Drugs List
- torasemide 10mg tablets
- torasemide 2.5mg tablets
- torasemide 5mg tablets
- TOREM 10mg tablets
- TOREM 2.5mg tablets
Therapeutic Indications
Uses
Oedema due to cardiac failure
Oedema of hepatic/pulmonary or renal origin
Treatment of essential hypertension
Dosage
Essential hypertension:
The recommended dose is 2.5mg once daily, increased if necessary to 5mg once daily. Studies suggest that doses above 5mg daily will not lead to further reduction in blood pressure. The maximum effect is exhibited after approximately twelve weeks of continuous treatment.
Oedema:
The usual dose is 5mg once daily. If necessary, the dose can be increased stepwise up to 20mg once daily. In individual cases, as much as 40mg torasemide per day has been administered.
Contraindications
Children under 18 years
Anuria
Breastfeeding
Cardiac arrhythmias
Galactosaemia
Hepatic coma
Hypotension
Long QT syndrome
Pre-coma associated with hepatic cirrhosis
Pregnancy
Renal damage secondary to nephrotoxic agents
Renal impairment secondary to hepatotoxic agents
Severe hypokalaemia
Severe hyponatraemia
Torsade de pointes
Precautions and Warnings
Elderly
Family history of long QT syndrome
Benign prostatic hyperplasia
Diabetes mellitus
Electrolyte imbalance
Glucose-galactose malabsorption syndrome
Gout
Hepatic impairment
History of torsade de pointes
Hyperuricaemia
Hypovolaemia
Lactose intolerance
Porphyria
Urinary obstruction
Correct hypotension before initiating treatment
Advise ability to drive/operate machinery may be affected by side effects
Correct existing water and electrolyte disturbances before administration
Not all available strengths are licensed for all indications
Contains lactose
Monitor serum electrolytes before and during treatment
Consider monitoring ECG in patients at risk of QT prolongation
Monitor antidiabetic drug treatment
Monitor blood / urinary glucose in patients suspected of latent diabetes
Monitor blood glucose
Monitor carbohydrate metabolism in diabetes mellitus
Monitor patients at risk of gout
Monitor renal function
Monitor serum creatinine
Monitor serum lipids
Monitor uric acid levels
Excess consumption of liquorice may increase the risk of hypokalaemia
Advise patient not to take NSAIDs unless advised by clinician
Use with caution in patients with urinary outflow obstruction such as in prostatic enlargement as torasemide may precipitate urinary retention in these patients.
Pregnancy and Lactation
Pregnancy
Torasemide is contraindicated in pregnancy.
Diuretics are no longer part of the standard therapy for hypertension and oedema during pregnancy, they should only be used for particular indications. There are no data available on the effect of torasemide on the human embryo and foetus. Whilst studies in rats have shown no teratogenic effect, malformed foetuses have been observed after high doses in pregnant rabbits.
Lactation
Torasemide is contraindicated during breastfeeding.
Side Effects
Aggravation of metabolic alkalosis
Allergic reaction
Anaemia
Angina
Asthenia
Bladder outflow obstruction
Cerebral ischaemia
Circulatory disturbances
Confusion
Decreased appetite
Disturbance of fluid balance
Dizziness
Dry mouth
Electrolyte disturbances
Exanthema
Fatigue
Gastro-intestinal symptoms
Headache
Hearing loss
Hypokalaemia
Hyponatraemia
Hypotension
Increase in serum glucose
Increased uric acid level
Increases in hepatic enzymes
Leukopenia