What is the appropriate dosing for Torsemide?

From the Guidelines

The appropriate dosing for Torsemide is 10-20 mg once daily, with a maximum total daily dose of 200 mg.

Key Points

• The initial daily dose of Torsemide can be started at 10-20 mg once daily 1.
• The maximum total daily dose of Torsemide should not exceed 200 mg 1.
• The duration of action of Torsemide is 12-16 hours 1.
• Torsemide can be used in combination with other diuretics, such as thiazide diuretics, to achieve sequential nephron blockade 1.
• The use of Torsemide should be monitored closely to avoid excessive diuresis, electrolyte depletion, and renal impairment 1.

Dosage Considerations

• The dose of Torsemide may need to be adjusted based on the patient's volume status and weight 1.
• Excessive doses of Torsemide may cause renal impairment and ototoxicity 1.
• The use of Torsemide in combination with other diuretics may increase the risk of electrolyte depletion 1.

Clinical Guidelines

• The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend the use of Torsemide as a loop diuretic for the treatment of heart failure 1.
• The European Society of Cardiology (ESC) guidelines also recommend the use of Torsemide as a loop diuretic for the treatment of heart failure 1.

From the FDA Drug Label

1. 1 Treatment of Edema Edema associated with heart failure The recommended initial dose is 10 mg or 20 mg oral torsemide tablets once daily. If the diuretic response is inadequate, titrate upward by approximately doubling until the desired diuretic response is obtained. Doses higher than 200 mg have not been adequately studied Edema associated with chronic renal failure The recommended initial dose is 20 mg oral torsemide tablets once daily. If the diuretic response is inadequate, titrate upward by approximately doubling until the desired diuretic response is obtained. Doses higher than 200 mg have not been adequately studied Edema associated with hepatic cirrhosis The recommended initial dose is 5 mg or 10 mg oral torsemide tablets once daily, administered together with an aldosterone antagonist or a potassium-sparing diuretic. If the diuretic response is inadequate, titrate upward by approximately doubling until the desired diuretic response is obtained. Doses higher than 40 mg have not been adequately studied in this population.
2. 2 Treatment of Hypertension The recommended initial dose is 5 mg once daily. If the 5 mg dose does not provide adequate reduction in blood pressure within 4 to 6 weeks, increase to 10 mg once daily. If the response to 10 mg is insufficient, add another antihypertensive agent to the treatment regimen.

The appropriate dosing for Torsemide is as follows:

• Edema associated with heart failure: 10 mg or 20 mg once daily, titrate upward by approximately doubling until the desired diuretic response is obtained, not to exceed 200 mg.
• Edema associated with chronic renal failure: 20 mg once daily, titrate upward by approximately doubling until the desired diuretic response is obtained, not to exceed 200 mg.
• Edema associated with hepatic cirrhosis: 5 mg or 10 mg once daily, administered with an aldosterone antagonist or a potassium-sparing diuretic, titrate upward by approximately doubling until the desired diuretic response is obtained, not to exceed 40 mg.
• Hypertension: 5 mg once daily, increase to 10 mg once daily if inadequate response, or add another antihypertensive agent if response to 10 mg is insufficient 2.

From the Research

Dosing Information for Torsemide

• The recommended initial oral dosages of torsemide are:
  • 10-20 mg/day for congestive heart failure (CHF) 3
  • 20 mg/day for chronic renal failure (CRF) 3
  • 5 mg/day for hypertension 3
  • 5-10 mg/day (in combination with a potassium-sparing diuretic or aldosterone antagonist) for hepatic cirrhosis 3
• Dosages of torasemide of 2.5 to 5 mg/day have been used to treat essential hypertension, both as monotherapy and in combination with other antihypertensive agents 4, 5
• In the treatment of chronic CHF, oral torasemide (5 to 20 mg/day) has been shown to be an effective diuretic 4
• Intravenous torasemide (20 to 60mg as a single dose) has been shown to be as effective as furosemide in the treatment of acute CHF 4

Special Considerations

• Torsemide has a longer duration of action and is more potent than furosemide, allowing for once-daily administration 6
• Torsemide appears to promote excretion of potassium and calcium to a lesser extent than furosemide 6
• Adverse effects due to torasemide are usually mild and transient in nature, and include orthostatic hypotension, fatigue, dizziness, and nervousness 4, 3, 5