Torsemide Side Effects
Some side effects of torsemide may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to torsemide: oral tablet
Other dosage forms:
Along with its needed effects, torsemide may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur while taking torsemide: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
Get emergency help immediately if any of the following symptoms of overdose occur while taking torsemide:Symptoms of overdose
- Blurred vision
- decreased urine output
- fast heartbeat
- increase in heart rate
- rapid breathing
- sunken eyes
- weak pulse
- wrinkled skin
Some side effects of torsemide may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: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 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. 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 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 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.
More torsemide resources
- torsemide MedFacts Consumer Leaflet (Wolters Kluwer)
- torsemide Concise Consumer Information (Cerner Multum)
- torsemide Advanced Consumer (Micromedex) - Includes Dosage Information
- Torsemide Prescribing Information (FDA)
- Torsemide Professional Patient Advice (Wolters Kluwer)
- Torsemide Monograph (AHFS DI)
- Demadex Prescribing Information (FDA)
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