What is folasemid?
Torasemid is a loop diuretic of the newer generation and a further development towards furosemid. It is used in high blood pressure and edema as a result of heart failure, kidney or liver disease.
Compared to furosemid, torasemid offers several advantages: a higher and more reliable bioavailability (80-100% vs. 50-70% for furosemid), a longer effective duration (12-16 hours), less potassium loss and no rebound sodium retention. Known preparations are Torasemid HEXAL®, Torasemid-ratiopharm and Torem®.
In the low dose of 2.5-5 mg, torasemid is also used as a mild diuretic at high blood pressure, similar to a thiazide.
Active Ingredients & Mechanism of Action
Active ingredient: Torasemid
Torasemid inhibits the NKCC2 cotransporter in the Henle loop:
Active mechanism:
- inhibits the resorption of sodium, potassium and chloride
- Promotes water separation
- Lowers blood volume and blood pressure
Advantages over furosemide:
- Higher bioavailability (80-100% oral)
- More uniform recording (less variable)
- Longer duration (12-16 hours vs. 4-6 hours)
- Less potassium loss
- No rebound sodium retention after the end of effect
- Additional aldosterone antagonistic effect
Antihypertensive action: In a low dose (2.5-5 mg), torasemid acts similarly to a thiazid diuretic and lowers blood pressure without strong dewatering. In a higher dose (10-200 mg) it acts as a powerful grinding diuretic.
Initiation of action: Oral after 1 hour. Maximum effect after 1-2 hours. Duration: 12-16 hours.
Who is it suitable for?
Torasemid is suitable for:
- Adults with high blood pressure (low dose)
- Edema in heart failure
- Edema in kidney disease
- Edema in liver cirrhosis
Especially recommended at:
- Heart failure (TORAFIC study shows advantages over furosemide)
- Patients with potassium loss under furosemid
- If more uniform drainage is desired
- High blood pressure as mild diuretic therapy
Not suitable:
- Anurie
- Heavy hypovolaemia
- Heavy electrolyte disorders
- Hepatic encephalopathy
- hypersensitivity to torasemid or sulfonylureas
Available Dosages
High blood pressure:
- usual dose: 2.5-5 mg once a day
- Maximum dose for high blood pressure: 5 mg daily
Edema in heart failure:
- start dose: 5-10 mg once a day
- usual dose: 10-20 mg once a day
- Maximum dose: 200 mg daily
Edema for kidney failure:
- 20-200 mg once a day
Edema in liver cirrhosis:
- 5-10 mg once a day (with potassium-saving diuretic)
Available starches:
- 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg, 100 mg, 200 mg tablets
How to Take
Intake:
- Once a day, preferably morning
- Independent meals
- With sufficient water
- Always at the same time
**
- Regular laboratory controls (electrolytes, kidneys, blood sugar)
- Control weight regularly
- Drink sufficient (according to medical instructions)
- Potassium-rich diet can be helpful
- In case of vomiting or diarrhea: contact doctor
Advantage to Furosemid: As a result of the longer duration of action, the urine rank is more uniform and less disturbing than with furosemide.
Contraindications
**Torasemid must not be taken at:* *
- Anurie (no urine production)
- Precious or comatious hepatic encephalopathy
- Heavy hypokalemia or hyponatriemia
- Heavy hypovolaemia/dehydration
- hypersensitivity to torasemid or sulfonylureas
- Still time
Preview at:
- Diabetes mellitus (blood sugar increase)
- gout/hyperuremia
- Liver cirrhosis (electrolyte control tight-mesh)
- Simultaneous use of digitalis preparations
- Prostate hyperplasia
pregnant: Only with strict indication. Torasemid can pass the placenta and influence the fetal diuresis.
Possible Side Effects
Acid (1-10%):
- Increased urinary rank (wanted)
- Light electrolyte displacement
- Mouth dryness
- Increased uric acid
** Occasionally (0,1-1%):* *
- Hypokaliemia (less than Furosemid)
- Hyponatriemia
- dizziness, headache
- Gastrointestinal complaints
- Muscle cramps
- Increase in blood sugar
Selten:
- Skin rash
- photosensitization
- Blood-image changes
- Pancreatitis
- hearing disorders (at very high doses)
Advantage: Torasemid causes less hypokaliemia than furosemid and has a more uniform dewatering without rebound effect.
Interactions
Dangerous combinations:
- Aminoglycosides → enhanced ovoid and nephrotoxicity
- Cisplatin → increased nephrotoxicity
- Lithium → increased lithium mirror
Preview at:
- Digitalis preparations → Potassium loss strengthens digitalis toxicity
- ACE-Hemmer/Sartane → Reinforced hypotension (especially for initial submission)
- NSAR → reduced diuretic action
- Corticosteroids → increased potassium loss
- Probeecid → reduced torasemid effect
- Cholestyramine → reduced torasemid absorption
** Torasemid has less variable absorption than furosemid, making the interactions more predictable with food and other medicines.
Frequently Asked Questions
Similar Medications
Is folasemid right for you?
A licensed doctor will review your information and issue a prescription if suitable. Discreet and secure.
Important Notice
This information does not replace medical advice. If you have questions about your health or the suitability of this medication, please consult a doctor or pharmacist.
Important Safety Information
This service operates under German pharmaceutical law (HWG). For risks and side effects, read the package leaflet and consult your doctor or pharmacist. All medications are dispensed from a licensed pharmacy in Germany.