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Loop diuretic Pregnancy: 'There is insufficient data from the use of torasemide in pregnant women. Studies in animals have shown reproductive toxicity. Torasemide should not be used during pregnancy, unless the clinical condition of the woman requires treatment with torasemide.' Breast-feeding: insufficient information on excretion in human milk; a risk to the suckling child cannot be excluded and loop diuretics may suppress lactation — a decision should be made whether to discontinue breast-feeding or torasemide.

Torasemide

Brand names: Torem

Torasemide is a loop diuretic used for oedema associated with heart failure, renal or hepatic disease, and for hypertension.

Adult dose

Dose: Oedema (oral tablets only — this source covers Torem 10 mg Tablets; it does not cover any intravenous torasemide preparation): usual dose 5 mg once daily, increased stepwise if necessary to 20 mg once daily
Route: oral
Frequency: once daily, taken in the morning; tablets swallowed with some fluid without chewing
Max: 20 mg once daily (in individual cases as much as 40 mg torasemide per day has been administered)
SCOPE: the page lists the route as PO/IV, but the only source in this bundle is the UK SPC for Torem 10 mg Tablets, an oral product. No dose is offered here for intravenous torasemide. VERBATIM UK SPC 4.2, Adults: 'Oedema: The usual dose is 5mg. once daily. If necessary, the dose can be increased stepwise up to 20mg once daily. In individual cases, as much as 40mg torasemide/day has been administered.' Elderly: 'No special dosage adjustments are necessary.' Hepatic impairment: 'As elimination half-lives of torasemide and its metabolites in patients with mild to moderate hepatic impairment are only slightly increased, dose adjustment in these patients is not required. Special caution is required for patients with hepatic cirrhosis and ascites. Extreme caution is required when torasemide is administered in patients with a history of hepatic encephalopathy.' Method of administration: 'Torasemide tablets are intended to be administered by oral route. Tablets must be swallowed with some fluid without chewing. For convenience, the tablets should be taken in the morning.' In patients with hepatic cirrhosis and ascites the SPC recommends diuresis be initiated in hospital. Concomitant use of an aldosterone antagonist or a potassium-sparing drug is recommended to prevent hypokalaemia and metabolic alkalosis. Some sections of the product information we used were incomplete — check the full SPC.

Dose adjustments

Renal

Contraindicated in anuria with renal failure and in renal dysfunction due to drugs which cause renal damage (SPC 4.3). No separate renal dose reduction is stated in section 4.2.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substances, sulphonamides ('sulfa drugs') or to any of the excipients
  • Anuria with renal failure
  • Hepatic coma, until the condition is improved or corrected
  • Hypotension
  • Pre-existing hypovolaemia
  • Cardiac arrhythmias
  • Simultaneous therapy with aminoglycosides or cephalosporins
  • Renal dysfunction due to drugs which cause renal damage

Side effects

  • Common: metabolic alkalosis; fluid and electrolyte imbalance (e.g. hypovolaemia, hyponatraemia)
  • Common: headache, dizziness
  • Common: gastrointestinal disorder (loss of appetite, upper abdominal pain, nausea, vomiting, diarrhoea, constipation)
  • Common: muscle spasms; fatigue, asthenia
  • Uncommon: hepatic enzyme increased (e.g. gamma-glutamyltransferase increased)
  • Uncommon: urinary retention, bladder dilatation
  • Uncommon: blood uric acid increased, blood glucose increased, lipids increased (triglycerides, cholesterol)
  • Rare: blood urea increased, blood creatinine increased
  • Very rare: allergic skin reactions (pruritus, exanthema), photosensitivity reaction
  • Frequency not known: thrombocytopenia, leukopenia, anaemia
  • Frequency not known: serious skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis)
  • Frequency not known: cerebral ischaemia, paraesthesia, confusional state; visual impairment; tinnitus, deafness
  • Frequency not known: acute myocardial infarction, myocardial ischaemia, angina pectoris, syncope, hypotension; embolism
  • Frequency not known: dry mouth, pancreatitis

Monitoring

  • SPC 4.4: 'Torasemide may lead to a profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required, and dose schedules have to be adjusted to the individual patient's needs. Especially at the start of the treatment and in elderly, patients must be carefully monitored.'
  • SPC 4.4: 'Regular blood monitoring of the electrolyte balance, potassium values and the parameters glucose, uric acid, and creatinine should be carried out especially during long-term treatment with torasemide for signs of electrolyte and volume deficiency and haemoconcentration.'
  • Potassium: 'the potassium level of patients must be closely monitored during treatment with torasemide. Existing hypokalemia or hypokalemia developing during torasemide treatment has to be corrected.' Hypokalaemia is a major risk factor for both ventricular and atrial arrhythmias.
  • Sodium and volume status: 'Low levels of sodium must be corrected before or during treatment' and 'Hypovolemia must be corrected before or during treatment with torasemide.'
  • Carbohydrate metabolism in latent or manifest diabetes mellitus should be monitored; there is an increased risk of gout attacks with diuretics, so caution in gout.
  • Urine retention must be corrected before or during treatment; patients with partial occlusion of the urinary tract must be closely monitored.
  • Patients should be warned not to drive or operate machinery if they experience dizziness or related symptoms.

Clinical monograph

How it works

It inhibits the sodium-potassium-chloride co-transporter in the thick ascending limb of the loop of Henle, promoting natriuresis and diuresis.

Prescribing in practice

  • It can cause electrolyte disturbance, including hypokalaemia and hyponatraemia, and volume depletion with associated renal impairment.
  • Use with caution in patients with gout, as it can raise serum urate.
  • Caution with other ototoxic or nephrotoxic drugs and avoid combinations that increase the risk of electrolyte imbalance.

Monitoring

Monitor electrolytes, renal function, fluid status and blood pressure during treatment.

Counselling the patient

  • It increases urine output; taking it earlier in the day can avoid disturbed sleep.
  • Report muscle cramps, marked weakness, dizziness or palpitations.
  • Attend for blood tests to check kidney function and salts.

Evidence & guidelines

Loop diuretics are a mainstay of symptomatic relief in fluid overload and heart failure, consistent with NICE guidance.

Reference: ESC HF; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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