Jun 22, 2014 provides accurate and independent information on more than 24,000 prescription drugs, overthecounter medicines and natural products. Asneeded dosing of loop diuretics may help patients control their volume status while minimising. Torsemide and bumetanide are 10100x more expensive. The effectiveness of switching furosemide to torsemide versus optimizing the furosemide dose following adhf has not yet been evaluated. Torsemide versus furosemide in patients with acute heart failure. Approximately 50% of heart failure patients are readmitted to hospital within 6 months, owing to deterioration of their condition. However, its important to remember the specific site of action for your board exams, that is the.
Torsemide and furosemide work the same way and most guidelines do not recommend one drug over the other. Weight loss was also significantly greater in the 20 mg torsemide group vs the 40 mg furosemide group at weeks 4 and. The aim of this study is to compare the effects of torasemide and furosemide on biochemical parameters of haemodynamic and neurohormonal. Torsemide is an effective diuretic for many patients with renal impairment. Evidencebased treatment strategies in acute kidney injury. This drug is given by mouth and can be taken with food or milk.
Torsemide may be less effective in these patients and delayed excretion of drug may increase the risk of toxicity. Torsemide use was associated with significant improvement in nyha functional class by at least 1 grade compared with furosemide use based on 2 trials 45. Common side effects include headache, increased urination, diarrhea, cough. The physiologic effect of furosemide is by means of increased. Demadex torsemide dosing, indications, interactions. This retrospective observational study aimed to assess the impact of switching furosemide to torsemide. Review drug interactions, dosing, and pregnancy and breastfeeding safety information. Furosemide is widely used to treat hypertension and edema. However, torsemide longterm effects and complications have not been sufficiently investigated. Should torsemide be the loop diuretic of choice in systolic heart failure. This site is not an online pharmacy and does not conduct remote and other trade in medicines and other products. Comparison of the urine acidification tests of torsemide vs.
Pdf torsemide versus furosemide in heart failure patients. Torsemide vs furosemide open label rct of 234 hospitalized patients with adhf, for one year. A reappraisal of loop diuretic choice in heart failure. Sep 28, 2017 heart failure need not be the reason for hospitalization. In this setting, drug dissolution characteristics can assume added significance. Diuretics furosemide lasix, bumetanide bumex, torsemide. The chi square test was used to compare categorical variables between the two groups optimized furosemide vs.
The loop diuretic torsemide has several characteristics that make it suitable for treatment of advanced heart failure including longer halflife, increased potency of diuretic action, and antialdosterone effects. Torsemide and bumetanide as firstline treatment have limited evidence for superiority than furosemide in fluid overload 9,10. This drug is also used to treat high blood pressure. This can lessen symptoms such as shortness of breath and swelling in your arms, legs, and abdomen. The novel use of intravenous pimobendan and oral torasemide in a cat with congestive heart failure secondary to endstage hypertrophic cardiomyopathy. Torsemide is a loop affecting water pilldiuretic which is a kind of water pill or diuretic heart failure drug, cardiovascular drug. It is most frequently used in patients who are fluid overloaded such as in congestive heart failure. Both are diuretics, but they work in very different ways. Comparison of longterm outcomes of torasemide vs furosemide in heart failure patients.
Furosemide versus torsemide is there a difference med. Torasemide, also known as torsemide, is a medication used to treat fluid overload due to heart failure, kidney disease, and liver disease and high blood pressure. Although the t 12 of furosemide is short, its duration of action is longer when administered orally, as its gastrointestinal absorption may be slower than its elimination t 12. Therefore, careful medical supervision is required and dose and dose schedule must be adjusted to the individual patients needs. Torsemide use began to increase in 2006 and rose to approximately 30%.
The effects of longterm therapy 70 days with torasemide 20 mgday, a new loop diuretic, were compared with those of furosemide 50 mgday in a. Shah et al metaanalysed the mortality of torasemide versus furosemide in hf patients and concluded no difference. Compare lasix vs torsemide comprehensive analysis by. However, torsemide did not provide significant benefits in reducing mortality or rehospitalization rates for hf or cvd compared with furosemide. Call your doctor right away if you have hearing problems like hearing loss. Chicago, ilin patients with acute heart failure hf, torsemide may be a better option than furosemide, and according to data from a posthoc analysis of the ascendhf trial presented here at the 2014 scientific sessions of the american heart association, significantly reduced 180day mortality in these patients when compared with furosemide. Torsemide group had lower adhf readmission rates 17% vs 32% shorter duration of hospital stay 106 vs 296 d. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Furosemide has an oral bioavailability of around 60%. Clinical pharmacology in diuretic use american society. Furosemide is a potent diuretic which increases dramatically urine output in most patients.
Where medication efficacy and safety collide wendy l. We used the duke echocardiography lab database to investigate patients admitted with heart failure to duke hospital from 2000 to 2010 who were discharged on either torsemide or furosemide. The data were extracted by 2 investigators mf, ms and confirmed by a third investigator ba. Loop diuretic conversion equivalent doses furosemide. Torsemide injection should be administered either slowly as a bolus over a period of 2 minutes or administered as a continuous infusion. Should torsemide be loop diuretic of choice in systolic hf. Torsemide is thought to be slightly more potent on a per milligram basis than furosemide, but this isnt thought to be evidence for better outcomes in treating patients. Capitals indicate lifethreatening, underlines indicate most frequent. Patients with acute decompensated heart failure received intravenous furosemide at either a low or a high dose and either boluses every 12 hours or continuous infusion. Combination of loop diuretics with thiazidetype diuretics. It is taken by mouth or by injection into a vein common side effects include headache, increased urination, diarrhea, cough, and dizziness. Furosemide has historically been the primary loop diuretic in heart failure patients despite data suggesting potential advantages with torsemide. Pdf on sep 1, 2018, priyank shah and others published torsemide versus furosemide in heart failure patients.
Torsemide versus furosemide after acute decompensated. The oral bioavailability of bumetanide and torsemide typically exceeds 80%, whereas that of furosemide is substantially lower, at approximately 50% see table 2. In residency i had to keep medicaidself pay patients in the hospital for up to an extra week while we waited for approval for bumex and demadex scripts. Furosemide lasix, bumetanide bumex, torsemide demadex, chlorothiazide diuril, hydrochlorothiazide hctz use. Doctors give trusted answers on uses, effects, sideeffects, and cautions. Change to torsemide or add a thiazidetype diuretic torsemide is more bioavailable than furosemide and the pt may have built a tolerance to furosemide a thiazide diuretic will augment the diuresis of the loop diuretic keep an eye on renal function and k replace if needed.
Our metaanalysis showed that torsemide is associated with statistically significant improvement in nyha functional class for patients with hf compared with furosemide. With a sample size of 4,580 patients, this is largest analysis to date comparing torsemide to furosemide use in the hf population. P5281comparison of longterm outcomes of torasemide vs. Its chemical 8 name is 1isopropyl34mtoluidino3pyridyl sulfonyl urea and its structural formula 9 is. Comparison of the urine acidification tests of torsemide vs furosemide in healthy volunteers. Heart failure need not be the reason for hospitalization. Lasix furosemide will cause the body to excrete potassium while spironolactone will cause the body to retain potassium. If torsemide is administered through an iv line, it is recommended that, as with other iv injections, the iv line be flushed with normal saline sodium chloride injection before and after administration.
Torsemide is a new loop diuretic that has shown, in shortterm studies, to induce a longer and higher diuretic and natriuretic action than frusemide. The chance may be higher if you have kidney problems or if you take high doses of torsemide. Furosemide is a weak organic acid, cleared mainly by the kidneys, half of which is actively secreted in an unchanged form by organic acid transporters in the proximal tubule. As a service to our customers we are providing this early version of the manuscript. Use of the loop diuretic torsemide in three dogs with. Metaanalysis comparing torsemide versus furosemide in.
Side effects can include headache, diarrhea, runny nose, dizziness, and cough. Diuretics are used to lower blood pressure or decrease swelling edema. Diuretic strategies in patients with acute decompensated. Longterm efficacy of torsemide compared with frusemide in. Torsemide use began to increase in 2006 and rose to approximately 30% of loop diuretic use in 2010. Metaanalysis comparing torsemide versus furosemide in patients. Hearing loss has rarely happened in people taking torsemide. The aim was to compare the efficacy and safety of torsemide versus frusemide in cirrhotic patients with uncomplicated. You may not have noticed but the majority of endstage heart failure patients arent generally the ones with good insurance coverage. The specific loop diuretic dose will be at the discretion of the treating physician with the above noted conversion. Torsemide treats fluid retention edema in people with congestive heart failure, liver disease, or a kidney disorder such as nephrotic syndrome.
Torsemide is a potent loop diuretic with better pharmacokinetic and pharmacodynamic profiles compared with furosemide. It is a less preferred treatment for high blood pressure. Furosemide is the most widely prescribed loop diuretic in the setting of systolic heart failure hf, yet torsemide has been shown to have less inter and intraindividual variation in. Torsemide is an anilinopyridine sulfonylurea belonging to the class of loop diuretics. Furosemide is the loop diuretic with the widest intra. Concomitant use of nonsteroidal antiinflammatory drugs nsaids and torsemide has been associated with the development of acute renal failure.
Furosemide is a sulfamoylanthranilic acid derivative, also known as frusemide, and potent loop diuretic. This retrospective observational study aimed to assess the impact of switching furosemide to torsemide versus optimizing the furosemide dose. Decline in diuresis was significantly slower after torsemide vs furosemide p torsemide caused a larger. Combination of loop diuretics with thiazidetype diuretics in heart failure jacob c. The most common loop diuretics used clinically are furosemide, bumetanide and torsemide. Learn about drug interactions between bumetanide oral and torsemide oral and use the rxlist drug interaction checker to check drug combinations.
If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. Loop diuretic conversion dose equivalents bumex bumetanide 1 mg po demadex torsemide 20 mg po lasix furosemide 40 mg po lasix furosemide 20 mg iv loop diuretics are given their name due to the site of action being the loop of henle. A small randomized trial of torsemide versus furosemide in patients with renal failure found that the diuretics had similar effects on fluid and sodium excretion but torsemide led to less reninangiotensinaldosterone system activation. The aim was to compare the effects of torasemide andfurosemide on clinical outcomes in hf patients. Feb 28, 2017 because torsemide and salicylates compete for secretion by renal tubules, patients receiving high doses of salicylates may experience salicylate toxicity when torsemide is concomitantly administered.
Are lasix and bumetanide safe to use while pregnant or breastfeeding. The half life of furosemide is 23 hrs while that of torsemide is 46 hrs. Drugs az pill identifier supplements symptom checker diseases dictionary media. Lasix furosemide is a potent diuretic which, if given in excessive amounts, can lead to a profound diuresis with water and electrolyte depletion. Compare lasix vs torsemide comprehensive analysis by treato. This agent is highly bound to albumin and is largely excreted unchanged in the urine.
There is little guidance on which loop diuretic to choose, but moderate strength evidence suggests torsemide may have advantages over furosemide, including higher potency, longer duration of action, and possibly improved symptomatic improvement. Torsemide may best furosemide in acute hf patients, but more. A sulfa moiety containing loop diuretics torsemide, bumetanide and furosemide have chances of sulfonamide allergies, in such conditions, ethacrynic acid is used to maintain fluid overload 11,12. Based on their bioequivalency data, one would predict that each 40 mg dose of furosemide was much less potent than each 40 mg dose of torsemide. Torsemide is a loop diuretic water pill that prevents your body from absorbing too much salt, allowing the salt to instead be passed in your urine. Implement fallprevention strategies, especially in older adults or if patient exhibits sedation, dizziness, blurred vision, or other impairments that affect gait and balance see appendix e use caution during aerobic exercise, especially in hot environments. These diuretics are sometimes given together, but they are not.
Furosemide is eliminated from the body, primarily through excretion in the urine. Drug absorption in the management of congestive heart. Potassium, sodium and magnesium can be lost in excess with the use of furosemide and must be closely monitored. Comparing furosemide to torsemide pharmacistanswers. This case report details the administration of torsemide in 3 dogs with advanced heart failure and apparent furosemide resistance. We investigated patients with hf in acute study of clinical effectiveness of nesiritide in decompensated heart failure who were discharged on either torsemide or furosemide. Loop diuretics are recommended by clinical practice guidelines to treat volume overload in acute decompensated heart failure adhf. Furthermore, data are not available for this cohort regarding whether or not there was equivalent dosing in torsemide vs. All issues related to the purchase of medicines and other products must be solved with the pharmacy in which you are ready to purchase the drug. This does allow for a little easier conversion as torsemide is closer to a 1. Comparison of longterm outcomes of torasemide vs furosemide in. Furosemide is the most commonly used loop diuretic in patients with heart failure hf despite data suggesting potential pharmacologic and antifibrotic benefits with torsemide.
Call your doctor if you gain more than 2 lbs 1 kg in two days or 5 lbs 2. Lasix furosemide is a very effective water pill and itll certainly make you go to the bathroom more often. Warning lasix furosemide is a potent diuretic which, if. Figure 1 presents the percentage of hf patients discharged on furosemide vs. Oral dosing of torsemide compared to furosemide will be 1mg. Studies comparing torsemide and furosemide have shown conflicting results. Thus, symptomatic treatment of heart failure requires significant improvement. Torsemide versus furosemide in patients with acute heart. Furosemide is used to reduce extra fluid in the body edema caused by conditions such as heart failure, liver disease, and kidney disease. Chronic heart failure, edema and high blood pressure.
This is a pdf file of an unedited manuscript that has been accepted for publication. Torsemide versus furosemide after acute decompensated heart. Compared with furosemide, torsemide has increased bioavailability and a longer halflife, yet furosemide remains the most commonly used loop diuretic. Torsemide versus furosemide after continuous renal. Lasix furosemide and demadex torsemide are diuretics water pills used to treat excessive fluid accumulation edema caused by congestive heart failure, liver failure, renal failure, and nephritic syndrome. Comparative effectiveness of torasemide versus furosemide in. Renal impairment may reduce clearance and warrant the use of higher doses with extended dosing intervals. Loop diuretic po iv conversions furosemide 40 mg po. Furosemide oral sliding scale in heart failure hf sample dosing ideas for managing otherwise stable hf patients 1,2,3. Torsemide has a prolonged duration of action compared to other loop diuretics, is extensively protein bound in plasma and has a relatively long halflife. Loop diuretics including furosemide and torsemide are prescribed for the. Torsemide demadex is a diuretic water pill used to treat edema due to kidney disease, liver disease, and congestive heart failure. Compare furosemide vs lasix headtohead with other drugs for uses, ratings, cost, side effects, interactions and more.