Dosing and uses of Demadex (torsemide)
Adult dosage forms and strengths
tablet
- 5mg
- 10mg
- 20mg
- 100mg
injectable solution
- 10mg/mL
Congestive Heart Failure
10-20 mg PO/IV once daily initially; doubled until desired diuretic effect is achieved; individual dose not to exceed 200 mg
Chronic Renal Failure
20 mg PO/IV once daily initially; doubled until desired diuretic effect is achieved; individual dose not to exceed 200 mg
Hepatic Cirrhosis
5-10 mg PO/IV once daily initially with aldosterone antagonist or potassium-sparing diuretic; individual dose not to exceed 40 mg
Hypertension
2.5-5 mg/day PO initially; increased to 10 mg/day PO in 4-6 weeks PRn
Dosing Considerations
Use for fluid retention refractory to thiazides or with impaired renal function
Overdose management
- Normal saline may be used for volume replacement
- Dopamine or norepinephrine may be used to treat hypotension
- If dysrhythmia due to decreased potassium or magnesium is suspected, replace aggressively
- Discontinue treatment if no symptoms are apparent after 6 hours
Pediatric dosage forms and strengths
Safety and efficacy not established
Demadex (torsemide) adverse (side) effects
1-10%
Excessive urination (7%)
Headache (7%)
Electrolyte imbalance (2-4%)
Dizziness (3%)
Rhinitis (3%)
Constipation (2%)
Cough (2%)
Diarrhea (2%)
Dyspepsia (2%)
Nausea (2%)
Insomnia (1%)
Nervousness (1%)
<1%
Fatigue
Hyperuricemia
Low back pain
Muscle cramps
Orthostatic hypotension
Ototoxicity (tinnitus and hearing loss, usually reversible; avoid doses >200 mg)
Pruritus
Rash
Postmarketing Reports
Leukopenia
Pancreatitis
Serious skin reactions (ie, Stevens-Johnson syndrome, toxic epidermal necrolysis)
Thrombocytopenia
Warnings
Contraindications
Documented hypersensitivity to torsemide or sulfonamides
Anuria
Cautions
Use with caution in diabetes mellitus, fluid or electrolyte imbalance (hypokalemia, hyponatremia), hyperglycemia, hyperlipidemia, hyperuricemia or gout, severe liver disease with cirrhosis and ascites
Risk of ototoxicity (occurring after rapid IV injection)
Use with caution in cirrhosis; avoid changes in fluid and electrolyte balance and acid-base status, which may lead to hepatic encephalopathy
Monitor fluid status and renal function to prevent azotemia, oliguria, and reversible increases in blood urea nitrogen (BUN) and creatinine
Pregnancy and lactation
Pregnancy category: B
Lactation: Unknown whether drug is excreted into breast milk; use with caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Demadex (torsemide)
Mechanism of action
Sulfonylurea diuretic; loop diuretic acting at Na-K-2Cl reabsorptive pump at ascending loop of Henle; interferes with chloride-binding cotransport system, causing increased excretion of water, sodium, chlorine, magnesium, and calcium
Absorption
Bioavailability: 80%
Onset: PO, 1 hr
Duration: PO, 6-8 hr; IV, 6 hr
Peak plasma time: PO, 1 hr
Peak effect: Diuresis, 1-2 hr; antihypertensive effect, 4-6 wk
Distribution
Protein bound: 99%
Vd: 12-15 L (doubled in cirrhosis)
Metabolism
Metabolized in liver by CYP450 system
Metabolites: M1 (active), M3 (active), M5 (inactive)
Elimination
Half-life: 3.5 hr
Dialyzable: Hemodialysis, no
Renal clearance: 0.38-0.78 L/hr
Excretion: Urine (20%)
Administration
IV Compatibilities
Solution: D5W
Y-site: Milrinone
IV Administration
Administer either as slow injection over 2 minutes or as continuous infusion
If given through IV line, flushing with NS before and afterward is recommended
Storage
Store at controlled room temperature
Protect from freezing
