From the FDA Drug Label
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 In single-dose studies in patients with non-anuric renal failure, high doses of torsemide (20 mg to 200 mg) caused marked increases in water and sodium excretion. In patients with non-anuric renal failure, severe enough to require hemodialysis, chronic treatment with up to 200 mg of daily torsemide has not been shown to change steady-state fluid retention
The recommended initial dose of torsemide in renal patients is 20 mg once daily, and it can be titrated upward by approximately doubling until the desired diuretic response is obtained, with a maximum dose of 200 mg. 1 1
From the Research
Torsemide dosing in renal patients typically does not require adjustment, which is an advantage over some other loop diuretics, with a standard starting dose of 10-20 mg once daily, which can be titrated up to 200 mg daily if needed based on clinical response, as supported by the most recent study 2. The pharmacokinetics of torsemide are not significantly affected by renal impairment, making it a suitable option for patients with chronic kidney disease (CKD) or acute kidney injury (AKI) 3, 4, 5. Some key points to consider when using torsemide in renal patients include:
- Higher and more consistent oral bioavailability (approximately 80-100%) compared to furosemide 3, 4
- Primarily metabolized by the liver (approximately 80%), with only about 20% excreted unchanged by the kidneys 3, 5
- Can be administered after dialysis sessions without dose adjustment for patients on hemodialysis 4
- When transitioning from furosemide to torsemide, a ratio of approximately 2-2.5:1 (furosemide:torsemide) is often used, meaning 40 mg of furosemide is roughly equivalent to 20 mg of torsemide 4
- Patients should be monitored for electrolyte imbalances, particularly hypokalemia and hypomagnesemia, as well as for signs of dehydration or worsening renal function, regardless of the initial dosing strategy 3, 4, 5, 2. It is essential to note that the most recent study 2 provides the most up-to-date information on the use of torsemide in patients with CKD, and its findings should be prioritized when making clinical decisions.