Adult Dosing
Edema with heart failure
- Initial: 10-20 mg IV q24 hrs
- Titrate: double dose until response obtained; Max: 200 mg/day IV
Edema with chronic renal failure
- Initial: 20 mg IV q24 hrs
- Titrate: double dose until result seen; Max: 200 mg/day IV
Edema with hepatic cirrhosis
- Initial: 5-10 mg IV q24 hrs
- Titrate: double dose until response obtained; Max: 40 mg/day IV
Hypertension
- Initial: 5 mg IV q24 hrs
- No adequate response, increase the dose to 10 mg IV q24hrs
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- Should be used cautiously in hepatic cirrhosis and ascites, as sudden alteration of fluid and electrolyte balance may lead to hepatic coma
- Concomitantly use aldosterone antagonist or potassium-sparing drug to prevent hypokalemia and metabolic alkalosis
- Administer torsemide IV slowly over 2 minutes, and single doses should not exceed 200 mg as it may cause ototoxicity
- Discontinue the drug if there is any sign of electrolyte imbalance, hypovolemia, or prerenal azotemia
- Monitor serum potassium and other electrolytes periodically in patients treated with torsemide
Cautions: Use cautiously in
- Renal and hepatic impairment
- Hearing impairment
- Arrhythmias
- Diabetes mellitus
- Acute MI
- SLE
- History of gout
- History of pancreatitis
- Gestational HTN
- Concomitant ototoxic agent
- Elderly patients
- Concomitant digitalis
Pregnancy Category:B
Breastfeeding: Safety unknown. Lactation might decrease because of intense diuresis; an alternate drug may be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 24 Nov 2010). Manufacturer advises caution.
