Torasemide

CLINICAL USE

Loop diuretic: Hypertension Oedema

DOSE IN NORMAL RENAL FUNCTION

2.5–40 mg once daily (varies according to indication) Maximum dose: 200 mg daily

PHARMACOKINETICS

Molecular weight : 348.4

%Protein binding : >99

%Excreted unchanged in urine : 25

Volume of distribution (L/kg) : 0.09–0.331

half-life – normal/ESRD (hrs) : 3–4/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD : Unlikely to be dialysed. Dose as in normal renal function

HD : Not dialysed. Dose as in normal renal function

HDF/high flux : Unknown dialysability. Dose as in normal renal function

CAV/VVHD : Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Analgesics: increased risk of nephrotoxicity with NSAIDs; antagonism of diuretic effect with NSAIDs

Anti-arrhythmics: risk of cardiac toxicity with anti-arrhythmics if hypokalaemia occurs; effects of lidocaine and mexiletine antagonised

Antibacterials: increased risk of ototoxicity with aminoglycosides, polymyxins and vancomycin; avoid concomitant use with lymecycline

Antidepressants: increased risk of hypokalaemia with reboxetine; enhanced hypotensive effect with MAOIs; increased risk of postural hypotension with tricyclics

Anti-epileptics: increased risk of hyponatraemia with carbamazepine

Antifungals: increased risk of hypokalaemia with amphotericin Antihypertensives: enhanced hypotensive effect; increased risk of first dose hypotensive effect with alpha-blockers; increased risk of ventricular arrhythmias with sotalol if hypokalaemia occurs

Antipsychotics: increased risk of ventricular arrhythmias with amisulpride, sertindole or pimozide (avoid with pimozide) if hypokalaemia occurs; enhanced hypotensive effect with phenothiazines

Atomoxetine: hypokalaemia increases risk of ventricular arrhythmias Cardiac glycosides: increased toxicity if hypokalaemia occurs

Lithium: risk of toxicity

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Torasemide 10 mg is equivalent to furosemide 20–40 mg In patients with renal failure, the renal clearance is reduced but total plasma clearance is not significantly altered Approximately 80% of dose is excreted renally as parent drug and metabolites

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