Torem

Torem - Use | Dosage | Side Effects

Torem is a medicine that contains the active substance called torasemide. It belongs to a group of medicines called loop diuretics. It works by causing natriuresis and diuresis (increased sodium excretion in the urine), which lowers blood pressure.1 It has a much stronger effect than furosemide, but leads to a much smaller loss of potassium and calcium than furosemide. It is used in the treatment of mild to moderate hypertension and of oedematous conditions caused by liver cirrhosis or congestive heart failure.

Precautions

Torem can cause hearing loss which is usually reversible adverse effect, meaning that hearing quickly returns after the discontinuation of therapy. However, if you notice that something is wrong with your hearing, contact your physician immediately. Concomitant use with other drugs which are also ototoxic (e.g. gentamicin) increases the risk of hearing loss.

Torem can also cause hypokalemia, which is much less frequent than with furosemide treatment. If you are experiencing symptoms, such as: muscle cramps, nausea, dizziness, hallucinations, palpitations or arrhythmia, contact your physician immediately. Hypokalemia can significantly change the way in which the heart works which can be dangerous for your health! The risk of hypokalemia is significantly higher in patients with poor nutrition or in patients taking laxatives. Patients who receive insulin also have an increased risk of hypokalemia.

Torem can increase the level of uric acid in the blood2, which is the reason why it is not recommended in patients with gout.

Patients with diabetes must carefully apply Torem, because it can affect blood glucose levels.

Torem and its use during pregnancy and lactation

Torem belongs to the group B, according to the FDA classification. This means that it is probably safe for application during pregnancy because animal studies have shown that it is safe for use during pregnancy, but there is not enough data on its safety during human pregnancy.

It is excreted into breast milk, so breastfeeding should be avoided while taking this medicine.

How to use

Recommended dosage for adult patients is given in the table below:

Indication Dosage
Edema caused by liver cirrhosis 5-10 mg once daily, administered orally or intravenously
Edema caused by renal insufficiency 20 mg once a day, administered orally or intravenously
Edema caused by heart failure 10-20 mg once a day, administered orally or intravenously
Hypertension 2.5-5 mg once a day orally. Doses greater than 5 mg are not recommended for the treatment of hypertension.

Doses above 80 mg/day are not recommended for the treatment of edema.

The tablet is best taken in the morning, because you will need to urinate more frequently while taking this drug. If you take this drug at night, you'll probably have to wake up frequently during the night because of the urge to urinate.

Interactions

Torem should not be used in combination with other medicines that can damage your hearing (e.g. antibiotics such as aminoglycosides and cephalosporins).

If used in combination with the following drugs, Torem may cause serious arrhythmia:

  • Dolasetron (a drug used for the treatment of chemotherapy-induced nausea)
  • Amiodarone and dronedarone (antiarrhythmics)
  • Droperidol (antipsychotic)

Adverse effects

Torem is associated with the following adverse effects:

  • Hallucinations
  • Depression
  • Confusion
  • Mood swings
  • Nervousness
  • Muscle cramps
  • Weakness
  • Fainting
  • Arrhythmias
  • Blurred vision
  • Hearing impairment
  • Dry mouth
  • Paraesthesia
  • Frequent urination
  • Palpitations
  • Arthralgia
  • Steven-Johnson syndrome

References

  1. NCBI link 1
  2. NCBI link 2