Demadex Side Effects
Generic Name: torsemide
Note: This page contains information about the side effects of torsemide. Some of the dosage forms included on this document may not apply to the brand name Demadex.
Not all side effects for Demadex may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.
For the Consumer
Applies to torsemide: oral tablet
Other dosage forms:
In addition to its needed effects, some unwanted effects may be caused by torsemide (the active ingredient contained in Demadex). In the event that any of these side effects do occur, they may require medical attention.
If any of the following side effects occur while taking torsemide, check with your doctor or nurse as soon as possible:Less common
- Chest pain
- decreased urination
- dry mouth
- electrocardiogram (ECG) changes
- increased thirst
- irregular heartbeat
- loss of appetite
- mood changes
- muscle pain or cramps
- nausea or vomiting
- numbness or tingling in hands, feet, or lips
- shortness of breath
- swelling of hands, ankles, feet, or lower legs
- unusual tiredness or weakness
- Black, tarry stools
- dizziness, faintness, or lightheadedness when getting up from a sitting or lying position suddenly
- ringing or buzzing in the ears or any hearing loss
- skin rash
If any of the following symptoms of overdose occur while taking torsemide, get emergency help immediately:Symptoms of overdose
- Blurred vision
- decreased urine output
- fast heartbeat
- increase in heart rate
- rapid breathing
- sunken eyes
- weak pulse
- wrinkled skin
Some of the side effects that can occur with torsemide may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:More common
- Increase in urination
- Acid or sour stomach
- difficulty having a bowel movement (stool)
- difficulty in moving
- increased cough
- joint pain
- lack or loss of strength
- muscle pain or stiffness
- pain in joints
- runny nose
- sore throat
- stomach discomfort, upset, or pain
- stuffy nose
- swollen joints
- trouble sleeping
- unable to sleep
For Healthcare Professionals
Applies to torsemide: injectable solution, oral tablet
The reported side effects associated with torsemide (the active ingredient contained in Demadex) are generally transient, and without relationship to age, sex, race, or duration of therapy. Approximately 4% of patients discontinue torsemide therapy due to side effects. In a controlled study, the withdrawal rate associated with torsemide versus placebo was similar.
Nervous system side effects have been associated with the use of torsemide (the active ingredient contained in Demadex) As with other loop diuretics, torsemide can rarely cause ototoxicity, especially with higher doses. Asthenia, nervousness, and insomnia have been reported in 1% to 2% of patients, headache in up to 10% of patients, and dizziness in up to 8% of patients. Withdrawal rates due to dizziness, headache, or weakness range from 0.1% to 0.5%.
Metabolic abnormalities can result from the urinary loss of potassium, sodium, calcium, and magnesium. Like other loop diuretics, hyperglycemia, hyperuricemia, hypercholesterolemia, and hypochloremic alkalosis have been reported, particularly after chronic administration. While many of these increases are not clinically significant, it is recommended that the blood glucose, serum uric acid, and serum cholesterol levels of patients with a history of diabetes, gout, or hypercholesterolemia, respectively, be monitored initially and periodically during therapy.
One case each of hypocalcemia and hypomagnesemia has been reported from a series of 426 patients who were treated for 11 months. Data from patients who were known not to have received magnesium supplementation reveal rates of serum magnesium levels less than 1.7 mg per dl (0.7 mmol per liter) of 6% and 7% after a four-week trial of torsemide 5 mg and 10 mg once a day, respectively.
Renal side effects including new or worsened renal insufficiency, as indicated by an average rise in BUN of 1.8 mg/dl (0.6 mmol/L), serum creatinine of 0.05 mg/dl (4 mcmol/L), and serum uric acid of 1.2 mg/dl (70 mcmol/L), is common. These changes appear to be reversible upon discontinuation of therapy.
Cardiovascular side effects including the effects of diuresis may become problematic. Hypovolemia, excessive thirst, and excessive urination can predispose some patients to lightheadedness and syncope. Cardiac arrhythmias may occur due to the urinary loss of potassium, although reports are extremely rare.
Gastrointestinal side effects are typically mild, and include nausea, vomiting, diarrhea, and dyspepsia. Constipation has been reported in up to 16% of patients. Postmarketing gastrointestinal side effects have included pancreatitis.
Hypersensitivity side effects including hypersensitivity reactions (such as angioedema) have been reported in a patient who was known to have a sulfa allergy.
Musculoskeletal cramping has occasionally been reported during torsemide-induced diuresis.
Muscle cramps associated with torsemide are usually of short duration and can be alleviated by walking or massage.
Hematologic side effects including significant increases in hematologic indices (including red blood cell count, hemoglobin concentration, and packed cell volume) have been reported after higher (20 mg or more) doses. These changes have been consistent with the loss of intravascular fluid volume secondary to torsemide-induced diuresis, and are not considered side effects of torsemide (the active ingredient contained in Demadex) itself. Hematologic side effects reported postmarketing have included leukopenia and thrombocytopenia.
A 64-year-old man with chronic renal failure came to the dermatology clinic in October 2006 for evaluation of blistering lesions on the backs of his hands and scalp since July 2006. He had no changes in his treatment in the preceding year except for starting treatment with torsemide (the active ingredient contained in Demadex) in May 2006, which had been replaced with furosemide in September 2006. Within 1 month after furosemide treatment was stopped, the lesions cleared. It is thought that torsemide induced pseudoporphyria is caused by the drug adhering to unknown specific target structures. Subsequent exposure to light may cause an inflammatory reaction resulting in blisters.
Dermatological side effects have included pseudoporphyria (an infrequent blistering skin disease), Stevens-Johnson syndrome, and toxic epidermal necrolysis.
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