Torsemide

Torsemide is a loop diuretic (water pill) that is used to treat fluid retention (edema) in people with heart failure, liver disease, or kidney disease.

Torsemide is also used to treat high blood pressure (hypertension). Lowering blood pressure may lower your risk of a stroke or heart attack.

Torsemide may also be used for other reasons that are not mentioned in this medication guide.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may change your dose from time to time. Use the medicine exactly as directed.

Torsemide oral is taken by mouth.

Torsemide injection is given as an infusion into a vein. A healthcare provider may teach you how to properly use the medication yourself. Torsemide injection can be given either as a slow infusion over 2 minutes or as a continuous (around the clock) infusion.

If you have cirrhosis or other liver problems, you may receive your first injection in a hospital or clinic setting to quickly manage any serious side effects.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand any instructions.

Prepare an injection only when you are ready to give it. Do not use if the medicine has changed colors or has particles in it. Call your pharmacist for new medicine.

You may take torsemide with or without food.

Your blood pressure will need to be checked often, and you may need other medical tests. Your blood and urine may both be tested if you have been vomiting or are dehydrated.

Some factors can cause your blood pressure to drop too low. This includes vomiting, diarrhea, or heavy sweating. Call your doctor if you are sick with vomiting or diarrhea.

Your condition may be treated with a combination of drugs. Use all medications as directed by your doctor. Do not change your doses or medication schedule without your doctor’s advice.

If you have high blood pressure, continue taking torsemide oral even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life.

Store at room temperature away from moisture and heat.

You should not use torsemide if you are allergic to sulfa drugs or if you cannot urinate.

You should not use torsemide if you are allergic to it, or if:

• you are unable to urinate; or
• you are allergic to an oral diabetes medicine.

Tell your doctor if you have ever had:

• heart disease;
• kidney problems (unless you are taking torsemide for edema related to kidney disease);
• liver problems such as cirrhosis or hepatitis (unless you are taking torsemide for edema related to liver disease);
• gout;
• an allergy to povidone (sometimes found in iodine, Betadine); or
• if you are on a low-salt diet.

If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, inform your caregivers that you currently take torsemide.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether torsemide will harm an unborn baby. However, having high blood pressure during pregnancy may cause complications such as diabetes or eclampsia (dangerously high blood pressure that can lead to medical problems in both mother and baby). The benefit of treating hypertension may outweigh any risks to the baby.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.

Torsemide is not approved for use by anyone younger than 18 years old.

Get emergency medical help if you notice signs of an allergic reaction: hives; trouble breathing; swelling of your face, lips, tongue, or throat.

Call your doctor right away if you have:

• a light-headed feeling, as if you might faint;
• ringing in your ears or sudden hearing loss;
• kidney problems—little or no urination, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath;
• low magnesium level—dizziness, irregular heartbeats, feeling jittery, muscle cramps, muscle spasms, cough or choking feeling;
• low potassium level—leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or feeling limp; or
• low sodium level—headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady.

Common side effects of torsemide may include:

• increased urination; or
• headache.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Usual Adult Dose for Edema:

Edema Associated with Congestive Heart Failure:IV and oral: 10 to 20 mg once a day; if diuresis remains inadequate, titrate upward by approximately doubling the dose until desired response is achieved; single doses higher than 200 mg have not been adequately studied.Edema Associated with Renal Disease:IV and oral: 20 mg once a day; if diuresis remains inadequate, titrate upward by approximately doubling the dose until desired response is achieved; single doses higher than 200 mg have not been adequately studied.Edema Associated with Hepatic Disease:IV and oral: 5 to 10 mg once a day together with an aldosterone antagonist or a potassium-sparing diuretic; if diuresis remains inadequate, titrate upward by approximately doubling the dose until desired response is achieved; single doses higher than 40 mg have not been adequately studied.Comments: Chronic use of any diuretic in hepatic disease has not been studied adequately.

Usual Adult Dose for Hypertension:

5 mg orally once a day; if diuresis remains inadequate after 4 to 6 weeks, titrate up to 10 mg orally once a day; if diuresis remains inadequate with 10 mg, an additional antihypertensive should be added.

Take the medicine as soon as you can, but skip the missed dose if it is close to the time for your next dose. Do not take two doses at once.

Call your doctor for instructions if you miss a dose of torsemide (injection).

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include dehydration, an electrolyte imbalance (such as low levels of potassium, magnesium, or sodium in your blood), or low blood pressure and fainting.

Avoid getting too hot or dehydrated while exercising, in hot weather, or by not drinking enough fluids. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Tell your doctor about all the medicines you are currently taking. Many drugs can affect torsemide, especially:

• any other diuretic medicine;
• cholestyramine, lithium, phenytoin, probenecid, rifampin, warfarin (Coumadin, Jantoven);
• an intravenous (IV) antibiotic medicine;
• antifungal medicine--fluconazole, miconazole;
• heart or blood pressure medicine--amiodarone, dronedarone, enalapril, irbesartan, lisinopril, losartan, olmesartan, valsartan, and others;
• NSAIDs (nonsteroidal anti-inflammatory drugs)--ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others;
• salicylates--aspirin, Nuprin Backache Caplet, Kaopectate, KneeRelief, Pamprin Cramp Formula, Pepto-Bismol, Tricosal, Trilisate, and others or
• steroid medicine--dexamethasone, oxandrolone, prednisone, and others.

This list is not complete, and many other drugs may affect torsemide. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

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