Torsemide (Torsemide (Torasemide))
Also sold as: Dytor, Torsemide Sun, Torsamide, Torvol
Pregnancy
Cat B
Lactation
Unknown
Schedule
H
Forms
Tablet (5mg, 10mg, 20mg, 40mg, 100mg) +1
Indications
- Oedema in congestive heart failure (acute and chronic)
- Oedema in hepatic cirrhosis
- Oedema in renal disease (nephrotic syndrome, chronic kidney disease)
- Hypertension (add-on)
- Pulmonary oedema (IV)
- Resistant oedema not responding to furosemide
Adult Dosing
Heart failure oedema
10–20mg once daily (start); titrate to 40mg OD if inadequate response
Ongoing; maximum 200mg/day for resistant heart failure oedema
Superior to furosemide in consistency of effect due to higher oral bioavailability (80% vs 50%) and longer duration (6–8h vs 4–6h); once-daily dosing preferred in heart failure
Hepatic cirrhosis oedema / ascites
5–10mg once daily (hepatic — start low)
Titrate cautiously; maximum 40mg/day
Less studied than furosemide for cirrhotic ascites; lower protein binding displacement than furosemide in hypoalbuminaemia
Renal oedema (nephrotic syndrome, CKD)
20–200mg/day
Once daily; titrate based on response
More predictable absorption than furosemide in nephrotic syndrome (less affected by hypoalbuminaemia in the tubular lumen)
Hypertension
5–10mg once daily
Ongoing; may increase to 10mg if inadequate response after 4–6 weeks
As effective as HCTZ for blood pressure reduction; use when GFR <30 (unlike thiazides)
Pulmonary oedema (acute)
10–20mg IV stat
Repeat if inadequate response after 30–60 min; maximum 100–200mg
IV and oral bioequivalent in torsemide — oral preferred if gut perfusion adequate
Pediatric Dosing
Very limited pharmacokinetic data in children; furosemide preferred in paediatric practice due to established dosing; use torsemide only when furosemide inadequate
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl 30–60 mL/min | Standard dose; may require dose escalation (20–40mg) for adequate response |
| CrCl <30 mL/min | Increase dose progressively (40–200mg/day); torsemide retains activity better than furosemide at low GFR; monitor response and electrolytes |
| Dialysis | Limited efficacy in anuric patients; dose reduction not required but benefit minimal |
Hepatic Adjustment
Torsemide undergoes significant hepatic metabolism (CYP2C9 — ~80% hepatic); in severe hepatic impairment, clearance is reduced and half-life prolonged; start low (5mg) and titrate cautiously; monitor for electrolyte disturbance
Pregnancy & Lactation
Pregnancy: Category B
Animal studies showed no harm; limited human data. Use only when clearly needed (preferred over furosemide when loop diuretic is essential in pregnancy). Avoid for gestational hypertension — may reduce placental perfusion.
Lactation: Unknown
No adequate human data on excretion in breast milk. Exercise caution; consider furosemide (more data available) as alternative during breastfeeding.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Aminoglycosides (gentamicin, amikacin) | Additive ototoxicity — loop diuretic + aminoglycoside combination is high risk for irreversible sensorineural hearing loss; avoid concurrent use; if unavoidable, minimise dose and duration | Major |
| Lithium | Reduces renal lithium clearance; increases lithium plasma levels and toxicity risk; monitor lithium levels; adjust dose | Major |
| NSAIDs | Blunt diuretic and antihypertensive effect; increased risk of acute kidney injury; avoid combination | Moderate |
| Digoxin | Torsemide-induced hypokalemia and hypomagnesaemia enhance digoxin toxicity; monitor electrolytes and digoxin levels | Moderate |
| Corticosteroids (prednisolone, dexamethasone) | Additive potassium loss; hypokalemia risk increased; supplement potassium or add spironolactone | Moderate |
| Probenecid | Reduces tubular secretion of torsemide, blunting diuretic response; avoid combination | Minor |
| CYP2C9 inhibitors (fluconazole, amiodarone) | Reduce torsemide clearance; increase plasma levels and risk of toxicity; monitor for excessive diuresis and electrolyte disturbance | Moderate |
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Side Effects
Common
- Hypokalemia (less frequent than equivalent furosemide doses)
- Hyponatraemia
- Dehydration and excessive thirst
- Dizziness and headache
- Increased urination
- Nausea
- Muscle cramps
- Hyperuricemia
Serious / Discontinue If
- Ototoxicity (less risk than furosemide at equivalent doses, but still possible — especially with aminoglycoside co-administration)
- Severe hypokalemia and hyponatraemia
- Volume depletion and prerenal acute kidney injury
- Metabolic alkalosis
- Severe hypotension
- Thrombocytopenia (rare)
Contraindications
- Anuria
- Severe dehydration or hypovolaemia
- Hypersensitivity to torsemide or sulphonylureas (cross-reactivity — note: different from sulphonamide hypersensitivity)
- Hepatic coma
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Dytor 10mg | Cipla | ₹48/10 tab |
| Torsemide Sun 10mg | Sun Pharma | ₹38/10 tab |
| Torvol 10mg | Zydus Cadila | ₹42/10 tab |
Monitoring Required
- Serum electrolytes (sodium, potassium, magnesium) — baseline, then every 2–4 weeks initially
- Renal function (creatinine, BUN)
- Blood pressure — including postural measurements
- Daily weight in heart failure (target 0.5–1kg/day loss in acute decompensation)
- Urine output
- Hearing (with aminoglycoside co-administration)
- Blood glucose in diabetics
- Serum uric acid in gout-prone patients
Patient Counseling Points
- Take torsemide in the morning — it starts working within 1 hour and effects last 6–8 hours.
- Weigh yourself every morning at the same time; report weight gain of >1.5kg in 2 days to your doctor.
- You may urinate more frequently in the morning after taking this medicine — this is expected.
- Eat potassium-rich foods: bananas, coconut water, lentils, tomatoes, potatoes. Take prescribed potassium supplements as directed.
- Rise slowly from bed or chair to prevent dizziness — postural hypotension is possible.
- Report muscle cramps, severe weakness, palpitations, or ringing in the ears promptly.
- NSAIDs like ibuprofen and diclofenac reduce the effect of this medicine and can harm your kidneys — avoid unless approved by your doctor.
- Unlike furosemide, torsemide is more predictably absorbed — so the response is more consistent day-to-day.
- Do not stop this medicine without consulting your doctor.
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Clinically reviewed by: Dr. Arjun Kapoor, MD (Medicine), DM (Cardiology), Fortis Escorts Heart Institute New Delhi
Last reviewed: 2026-04-08
References
- Vargo DL et al. Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide and furosemide. Clin Pharmacol Ther 1995;57:601–609.
- Felker GM et al. Diuretic Strategies in Patients with Acute Decompensated Heart Failure (DOSE trial). NEJM 2011;364(9):797–805.
- BNF 86 (2024). Torsemide monograph.
- CIMS India Drug Reference 2024. Torsemide monograph.
- Brater DC. Pharmacology of diuretics. Am J Med Sci 2000;319(1):38–50.
- Murray MD, Deer MM. Open-label randomised trial of torsemide vs furosemide in heart failure. Am J Med 2001.