Torsemide
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Torsemide
Demadex, Soaanz
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Summary
Classes
Common uses
Volume overload in heart failure0, Hepatic edema/ascites0, Edema in CKD0, Hypertension (selected cases)0
Pharmacy
Starting dose
10-20 mg PO/IV once daily; titrate by clinical response. 1:1 IV to PO conversion (unlike furosemide's 1:2)
Preparations
5, 10, 20, 100 mg tablets; 10 mg/mL IV
US FDA Max
200 mg/d typical practical ceiling
Pharmacology
Routes
Oral, IV
Onset
PO 1 hour; IV 10 minutes
Duration
6-8 hours
Half-life
3-4 hours (similar between PO and IV due to high oral bioavailability)[1]
Bioavailability
~80% (oral; predictable absorption — a substantive practical advantage over furosemide whose oral absorption is 10-100% variable)[1]
Pregnancy
Avoid where possible; class concerns as for other loop diuretics.[citation needed]
Legal status
Rx-only in US
Purported mechanism
Torsemide blocks the Na+/K+/2Cl- cotransporter (NKCC2) on the apical membrane of thick ascending limb cells, producing brisk natriuresis, kaliuresis, and free-water clearance like furosemide but with a more reliable oral pharmacokinetic profile.0 The TRANSFORM-HF trial (2023) found no all-cause mortality difference between torsemide and furosemide in heart failure, although torsemide remains pharmacologically preferred where furosemide oral absorption is unreliable[1].
References
edit- ↑ 1.0 1.1 1.2 FDA Prescribing Information, Demadex (torsemide), Roche/Meda, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020136s019,020137s018lbl.pdf