Torsemide Side Effects

In Summary

Commonly reported side effects of torsemide include: polyuria. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to torsemide: oral tablet

As well as its needed effects, torsemide may cause unwanted side effects that require medical attention.

Severity: Moderate

If any of the following side effects occur while taking torsemide, check with your doctor or nurse as soon as possible:

• Chest pain
• convulsions
• decreased urination
• diarrhea
• 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:

• Blurred vision
• coma
• confusion
• decreased urine output
• dizziness
• drowsiness
• fainting
• fast heartbeat
• fatigue
• headache
• increase in heart rate
• irritability
• lightheadedness
• rapid breathing
• sunken eyes
• sweating
• weak pulse
• wrinkled skin

Minor Side Effects

Some torsemide side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

• Increase in urination

• Acid or sour stomach
• belching
• difficulty having a bowel movement (stool)
• difficulty in moving
• heartburn
• increased cough
• indigestion
• joint pain
• lack or loss of strength
• muscle pain or stiffness
• nervousness
• pain in joints
• runny nose
• sleeplessness
• sneezing
• 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

General

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.^[Ref]

Nervous system

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%.^[Ref]

Metabolic

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.^[Ref]

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.^[Ref]

Renal

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.^[Ref]

Cardiovascular

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.^[Ref]

Gastrointestinal

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.^[Ref]

Hypersensitivity

Hypersensitivity side effects including hypersensitivity reactions (such as angioedema) have been reported in a patient who was known to have a sulfa allergy.^[Ref]

Musculoskeletal

Musculoskeletal cramping has occasionally been reported during torsemide-induced diuresis.^[Ref]

Muscle cramps associated with torsemide are usually of short duration and can be alleviated by walking or massage.^[Ref]

Hematologic

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.^[Ref]

Dermatologic

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.^[Ref]

Dermatological side effects have included pseudoporphyria (an infrequent blistering skin disease), Stevens-Johnson syndrome, and toxic epidermal necrolysis.^[Ref]

It is possible that some side effects of torsemide may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

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