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|Torsemide

TORSEMIDE (Systemic)†

Some commonly used brand names are:

In the U.S.—

• Demadex

† Not commercially available in Canada.

Category

• Antihypertensive
• Diuretic

Description

Torsemide (TORE-se-mide) belongs to the group of medicines called loop diuretics. Torsemide is given to help reduce the amount of water in the body in certain conditions, such as congestive heart failure, severe liver disease (cirrhosis), or kidney disease. It works by acting on the kidneys to increase the flow of urine.

Torsemide is also used to treat high blood pressure (hypertension). High blood pressure adds to the work load of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.

Torsemide is available only with your doctor"s prescription, in the following dosage forms:

• Oral
• Tablets (U.S.)

• Parenteral
• Injection (U.S.)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For torsemide, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to bumetanide, ethacrynic acid, furosemide, sulfonamides (sulfa drugs), or thiazide diuretics (water pills). Also, tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Studies have not been done in pregnant women. In general, diuretics are not useful for normal swelling of feet and hands that occurs during pregnancy. Diuretics should not be taken during pregnancy unless recommended by your doctor.

Breast-feeding—It is not known whether torsemide passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are taking this medicine and who wish to breast-feed should discuss this with their doctor.

Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of torsemide in children with use in other age groups.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. Although there is no specific information comparing use of torsemide in the elderly with use in other age groups, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking torsemide, it is especially important that your health care professional know if you are taking any of the following:

• Acetazolamide (e.g., Diamox) or
• Alcohol or
• Amphotericin B by injection (e.g., Fungizone) or
• Azlocillin (e.g., Azlin) or
• Capreomycin (e.g., Capastat) or
• Carbenicillin by injection (e.g., Geopen) or
• Corticosteroids (cortisone-like medicine) or
• Corticotropin (ACTH) or
• Dichlorphenamide (e.g., Daranide) or
• Diuretics (water pills) or
• Insulin or
• Laxatives (with overdose or chronic misuse) or
• Methazolamide (e.g., Neptazane) or
• Mezlocillin (e.g., Mezlin) or
• Piperacillin (e.g., Pipracil) or
• Salicylates or
• Sodium bicarbonate (e.g., baking soda) or
• Ticarcillin (e.g., Ticar) or
• Ticarcillin and clavulanate (e.g., Timentin) or
• Vitamin B ₁₂ (e.g., AlphaRedisol, Rubramin-PC) (when used in megaloblastic anemia) or
• Vitamin D—Use of these medicines with torsemide may increase the chance of potassium loss

• Aldesleukin (e.g., Proleukin) or
• Anti-infectives by mouth or by injection (medicine for infection) or
• Carmustine (e.g., BiCNU) or
• Cisplatin (e.g., Platinol) or
• Combination pain medicine containing acetaminophen and aspirin (e.g., Excedrin) or other salicylates (with large amounts taken regularly) or
• Cyclosporine (e.g., Sandimmune) or
• Deferoxamine (e.g., Desferal) (with long-term use) or
• Gold salts (medicine for arthritis) or
• Inflammation or pain medicine, except narcotics, or
• Methotrexate (e.g., Mexate) or
• Penicillamine (e.g., Cuprimine) or
• Pentamidine (e.g., Pentam 300) or
• Plicamycin (e.g., Mithracin) or
• Streptozocin (e.g., Zanosar) or
• Tiopronin (e.g., Thiola)—Use of these medicines with torsemide may increase the chance of kidney damage

• Anticoagulants (blood thinners)—Torsemide may decrease the effects of these medicines

• Lithium (e.g., Lithane)—Use of lithium with torsemide may increase the chance of kidney damage; also, the chance of side effects of lithium may be increased

Other medical problems—The presence of other medical problems may affect the use of torsemide. Make sure you tell your doctor if you have any other medical problems, especially:

• Type 2 diabetes mellitus—Torsemide may increase the amount of sugar in the blood

• Gout or
• Hearing problems—Torsemide may make these conditions worse

• Heart attack (recent)—Use of torsemide after a recent heart attack may make this condition worse

• Kidney disease (severe) or
• Liver disease—Higher blood levels of torsemide may occur, which may increase the chance of side effects

Proper Use of This Medicine

This medicine may cause you to have an unusual feeling of tiredness when you begin to take it. You may also notice an increase in the amount of urine or in your frequency of urination. After you have taken the medicine for a while, these effects should lessen.

It is best to plan your dose or doses according to a schedule that will least affect your personal activities and sleep. Ask your health care professional to help you plan the best time to take this medicine.

To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.

For patients taking this medicine for high blood pressure :

• In addition to the use of the medicine your doctor has prescribed, treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.
• Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.
• Remember that this medicine will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life . If high blood pressure is not treated, it can cause serious problems, such as heart failure, blood vessel disease, stroke, or kidney disease.

Dosing—The dose of torsemide will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of torsemide. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets that you take depends on the strength of the medicine. Also, the length of time you take the medicine depends on the medical problem for which you are taking torsemide .

• For oral dosage form (tablets):
  • For lowering the amount of water in the body:
    • Adults—Dose is usually 5 to 20 milligrams (mg) once a day. However, your doctor may increase your dose as needed.
    • Children—Use and dose must be determined by your doctor.
  • For high blood pressure:
    • Adults—5 to 10 mg once a day.
    • Children—Use and dose must be determined by your doctor.
• For injection dosage form:
  • For lowering the amount of water in the body:
    • Adults—Dose is usually 5 to 20 mg injected into a vein once a day. However, your doctor may increase your dose as needed.
    • Children—Use and dose must be determined by your doctor.

Missed dose—If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Keep the medicine from freezing. Do not refrigerate.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

It is important that your doctor check your progress at regular visits to make sure that this medicine is working properly.

This medicine may cause a loss of potassium from your body :

• To help prevent this, your doctor may want you to:
  • eat or drink foods that have a high potassium content (for example, orange or other citrus fruit juices), or
  • take a potassium supplement, or
  • take another medicine to help prevent the loss of the potassium in the first place.
• It is very important to follow these directions. Also, it is important not to change your diet on your own. This is more important if you are already on a special diet (as for diabetes) or if you are taking a potassium supplement or a medicine to reduce potassium loss. Extra potassium may not be necessary and, in some cases, too much potassium could be harmful.

To prevent the loss of too much water and potassium, tell your doctor if you become sick, especially with severe or continuing nausea and vomiting or diarrhea.

Before having any kind of surgery (including dental surgery) or emergency treatment, make sure the medical doctor or dentist in charge knows that you are taking this medicine.

Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position . This is more likely to occur in the morning. Getting up slowly may help . When you get up from lying down, sit on the edge of the bed with your feet dangling for 1 or 2 minutes. Then stand up slowly. If the problem continues or gets worse, check with your doctor.

The dizziness, lightheadedness, or fainting is also more likely to occur if you drink alcohol, stand for long periods of time, or exercise, or if the weather is hot. While you are taking this medicine, be careful to limit the amount of alcohol you drink. Also, use extra care during exercise or hot weather or if you must stand for long periods of time .

For diabetic patients :

• This medicine may affect blood sugar levels. While you are using this medicine, be especially careful in testing for sugar in your blood or urine.

For patients taking this medicine for high blood pressure :

• Do not take other medicines unless they have been discussed with your doctor . This especially includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

Revised: 08/19/1998

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