Torsemide

DEMADEX

What it isNKCC2-inhibiting loop diuretic; edema and hypertension, especially with heart failure or kidney disease.

Why this oneOral absorption is more reliable and its action longer than furosemide, making outpatient response more predictable.

What limits itVolume depletion, hypokalemia, and hyponatremia require monitoring; excessive diuresis can worsen kidney function.

FDA-approved for

FDA dosing	Population	Start	Target	Max
Edema - heart failure	Adult	10-20 mg QD		200 mg/day (higher not studied)
Edema - chronic renal failure	Adult	20 mg QD		200 mg/day (higher not studied)
Edema - hepatic cirrhosis	Adult (with aldosterone antagonist or K-sparing diuretic)	5-10 mg QD		40 mg/day (higher not studied)
Hypertension	Adult	5 mg QD	10 mg QD

Titration Hypertension: increase after 4-6 weeks if needed; edema: titrate by doubling per diuretic response

Renal Undefined (contraindicated in anuria)

Hepatic Contraindicated in hepatic coma

Hypotension and worsening renal function
Electrolyte/metabolic abnormalities (hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia, alkalosis); hyperglycemia; hyperuricemia/gout
Ototoxicity

Pregnancy No human data; animal fetal/maternal toxicity at high doses

Lactation No data; diuretics can suppress lactation

NO BOXED WARNINGS

Principal riskVolume depletion with hypokalemia

Cost, est. cash$20–$1,500/dose or month

Generic entry2002

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityVolume depletion and electrolyte disturbances; kidney function and interacting medications modify risk.

CYP2C9 substrate