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Indications ⬇

BEERS REMS

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension

Derm: photosensitivity, rash, STEVENS-JOHNSON SYNDROME (SJS), TOXIC EPIDERMAL NECROLYSIS (TEN)

EENT: hearing loss, tinnitus

Endo: hyperglycemia

F and E: dehydration, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis, hypocalcemia

GI: constipation, diarrhea, dry mouth, dyspepsia, nausea, vomiting

GU: acute renal failure, excessive urination, renal impairment

Metab: hyperuricemia

MS: arthralgia, muscle cramps, myalgia

Neuro: dizziness, headache, nervousness

Interactions ⬆ ⬇

Drug-drug:

Availability ⬆ ⬇

(Generic available)

Route/Dosage ⬆ ⬇

Heart Failure

Chronic Renal Failure

Hepatic Cirrhosis

Hypertension

US Brand Names ⬆ ⬇

Demadex, Soaanz

Action ⬆ ⬇

  • Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule.
  • Increases renal excretion of water, sodium, chloride, magnesium, hydrogen, and calcium.
  • Effectiveness persists in impaired renal function.
Therapeutic effects:
  • Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions).
  • Decreased BP.

Classifications ⬆ ⬇

Therapeutic Classification: antihypertensives

Pharmacologic Classification: loop diuretics

Pharmacokinetics ⬆ ⬇

Absorption: 80% absorbed after oral administration.

Distribution: Widely distributed to tissues.

Protein Binding: ≥99%.

Metabolism/Excretion: Primarily metabolized by the liver via the CYP2C9 isoenzyme, with minor metabolism via the CYP2C8 and CYP2C18 isoenzymes. 80% metabolized by liver, 20% excreted in urine.

Half-Life: 3.5 hr.

Time/Action Profile ⬆ ⬇

(diuretic effect)

ROUTEONSETPEAKDURATION
POwithin 60 min60–120 min6–8 hr

Patient/Family Teaching ⬆ ⬇

Pronunciation ⬆ ⬇

TORE-se-mide

Code ⬆

NDC Code