Torsemide

A to Z Drug Facts

Torsemide

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(TORE-suh-MIDE)

Demadex

Class: Loop diuretic

Action Inhibits sodium/potassium/chloride carrier system in ascending loop of Henle, resulting in increased urinary excretion of sodium, chloride and water. Does not significantly alter glomerular filtration rate, renal plasma flow or acid-base balance.

Indications Management of edema associated with CHF, hepatic cirrhosis and renal disease; treatment of hypertension.

Contraindications Hypersensitivity to sulfonylureas; anuria; severe electrolyte depletion.

Route/Dosage

ADULTS: PO/IV 5–20 mg once daily. Titrate dose upward until desired response is obtained. Single doses > 200 mg have not been studied.

Interactions

Aminoglycosides: May increase ototoxicity. Anticoagulants: May enhance anticoagulant activity. Cisplatin: May cause additive ototoxicity. Digitalis glycosides: Electrolyte disturbances may predispose to digitalis-induced arrhythmias. Lithium: May increase plasma lithium levels and toxicity. Nondepolarizing muscle relaxants: May antagonize or potentiate response to muscle relaxants. NSAIDs: May decrease effects of torsemide. Probenecid: May reduce action of torsemide. Salicylates: May impair diuretic response in patients with cirrhosis and ascites. Sulfonylureas: May decrease glucose tolerance, resulting in need for increased sulfonylurea dose. Thiazide diuretics: May cause synergistic effects that may result in profound diuresis and serious electrolyte abnormalities.

Lab Test Interferences None well documented.

Adverse Reactions

CV: ECG abnormality; chest pain; atrial fibrillation; orthostatic hypotension; ventricular tachycardia; shunt thrombosis. CNS: Headache; dizziness; asthenia; insomnia; nervousness; syncope. DERM: Rash; pruritus. EENT: Hearing loss; sore throat. GI: Diarrhea; constipation nausea; dyspepsia; GI hemorrhage; rectal bleeding. GU: Excessive urination. META: Hyperglycemia; hyperuricemia; hypomagnesemia; hypokalemia; hypocalcemia; yponatremia; hypochloremia; hypovolemia. RESP: Rhinitis; cough increase. OTHER: Arthralgia; myalgia.

Precautions

Pregnancy: Category B. Lactation: Unknown. Children: Safety and efficacy not established. Hepatic cirrhosis and ascites: Sudden alterations of electrolyte balance may precipitate hepatic encephalopathy and coma. Hypersensitivity. Patients with known sulfonamide sensitivity may show allergic reactions to torsemide. Hyperuricemia: Asymptomatic hyperuricemia or gout may occur. Lipids: Increases in LDL, total cholesterol and triglycerides with decreases in HDL cholesterol may occur. Ototoxicity: Associated with rapid injection or very large doses. Photosensitivity: Photosensitization may occur.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Administer oral form with or without food.
Administer IV form once daily via slow (over 2 min) infusion.
Store in dry area away from sunlight.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies. Note whether patient has lupus erythematosus, kidney dysfunction or cirrhosis.
Assess gross hearing acuity before administration and periodically during drug therapy, especially if drug is being given at high doses or concurrently with another ototoxic drug.
Monitor lying and standing BP before drug administration. Consult with physician if patient is hypotensive.
Monitor I&O and body weight.
Monitor electrolytes. Notify physician of electrolyte imbalances, especially hypokalemia.
Monitor hepatic and renal function.

OVERDOSAGE: SIGNS & SYMPTOMS
	Dehydration, arrhythmias, decreased renal function, blood volume and electrolyte depletion, weakness, dizziness, mental confusion, anorexia, lethargy, vomiting, cramps, circulatory collapse, vascular thrombosis and embolism

Patient/Family Education

Instruct patient to inform physician of all otc or prescription drugs being taken, especially NSAIDs, digitalis or lithium.
Advise hypertensive patient to avoid foods or medications that may increase BP, including otc drugs for appetite suppression or cold symptoms, otc drugs to help to keep awake and excessive consumption of coffee or other substances containing caffeine.
Instruct patient to eat potassium-rich foods daily. These foods include banana, cantaloupe and potatoes.
Advise patient not to store drug in bathroom, but in a cool, dry place.
Inform patient that drug may raise blood sugar levels. Instruct diabetic patients to monitor blood glucose regularly and report patterns of hyperglycemia.
Advise patient that this drug increases urination. Advise patient to take medication early in morning to avoid disrupted sleep.
Caution patient to notify physician immediately if vomiting and diarrhea occur or if signs of excessive potassium loss (cramps, muscle weakness, nausea, dizziness) are noted.
Instruct patient to report these symptoms to physician: chest pain, dizziness, rapid heart beat, headache, nausea, increased swelling of feet, black stools, rectal bleeding, rash, face rash, fatigue or hearing loss.
Caution patient to avoid sudden position changes to prevent dizziness or fainting.
Advise patient that drug may cause dizziness and to use caution while driving or performing other tasks requiring mental alertness.
Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.