolism
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Filter the extracted dose blocks for this individual drug.
HF diuresis
• Adult: PO 10-20 mg/day, may increase as needed, max 200 mg/day Diuresis in chronic renal failure
Candidate age grouping · source page 1318
HF diuresis
• Adult: PO 20 mg/day, may increase to 200 mg/day Hepatic cirrhosis
Candidate age grouping · source page 1318
HF diuresis
• Adult: PO 5-10 mg/day, may increase as needed, max 40 mg/day Hypertension
Candidate age grouping · source page 1318
HF diuresis
• Adult: PO 5mg/day, after 4-6 weeks may increase to 10mg/day
Candidate age grouping · source page 1318