Dytor (Torsemide) 5 mg Oral Management
For hypertension, start with torsemide 5 mg once daily, and if blood pressure is not adequately controlled after 4-6 weeks, increase to 10 mg once daily. 1
Indication-Specific Dosing
Hypertension
- Initial dose: 5 mg once daily 1
- If inadequate blood pressure reduction after 4-6 weeks, increase to 10 mg once daily 1
- If response to 10 mg remains insufficient, add another antihypertensive agent rather than further increasing torsemide 1
- Low-dose torsemide (2.5-5 mg/day) achieves diastolic blood pressure <90 mmHg in 70-80% of patients within 8-12 weeks 2
Edema Associated with Hepatic Cirrhosis
- Initial dose: 5 mg once daily 1
- Must be administered together with an aldosterone antagonist or potassium-sparing diuretic 1
- If diuretic response is inadequate, titrate upward by approximately doubling the dose 1
- Maximum studied dose in hepatic cirrhosis: 40 mg daily 1
Edema Associated with Heart Failure
- Initial dose: 10-20 mg once daily (not 5 mg) 1
- Torsemide 10-20 mg produces significant weight loss and edema reduction in heart failure patients 3
Administration Guidelines
Timing and Food Interactions
- Administer once daily without regard to meals 4
- Torsemide has approximately 80% bioavailability with minimal first-pass metabolism 4
- Peak serum concentration occurs within 1 hour after oral administration 4
- Duration of diuretic effect: approximately 6-8 hours 4
Route Equivalence
- Oral and intravenous doses are therapeutically equivalent due to high bioavailability 4
- This allows seamless transition between routes without dose adjustment 4
Clinical Advantages Over Furosemide
- Higher and more consistent bioavailability (>80% vs 10-90% for furosemide) 2, 4
- Longer elimination half-life (3-4 hours) allows once-daily dosing 2
- More prolonged water and electrolyte excretion than equipotent doses of furosemide 5
- Does not increase potassium loss to the same extent as furosemide 5
- Superior for treating cardiogenic pulmonary edema due to greater efficacy and absorption 6
Monitoring Requirements
Electrolytes
- Monitor for transient hypokalemia, particularly at doses >5 mg/day 2
- At doses ≤5 mg/day, torsemide does not significantly affect serum potassium levels 5
- Check serum potassium, sodium, and chloride periodically 3
Other Parameters
- Monitor body weight to assess diuretic response 3
- Assess for hyperuricemia 2
- Torsemide does not affect blood glucose levels at doses below 5 mg/day 5
Common Pitfalls and Caveats
Dosing Errors
- Do not start at 5 mg for heart failure-associated edema—this dose is insufficient; begin with 10-20 mg 1
- For hypertension, 5 mg is appropriate, but many clinicians incorrectly start higher 1
Hepatic Cirrhosis Considerations
- Never use torsemide alone in hepatic cirrhosis—always combine with aldosterone antagonist or potassium-sparing diuretic 1
- Do not exceed 40 mg daily in this population due to lack of safety data 1
Renal Considerations
- No special dosage adjustments needed in elderly patients 4
- Torsemide is eliminated both hepatically (80%) and renally (20%) 4
Adverse Effects Profile
- Generally well tolerated at doses up to 20 mg/day for at least 1 year 2
- Most common adverse effects: dizziness, headache, gastrointestinal disturbances, orthostatic hypotension, fatigue 2
- No evidence of ototoxicity in humans 5
- Adverse effects rarely necessitate drug withdrawal 2
- Frequency of adverse effects does not increase with dose escalation from 5-20 mg 3