torasemide

Torsemide is a loop diuretic used to treat edema associated with congestive heart failure, hepatic cirrhosis, and nephrotic syndrome, and is sometimes employed in hypertension when fluid overload is present. It acts by inhibiting the Na+-K+-2Cl− cotransporter in the thick ascending limb of the loop of Henle, promoting the excretion of sodium, chloride, and water.

Compared with other loop diuretics such as furosemide, torasemide generally offers more predictable absorption and a longer duration of action, which often allows once-daily dosing. After oral administration, diuresis typically begins within about one hour, with peak effects in 1–2 hours and a duration that can extend through several hours, depending on individual factors. Torasemide is largely processed by the liver and eliminated by the kidneys, so dosing can require adjustment for renal or hepatic impairment.

The drug is available in oral tablet form and as an injectable solution. Dosing is individualized and titrated to achieve adequate diuresis while avoiding excessive volume depletion. Monitoring of electrolytes, renal function, fluid balance, and blood pressure is recommended during therapy. Caution is warranted in patients with dehydration, hypotension, or electrolyte disturbances; and diuretic therapy can precipitate gout via hyperuricemia.

Common adverse effects include volume depletion, orthostatic hypotension, and electrolyte disturbances (notably hypokalemia and hypomagnesemia, with hyponatremia possible). Less frequent but serious risks include ototoxicity (rare) and hypersensitivity reactions in susceptible individuals.

Contraindications include anuria and significant electrolyte or volume depletion. Torasemide should be used with caution in pregnancy and in patients with sulfonamide sensitivity, and interactions with NSAIDs, lithium, and other antihypertensives can affect efficacy and safety.