torsemide (Demadex) Diuretic Side Effects, Dosing, vs. furosemide

What is torsemide, and how does it work?

Torsemide (Demadex) is a potent drug that's a diuretic (water pill). This medicine causes a profound increase in urine output (diuresis) by preventing the kidney from retaining water. Specifically, it blocks the reabsorption back into the blood of sodium and water that has been filtered out of the blood by the kidneys.

Torsemide is in a class of diuretic drugs called "loop" diuretics, which also includes the drugs furosemide (Lasix) and bumetanide (Bumex). Torsemide 10-20 mg is approximately equivalent to 1 mg of bumetanide and 40 mg of furosemide. The potent diuretic effect of torsemide can cause the loss of large amounts of body water leading to dehydration as well as the loss of electrolytes (for example, sodium, potassium, magnesium, and calcium). Therefore, careful medical supervision is necessary during treatment.

What brand names are available for torsemide?

Demadex is the brand name for this medication in the U.S.

Is torsemide available as a generic drug?

Yes, it's available as a generic drug.

Do I need a prescription for torsemide?

Yes, your medical doctor or health care professional will need to write you a prescription for the medication.

What are the uses for torsemide?

Torsemide is prescribed by doctors to treat several diseases and conditions.

• Torsemide (Demadex) is used for the medical treatment of edema (water retention) due to congestive heart failure, kidney disease, chronic kidney failure, or liver disease.
• Torsemide also is used alone or combined with other antihypertensive medications for the treatment of high blood pressure (hypertension).

Who shouldn't take torsemide?

• Patients shouldn't take torsemide if they are allergic to it or to sulfonylureas to which it is related.
• Don't take torsemide if you aren't able to urinate.
• Patients with liver disease with cirrhosis and ascites should use this drug with caution because sudden changes in fluid and electrolyte balance can cause hepatic coma.

What are torsemide side effects?

Potent medication like torsemide can cause low blood levels of potassium, magnesium, sodium, and calcium. Additionally, fluid losses may lead to dehydration. The symptoms of dehydration may include:

• Dry mouth
• Thirst
• Weakness
• Drowsiness
• Reduced kidney function
• Heart arrhythmias
• Muscle aches and pains
• Nausea
• Vomiting

Possible side effects of this medication reported often include:

• Headache
• Excessive urination
• Dizziness
• Runny nose
• Asthenia
• Diarrhea
• ECG abnormality
• Cough
• Constipation
• Nausea
• Joint pain
• Stomach upset
• Sore throat
• Muscle pain
• Insomnia
• Edema
• Nervousness

Possible serious side effects and adverse effects include:

• Atrial fibrillation
• Chest pain
• Gastrointestinal bleeding
• High blood sugar (hyperglycemia)
• Increased uric acid (hyperuricemia)
• Low blood potassium (hypokalemia)
• Low blood pressure (hypotension)
• Dehydration (symptoms listed previously)
• Shunt thrombosis
• Rectal bleeding
• Fainting
• Ventricular tachycardia
• Serious skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis)
• Allergic reactions
• Pancreatitis
• Reduced number of white blood cells and platelets

Ringing in the ears (tinnitus) and reversible hearing loss may occur.

Demadex can cause dehydration and loss of potassium and other electrolytes. Low potassium levels (hypokalemia) can cause abnormal heartbeats especially in people with heart disease or those taking the medicine digoxin (Lanoxin). Levels of potassium and other electrolytes should be monitored during medical treatment with this medicine.

Salt and sodium are the same.
See Answer

What dosages are available for torsemide, and how do I take it?

• Torsimide (Demadex) comes in tablets of 5, 10, 20, and 100 mg. The 10 mg/ml injectable solution has been discontinued.
• Patients can take the tablets at any time without regard to meals. (You can take it on an empty stomach.)
• For the treatment for patients with heart failure, the initial dose is 10 to 20 mg by mouth or injection once daily. The dose may be doubled until the desired diuretic effect is achieved. The maximum dose is 200 mg daily.
• Chronic kidney failure is treated with 20 to 200 mg orally or by injection once daily.
• The dose for treating high blood pressure is 2.5 to 10 mg orally once daily.
• Liver cirrhosis is treated with 5 to 40 mg orally or by injection once daily. It is combined with aldosterone antagonists or potassium-sparing diuretics.

Which drugs or supplements interact with torsemide?

Several medicines may cause interactions with torsemide.

• Torsemide can cause low blood potassium, calcium, and magnesium levels. These changes can increase the risk of toxicity from digoxin (Lanoxin). Combining torsemide with other diuretics such as metolazone (Zaroxolyn), hydrochlorothiazide, or chlorthalidone (Hygroton) can exaggerate the losses of potassium and magnesium.
• The body's ability to eliminate lithium (Lithobid, Eskalith) may decrease in patients receiving torsemide. Therefore, careful monitoring of lithium levels in blood is recommended when torsemide and lithium are taken together in order to prevent increases in lithium levels and lithium toxicity.
• Indomethacin (Indocin) can reduce the diuretic and blood pressure-lowering effects of other loop diuretics (for example furosemide) and it probably can do the same with torsemide. Other nonsteroidal anti-inflammatory drugs — for example, ibuprofen (Motrin) and naproxen (Naprosyn) — may interact similarly.
• Concomitant use of torsemide and aminoglycosides may increase the risk of hearing impairment since both agents can affect hearing.
• Probenecid decreases the diuretic effect of torsemide by reducing secretion of torsemide into the kidney tubules.

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Is torsemide safe to use during pregnancy or while breastfeeding?

• Researchers, doctors, and other health care professionals haven't established the safety of torsemide in pregnant women.
• It's also not known whether torsemide is excreted in human milk.

What else should I know about torsemide?

Storage and FDA approval

• Keep this drug stored at room temperature, 15 C to 30 C (59 F to 86 F).
• The FDA approved torsemide in August 1993.

Overdose information

There have been no human experiences with overdoses of this medication. Signs and symptoms of overdose may include:

• Dehydration
• Low blood pressure (hypotension)
• Hyponatremia
• Hypokalemia (low potassium levels)
• Hypochloremic alkalosis
• Hemoconcentration

If you think someone has taken an overdose of this drug call 911 or the poison control center at 1-800-222-1222.