Adults

For edema: Initial dose 10-20 mg once daily. May be increased up to 200 mg once daily if needed. For hypertension: Initial dose 5 mg once daily. May be increased to 10 mg once daily after 4-6 weeks if blood pressure is not adequately controlled.

Elderly

Start with lower doses and titrate carefully, monitoring for dehydration and electrolyte imbalances.

Renal_impairment

No initial dose adjustment required in mild to moderate renal impairment, but monitor closely. Higher doses may be required for diuresis in severe renal failure.

Onset

Diuretic effect typically begins within 1 hour.

Excretion

Approximately 80% is excreted in the urine as metabolites and about 20% as unchanged drug.

Half life

Approximately 3.5 hours in healthy individuals; can be longer in patients with hepatic or renal impairment.

Absorption

Rapidly absorbed from the gastrointestinal tract; bioavailability is approximately 80-90%. Peak plasma concentrations are achieved within 1 hour.

Metabolism

Primarily metabolized in the liver by the cytochrome P450 system (CYP2C9) to inactive metabolites.

Digoxin

Increased risk of digitalis toxicity due to hypokalemia caused by Torsemide.

Lithium

Reduced renal clearance of lithium, leading to increased lithium levels and toxicity.

Cisplatin

Increased risk of ototoxicity.

Other antihypertensives

Additive hypotensive effects, potentially leading to excessive blood pressure reduction.

NSAIDs (e.g., ibuprofen, indomethacin)

May reduce the diuretic and antihypertensive effects of Torsemide.

Aminoglycoside antibiotics (e.g., gentamicin)

Increased risk of ototoxicity and nephrotoxicity.