Pronunciation:

TORE-se-mide

Brand Names:

• Demadex
• Soaanz

Dosage Forms:

• Tablet

Classifications:

Therapeutic—

Cardiovascular Agent

Pharmacologic—

Diuretic, Loop

Uses of This Medicine:

Torsemide is used to help treat fluid retention (edema) and swelling that is caused by congestive heart failure, liver disease, kidney disease. It belongs to the group of medicines called loop diuretics (water pills). This medicine works by acting on the kidneys to increase the flow of urine.

Torsemide is also used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload 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.

This medicine is available only with your doctor's prescription.

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 this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of torsemide in the pediatric population. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of torsemide in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for elderly patients receiving torsemide.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

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 this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Desmopressin

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Aceclofenac
• Acemetacin
• Albuterol
• Amtolmetin Guacil
• Arsenic Trioxide
• Aspirin
• Bromfenac
• Bufexamac
• Buprenorphine
• Capecitabine
• Celecoxib
• Ceritinib
• Choline Salicylate
• Clonixin
• Codeine
• Dexibuprofen
• Dexketoprofen
• Diclofenac
• Diflunisal
• Digitoxin
• Dipyrone
• Dofetilide
• Droperidol
• Droxicam
• Etodolac
• Etofenamate
• Etoricoxib
• Felbinac
• Fenoprofen
• Fepradinol
• Feprazone
• Floctafenine
• Fluconazole
• Flufenamic Acid
• Flurbiprofen
• Formoterol
• Foscarnet
• Ibuprofen
• Indomethacin
• Ketanserin
• Ketoprofen
• Ketorolac
• Levomethadyl
• Lithium
• Lornoxicam
• Loxoprofen
• Lumiracoxib
• Mavacamten
• Meclofenamate
• Mefenamic Acid
• Meloxicam
• Methotrexate
• Metolazone
• Morniflumate
• Nabumetone
• Naproxen
• Nepafenac
• Niflumic Acid
• Nimesulide
• Nimesulide Beta Cyclodextrin
• Oxaprozin
• Oxyphenbutazone
• Parecoxib
• Phenobarbital
• Phenylbutazone
• Piketoprofen
• Piroxicam
• Pixantrone
• Primidone
• Proglumetacin
• Propyphenazone
• Proquazone
• Rofecoxib
• Salicylic Acid
• Salsalate
• Sodium Salicylate
• Sotalol
• Sparsentan
• Sulindac
• Tapentadol
• Tenoxicam
• Tiaprofenic Acid
• Tolfenamic Acid
• Tolmetin
• Valdecoxib
• Warfarin

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Benazepril
• Captopril
• Cilazapril
• Enalapril
• Enalaprilat
• Fosinopril
• Germanium
• Ginseng
• Gossypol
• Licorice
• Lisinopril
• Moexipril
• Perindopril
• Quinapril
• Ramipril
• Spirapril
• Trandolapril
• Zofenopril

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

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

• Anuria (not able to pass urine) or
• Hepatic coma—Should not be used in patients with these conditions.

• Dehydration or
• Electrolyte imbalance (eg, low calcium, chlorine, magnesium, potassium, or sodium in the blood) or
• Gout or
• Hearing problems (eg, tinnitus) or
• Hyperuricemia (high uric acid in the blood) or
• Hypotension (low blood pressure) or
• Hypovolemia (low blood volume) or
• Kidney failure or
• Liver disease, severe (eg, cirrhosis)—Use with caution. May make these conditions worse.

• Hypoproteinemia (low protein in the blood) from a kidney problem or
• Radiocontrast nephropathy (kidney problem)—May cause side effects to become worse.

Proper Use of This Medicine:

Take this medicine exactly as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

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

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, most patients 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.

This medicine will not cure your high blood pressure but it does help control it. 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.

If you are taking cholestyramine (Questran®), take it at least 1 hour after or 4 to 6 hours before taking torsemide. It may keep torsemide from working properly.

Dosing—

The dose of this medicine 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 this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (Demadex® tablets):
  • For edema caused by heart failure:
    • Adults—At first, 10 or 20 milligrams (mg) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 200 mg per day.
    • Children—Use and dose must be determined by your doctor.
  • For edema caused by kidney failure:
    • Adults—At first, 20 milligrams (mg) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 200 mg per day.
    • Children—Use and dose must be determined by your doctor.
  • For edema caused by liver cirrhosis:
    • Adults—At first, 5 or 10 milligrams (mg) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 40 mg per day.
    • Children—Use and dose must be determined by your doctor.
  • For high blood pressure:
    • Adults—At first, 5 milligrams (mg) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 10 mg per day.
    • Children—Use and dose must be determined by your doctor.
• For oral dosage form (Soaanz® tablets):
  • For edema caused by heart failure or kidney failure:
    • Adults—At first, 20 milligrams (mg) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 200 mg per day.
    • 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—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Getting up slowly may help. If the problem continues or gets worse, check with your doctor.

This medicine may make you dizzy or drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Sit or lie down if you feel dizzy. Stand up carefully.

This medicine may cause you to lose more potassium from your body than normal (hypokalemia). This is more likely to occur if you have liver disease (eg, cirrhosis), or if you are using this medicine together with steroids (cortisone-like medicines), adrenocorticotropic hormone (ACTH), large amounts of licorice, or laxatives for a long time. Tell your doctor if you become sick with severe or continuing nausea, vomiting, or diarrhea, and drink fluids to prevent getting dehydrated. Check with your doctor right away if you have dry mouth, increased thirst, muscle cramps, or nausea or vomiting.

Check with your doctor right away if you have a sudden decrease in hearing or loss of hearing. You may also have dizziness or ringing in the ears. Tell your doctor if you have a feeling of constant movement of self or surroundings or a sensation of spinning.

This medicine may cause an increase in blood sugar levels. If you are diabetic and notice a change in the results of your blood or urine sugar tests, check with your doctor.

Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests.

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

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 immediately if any of the following side effects occur:

Less common

Chest pain

decreased urination

diarrhea

dry mouth

increased thirst

irregular heartbeat

loss of appetite

mood changes

muscle pain or cramps

nausea or vomiting

numbness or tingling in the hands, feet, or lips

seizures

swelling of the hands, ankles, feet, or lower legs

trouble breathing

unusual tiredness or weakness

Rare

Black, tarry stools

dizziness, faintness, or lightheadedness when getting up from a suddenly sitting or lying position

ringing or buzzing in the ears or any hearing loss

skin rash

Incidence not known

Blistering, peeling, or loosening of the skin

bloating

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

chills

constipation

darkened urine

decrease in frequency of urination

decrease in urine volume

difficulty in passing urine (dribbling)

fever

indigestion

itching

joint or muscle pain

painful or difficult urination

pains in the stomach, side, or abdomen, possibly radiating to the back

pale skin

red irritated eyes

red skin lesions, often with a purple center

sore throat

sores, ulcers, or white spots on the lips or in the mouth

swollen glands

unusual bleeding or bruising

yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Blurred vision

coma

confusion

decreased urine output

dizziness

drowsiness

fainting

fast heartbeat

headache

increase in heart rate

irritability

lightheadedness

rapid breathing

sunken eyes

sweating

unusual tiredness or weakness

weak pulse

wrinkled skin

Some 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. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Increase in urination

Less common

Acid or sour stomach

belching

difficulty having a bowel movement (stool)

difficulty in moving

heartburn

increased cough

lack or loss of strength

muscle pain or stiffness

nervousness

pain in the joints

sneezing

sore throat

stomach discomfort, upset, or pain

stuffy or runny nose

swollen joints

trouble sleeping

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.