Torasemide interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

  What to do: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

  8 sources

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595

Conditions

Conditions in which Torasemide needs care, as documented in this source.

• Anuria

  Major

  The use of loop diuretics is contraindicated in patients with anuria.

  4 sources

  1. "Product Information. Bumex (bumetanide)." Roche Laboratories (2002):
  2. "Product Information. Lasix (furosemide)." sanofi-aventis (2007):
  3. "Product Information. Demadex (torsemide)." Boehringer Mannheim
  4. "Product Information. Edecrin (ethacrynic acid)." Merck & Co., Inc (2001):

• Fibrosis

  Major

  Loop diuretic therapy should be initiated in the hospital under strict observation in patients with liver cirrhosis and ascites. Sudden alteration of fluid and electrolyte balance may precipitate hepatic encephalopathy and coma in such patients, who are also at increased risk for the development of hypokalemia. Supplemental potassium and/or concomitant use of an aldosterone antagonist or potassium-sparing agent may help prevent hypokalemia and metabolic alkalosis. Loop diuretics should be withheld in patients with hepatic coma until the condition improves.

  8 sources

  1. Ring-Larsen H "Bumetanide in the treatment of hepatic ascites. A short and long-term study." Acta Med Scand 195 (1974): 411-4
  2. "Product Information. Bumex (bumetanide)." Roche Laboratories (2002):
  3. "Product Information. Lasix (furosemide)." sanofi-aventis (2007):
  4. "Product Information. Demadex (torsemide)." Boehringer Mannheim
  5. Schwartz FD, Pillay VK, Kark RM "Ethacrynic acid: its usefulness and untoward effects." Am Heart J 79 (1970): 427-8
  6. Lieberman FL, Reynolds TB "The use of ethacrynic acid in patients with cirrhosis and ascites." Gastroenterology 49 (1965): 531-8
  7. "Product Information. Edecrin (ethacrynic acid)." Merck & Co., Inc (2001):
  8. Knauf H, Mutschler E "Liver cirrhosis with ascites: pathogenesis of resistance to diuretics and long-term efficacy and safety of torasemide." Cardiology 84 (1994): 87-98

• Kidney Diseases

  Major

  Impaired effectiveness and possible delayed excretion of loop diuretics may occur in patients with severe renal dysfunction. These individuals may require high dosages that are associated with an increased risk of electrolyte abnormalities (hyponatremia, hypochloremic alkalosis, hypokalemia, hypomagnesemia, hypocalcemia) and ototoxicity (tinnitus, hearing loss). Therapy with loop diuretics should be administered cautiously in patients with significantly impaired renal function. Prolongation of the dosing intervals may be appropriate to prevent drug accumulation. The patient should be monitored closely for the signs and symptoms of fluid or electrolyte imbalance, including dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, arrhythmia, or gastrointestinal disturbances such as nausea and vomiting. Excessive diuresis should be avoided as it may induce dehydration and hypovolemia, which can result in an abrupt reduction in glomerular filtration and renal blood flow. If increasing azotemia and oliguria occur during treatment of severe progressive renal disease, or if renal function becomes progressively worse as indicated by rising BUN or serum creatinine levels, an interruption or discontinuation of therapy should be considered.

  28 sources

  1. Huang CM, Atkinson AJ, Levin M, et al. "Pharmacokinetics of furosemide in advanced renal failure." Clin Pharmacol Ther 16 (1974): 659-66
  2. Cutler RE, Forrey AW, Christopher TG, Kimpel BM "Pharmacokinetics of furosemide in normal subjects and functionally anephric patients." Clin Pharmacol Ther 15 (1974): 588-96
  3. Rose HJ, O'Malley K, Pruitt AW "Depression of renal clearance of furosemide in man by azotemia." Clin Pharmacol Ther 21 (1976): 141-6
  4. Beermann B, Dalen E, Lindstrom B "Elimination of furosemide in healthy subjects and in those with renal failure." Clin Pharmacol Ther 22 (1977): 70-8
  5. Tilstone WJ, Fine A "Furosemide kinetics in renal failure." Clin Pharmacol Ther 23 (1978): 644-50
  6. Rane A, Villeneuve JP, Stone WJ, et al. "Plasma binding and disposition of furosemide in the nephrotic syndrome and in uremia." Clin Pharmacol Ther 24 (1978): 199-207
  7. Andreasen F, Hansen HE, Mikkelsen E "Pharmacokinetics of furosemide in anephric patients and in normal subjects." Eur J Clin Pharmacol 13 (1978): 41-8
  8. Keller E, Hoppe-Seyler G, Mumm R, Schollmeyer P "Influence of hepatic cirrhosis and end-stage renal disease on pharmacokinetics and pharmacodynamics of furosemide." Eur J Clin Pharmacol 20 (1981): 27-33

  Show all 28 sourcesShow fewer sources

  9. Donatucci CF, Deshon GE, Wade CE, Hunt M "Furosemide-induced disturbances of renal function in patients undergoing TURP." Urology 35 (1990): 295-300
  10. Keller E, Hoppe-Seyler G, Schollmeyer P "Disposition and diuretic effect of furosemide in the nephrotic syndrome." Clin Pharmacol Ther 32 (1982): 442-9
  11. Ward A, Heel RC "Bumetanide: a review of its pharmacodynamic and pharmacokinetic properties and therapeutic use." Drugs 28 (1984): 426-64
  12. Menday AP, Adnitt PI, Underwood PN "Effect of long-term treatment with bumetanide/amiloride on electrolytes and renal function in elderly patients with heart failure." Curr Ther Res Clin Exp 50 (1991): 57-64
  13. Pentikainen PJ, Pasternack A, Lampainen E, Neuvonen PJ, Penttila A "Bumetanide kinetics in renal failure." Clin Pharmacol Ther 37 (1985): 582-8
  14. Marcantonio LA, Auld WH, Murdoch WR, Purohit R, Skellern GG, Howes CA "The pharmacokinetics and pharmacodynamics of the diuretic bumetanide in hepatic and renal disease." Br J Clin Pharmacol 15 (1983): 245-52
  15. Berg KJ, Tromsdal A, Wideroe TE "Diuretic action of bumetanide in advanced chronic renal insufficiency." Eur J Clin Pharmacol 9 (1976): 265-75
  16. Lowenthal DT, Dickerman D "The use of diuretics in varying degrees of renal impairment: an overview." Clin Exp Hypertens A 5 (1983): 297-307
  17. "Product Information. Bumex (bumetanide)." Roche Laboratories (2002):
  18. "Product Information. Lasix (furosemide)." sanofi-aventis (2007):
  19. "Product Information. Demadex (torsemide)." Boehringer Mannheim
  20. Matz GJ, Naunton RF "Ototoxic drugs and poor renal function." JAMA 206 (1968): 2119
  21. Pillay VK, Schwartz FD, Aimi K, Kark RM "Transient and permanent deafness following treatment with ethacrynic acid in renal failure." Lancet 1 (1969): 77-9
  22. Kaye M, Dufresne L, McDade D "Ethacrynic acid in acute renal failure." Lancet 1 (1968): 1255
  23. Sullivan RC, Freemon FR, Caranasos GJ "Complications from diuretic therapy with ethacrynic acid and furosemide." South Med J 64 (1971): 869-72
  24. Plumb VJ, James TN "Clinical hazards of powerful diuretics. Furosemide and ethacrynic acid." Mod Concepts Cardiovasc Dis 47 (1978): 91-4
  25. White SJ, Williamson K "What to watch for when you give loop diuretics." RN 42 (1979): 25-7
  26. "Product Information. Edecrin (ethacrynic acid)." Merck & Co., Inc (2001):
  27. Risler T, Schwab A, Kramer B, Braun N, Erley C "Comparative pharmacokinetics and pharmacodynamics of loop diuretics in renal failure." Cardiology 84 (1994): 155-61
  28. Russo D, Minutolo R, Andreucci VE "Role of loop diuretics in chronic renal failure." Cardiology 84 (1994): 162-70

• Ototoxicity

  Major

  Tinnitus and hearing loss, both reversible and permanent, have been reported with the use of loop diuretics. Ototoxic effects have generally been associated with rapid intravenous or intramuscular injection, severe renal impairment, unusually high dosages (i.e. several times the usual recommended dosages), and/or concomitant use of other ototoxic agents. Therapy with loop diuretics should be administered cautiously in patients with preexisting vestibular and/or auditory impairment, since it may delay the recognition or confound the diagnosis of a drug-induced ototoxic effect. High-dose parenteral therapy should be administered as controlled infusion.

  40 sources

  1. "Product Information. Bumex (bumetanide)." Roche Laboratories (2002):
  2. "Product Information. Lasix (furosemide)." sanofi-aventis (2007):
  3. Vargish T, Benjamin R, Shenkman L "Deafness from furosemide." Ann Intern Med 72 (1970): 761
  4. Quick CA, Hoppe W "Permanent deafness associated with furosemide administration." Ann Otol Rhinol Laryngol 84 (1975): 94-101
  5. David D, Hitzig P "Diuretics and ototoxicity." N Engl J Med 284 (1971): 1328
  6. Heidland A, Wigand N "Influence of high doses of furosemide on hearing of uremic patients." Klin Wochenschr 48 (1970): 1052
  7. Lloyd-Mostyn R, Lord I "Ototoxicity of intravenous furosemide." Lancet 2 (1971): 1156
  8. Schwartz G "Ototoxicity induced by furosemide." N Engl J Med 282 (1970): 1413

  Show all 40 sourcesShow fewer sources

  9. Venkateswaran P "Transient deafness from high doses of furosemide." Br Med J 4 (1971): 113
  10. "Product Information. Demadex (torsemide)." Boehringer Mannheim
  11. Cooperman LB, Rubin IL "Toxicity of ethacrynic acid and furosemide." Am Heart J 85 (1973): 831-4
  12. Schwartz FD, Pillay VK, Kark RM "Ethacrynic acid: its usefulness and untoward effects." Am Heart J 79 (1970): 427-8
  13. Schneider WJ, Becker EL "Acute transient hearing loss after ethacrynic acid therapy." Arch Intern Med 117 (1966): 715-7
  14. Matz GJ, Beal DD, Krames L "Ototoxicity of ethacrynic acid. Demonstrated in a human temporal bone." Arch Otolaryngol 90 (1969): 152-5
  15. Rybak LP "Ototoxicity of ethacrynic acid (a persistent clinical problem)." J Laryngol Otol 102 (1988): 518-20
  16. Meriwether WD, Mangi RJ, Serpick AA "Deafness following standard intravenous dose of ethacrynic acid." JAMA 216 (1971): 795-8
  17. Merrill JP "Hazards of ethacrynic acid." JAMA 212 (1970): 159
  18. Chaffee WG Jr "Hazards of ethacrynic acid." JAMA 212 (1970): 159
  19. Matz GJ, Naunton RF "Ototoxic drugs and poor renal function." JAMA 206 (1968): 2119
  20. Pillay VK, Schwartz FD, Aimi K, Kark RM "Transient and permanent deafness following treatment with ethacrynic acid in renal failure." Lancet 1 (1969): 77-9
  21. Ng PS, Conley CE, Ing TS "Deafness after ethacrynic acid." Lancet 1 (1969): 673-4
  22. Matz GJ "The ototoxic effects of ethacrynic acid in man and animals." Laryngoscope 86 (1976): 1065-86
  23. Quick CA, Duvall AJ 3d "Early changes in the cochlear duct from ethacrynic acid: an electronmicroscopie evaluation." Laryngoscope 80 (1970): 954-65
  24. Hybels RL "Drug toxicity of the inner ear." Med Clin North Am 63 (1979): 309-19
  25. Gomolin IH, Garschick E "Ethacrynic acid-induced deafness accompanied by nystagmus." N Engl J Med 303 (1980): 702
  26. Homer MJ "Deafness after ethacrynic acid." N Engl J Med 285 (1971): 1152
  27. David DS, Hitzig P "Diuretics and ototoxicity." N Engl J Med 284 (1971): 1328-9
  28. Marlowe FI "Ototoxic agents." Otolaryngol Clin North Am 11 (1978): 791-800
  29. Rybak LP "Ototoxicity of loop diuretics." Otolaryngol Clin North Am 26 (1993): 829-44
  30. Sheffield PA, Turner JS Jr "Ototoxic drugs: a review of clinical aspects, histopathologic changes and mechanisms of action." South Med J 64 (1971): 359-63
  31. Arnold W, Nadol JB Jr, Weidauer H "Ultrastructural histopathology in a case of human ototoxicity due to loop diuretics." Acta Otolaryngol (Stockh) 91 (1981): 399-414
  32. Ballantyne J "Ototoxicity: a clinical review." Audiology 12 (1973): 325-36
  33. Beauchamp GD, Crouch TC "Deafness. Review of intravenous ethacrynic acid." J Kans Med Soc 76 (1975): 166-8,180
  34. Ajodhia JM, Dix MR "Drug-induced deafness and its treatment." Practitioner 216 (1976): 561-70
  35. Boston Collaborative Drug Surveillance Program "Drug-induced deafness." JAMA 224 (1973): 515-6
  36. "Product Information. Edecrin (ethacrynic acid)." Merck & Co., Inc (2001):
  37. Dunn CJ, Fitton A, Brogden RN "Torasemide: an update of its pharmacological properties and therapeutic efficacy." Drugs 49 (1995): 121-42
  38. Blose JS, Adams KF, Patterson JH "Torsemide: a pyridine-sulfonylurea loop diuretic." Ann Pharmacother 29 (1995): 396-402
  39. Fowler SF, Murray KM "Torsemide: a new loop diuretic." Am J Health Syst Pharm 52 (1995): 1771-80
  40. Fowler SF, Murray KM "Torsemide: a new loop diuretic." Am J Health Syst Pharm 52 (1995): 1771-80

• Water-Electrolyte Imbalance

  Major

  The use of loop diuretics, particularly at high dosages or during chronic therapy, is commonly associated with loss of electrolytes, including potassium, sodium, chloride, magnesium, and calcium. Potassium and magnesium depletion may lead to cardiac arrhythmias and cardiac arrest. Other electrolyte-related complications include metabolic alkalosis and hyponatremia, which are rarely life-threatening. Excessive diuresis, as indicated by rapid weight loss, may induce dehydration and hypovolemia, which can result in acute hypotension, orthostasis, circulatory collapse, vascular thrombosis and embolism, and abrupt reduction in glomerular filtration and renal blood flow. Severe dehydration is most likely to occur in the elderly and patients under prolonged sodium restriction. Therapy with loop diuretics should be administered cautiously in patients with or predisposed to fluid and electrolyte depletion, including patients with primary or secondary aldosteronism (may have low potassium levels); those with severe or prolonged diarrhea or vomiting; and those with poor nutritional status. Fluid and electrolyte abnormalities should be corrected before initiating therapy, and blood pressure as well as serum electrolyte concentrations monitored periodically and maintained at normal ranges during therapy. Patients should be advised to immediately report signs and symptoms of fluid or electrolyte imbalance, including dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, arrhythmia, or gastrointestinal disturbances such as nausea and vomiting. Digitalized patients and patients with a history of ventricular arrhythmias should be monitored carefully, since the development of hypokalemia may be particularly dangerous in these patients. The risk of hypokalemia may be minimized by slow diuresis, a lower diuretic dosage, potassium supplementation, or combined use with a potassium-sparing diuretic. Similarly, to prevent excessive dehydration and hyponatremia, sodium intake should be liberalized if clinically feasible.

  27 sources

  1. Tambyah JA, Lim MK "Effect of furesomide on calcium excretion." Br Med J 03/22/69 (1969): 751-2
  2. Roesner M "The loop diuretics: focus on furosemide and ethacrynic acid." N C Med J 47 (1986): 93-6
  3. Ponto LL, Schoenwald RD "Furosemide (frusemide): a pharmacokinetic/pharmacodynamic review." Clin Pharmacokinet 18 (1990): 381-408
  4. Ward A, Heel RC "Bumetanide: a review of its pharmacodynamic and pharmacokinetic properties and therapeutic use." Drugs 28 (1984): 426-64
  5. Menday AP, Adnitt PI, Underwood PN "Effect of long-term treatment with bumetanide/amiloride on electrolytes and renal function in elderly patients with heart failure." Curr Ther Res Clin Exp 50 (1991): 57-64
  6. Kubik MM, Bowers E, Underwood PN "Longterm experience of the routine use of bumetanide." Br J Clin Pract 30 (1976): 11-4
  7. "Product Information. Bumex (bumetanide)." Roche Laboratories (2002):
  8. "Product Information. Lasix (furosemide)." sanofi-aventis (2007):

  Show all 27 sourcesShow fewer sources

  9. "Product Information. Demadex (torsemide)." Boehringer Mannheim
  10. Schwartz AB "Diuretic-induced hypokalemia." Am Fam Physician 11 (1975): 101-4
  11. Cooperman LB, Rubin IL "Toxicity of ethacrynic acid and furosemide." Am Heart J 85 (1973): 831-4
  12. Schwartz FD, Pillay VK, Kark RM "Ethacrynic acid: its usefulness and untoward effects." Am Heart J 79 (1970): 427-8
  13. DeRubertis FR, Michelis MF, Beck N, Davis BB "Complications of diuretic therapy: severe alkalosis and syndrome resembling inappropriate secretion of antidiuretic hormone." Metabolism 19 (1970): 709-19
  14. Sullivan RC, Freemon FR, Caranasos GJ "Complications from diuretic therapy with ethacrynic acid and furosemide." South Med J 64 (1971): 869-72
  15. Plumb VJ, James TN "Clinical hazards of powerful diuretics. Furosemide and ethacrynic acid." Mod Concepts Cardiovasc Dis 47 (1978): 91-4
  16. Schmidt P, Friedman IS "Adverse effects of ethacrynic acid." N Y State J Med 67 (1967): 1438-42
  17. Martinez-Maldonado M "Electrolyte disturbances resulting from diuretic therapy." Tex Med 69 (1973): 83-7
  18. Gaillard R, Vallotton B, Muller F "Letter: Hypotension after angiotensin-II infusion and hypovolaemia induced by diuretic." Lancet 1 (1974): 1349
  19. White SJ, Williamson K "What to watch for when you give loop diuretics." RN 42 (1979): 25-7
  20. "Product Information. Edecrin (ethacrynic acid)." Merck & Co., Inc (2001):
  21. Patterson JH, Adams KF, Applefeld MM, Corder CN, Masse BR "Oral torsemide in patients with chronic congestive heart failure: effects on body weight, edema, and electrolyte excretion." Pharmacotherapy 14 (1994): 514-21
  22. Oberbauer R, Krivanek P, Turnheim K "Pharmacokinetics and pharmacodynamics of the diuretic bumetanide in the elderly." Clin Pharmacol Ther 57 (1995): 42-51
  23. Dunn CJ, Fitton A, Brogden RN "Torasemide: an update of its pharmacological properties and therapeutic efficacy." Drugs 49 (1995): 121-42
  24. Blose JS, Adams KF, Patterson JH "Torsemide: a pyridine-sulfonylurea loop diuretic." Ann Pharmacother 29 (1995): 396-402
  25. Fowler SF, Murray KM "Torsemide: a new loop diuretic." Am J Health Syst Pharm 52 (1995): 1771-80
  26. Fowler SF, Murray KM "Torsemide: a new loop diuretic." Am J Health Syst Pharm 52 (1995): 1771-80
  27. Palmer BF, Gates JR, Lader M "Causes and management of hyponatremia." Ann Pharmacother 37 (2003): 1694-702

• Diabetes Mellitus

  Moderate

  Loop diuretics may cause hyperglycemia, glycosuria, and alterations in glucose tolerance tests. Rarely, precipitation of diabetes mellitus has been reported. Therapy with loop diuretics should be administered cautiously in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Patients with diabetes mellitus should be monitored more closely during therapy, and their antidiabetic regimen adjusted accordingly.

  10 sources

  1. Chaudhuri ML, Catania J "A comparison of the effects of bumetanide (Burinex) and frusemide on carbohydrate metabolism in the elderly." Br J Clin Pract 42 (1988): 427-9
  2. Andersen OO, Persson I "Carbohydrate metabolism during treatment with chlorthalidone and ethacrynic acid." Br Med J 2 (1968): 798-801
  3. Gray GM "Drugs, malnutrition, and carbohydrate absorption." Am J Clin Nutr 26 (1973): 121-4
  4. "Product Information. Bumex (bumetanide)." Roche Laboratories (2002):
  5. "Product Information. Lasix (furosemide)." sanofi-aventis (2007):
  6. Dimitriadis G, Tegos C, Golfinopoulou L, Roboti C, Raptis S "Furosemide-induced hyperglycaemia - the implication of glycolytic kinases." Horm Metab Res 25 (1993): 557-9
  7. "Product Information. Demadex (torsemide)." Boehringer Mannheim
  8. Domenet JG "Diabetogenic effect of oral diuretics." Br Med J 3 (1968): 188

  Show all 10 sourcesShow fewer sources

  9. Coni NK, Gordon PW, Mukherjee AP, Read PR "The effect of frusemide and ethacrynic acid on carbohydrate metabolism." Age Ageing 3 (1974): 85-90
  10. "Product Information. Edecrin (ethacrynic acid)." Merck & Co., Inc (2001):

• Hyperuricemia

  Moderate

  Loop diuretics may decrease the rate of uric acid excretion. Hyperuricemia can occur but is usually asymptomatic and rarely leads to clinical gout except in patients with a history of gout or chronic renal failure. Therapy with loop diuretics should be administered cautiously in such patients.

  4 sources

  1. "Product Information. Bumex (bumetanide)." Roche Laboratories (2002):
  2. "Product Information. Lasix (furosemide)." sanofi-aventis (2007):
  3. "Product Information. Demadex (torsemide)." Boehringer Mannheim
  4. "Product Information. Edecrin (ethacrynic acid)." Merck & Co., Inc (2001):