Urine production in control animals, those receiving standard-dose furosemide, and those receiving torsemide orally. Commonly reported Torsemide has more potent natriuretic and chloruretic effects than furosemide.
This could be good or bad. My blood pressure wasn't dangerously high but higher than normal & I was extremely short of breath.
Lasix (furosemide) and Demadex (torsemide) are diuretics (water pills) used to treat edema (water retention) due to congestive heart failure, kidney disease, chronic kidney failure, or liver disease. Another important consideration that can impact dosing is bioavailability. Note the higher peak urine level compared with furosemide at the original dosage, slight delay in peak diuresis, and prolonged period of time in the therapeutic range (dashed arrow; 10–12 H in this model).Other antialdosterone and antifibrotic effects of torsemide are postulated, however, and warrant further study.FIGURE 7. Data sources include IBM Watson Micromedex (updated 2 Sep 2020), Cerner Multum™ (updated 1 Sep 2020), … This characteristic—multiple peaks and valleys in serum drug concentrations—may enhance furosemide’s stimulation of the sympathetic nervous system and RAAS, contributing to diuretic resistance.7 Increasing dosages are required over time and, in many cases, other diuretics are added to maintain patient comfort.Diuretic resistance is multifactorial, resulting from neurohormonal activation as well as:Torsemide appears to be less affected by resistance, but a mechanism for this characteristic has not been identified.Furosemide is the diuretic of choice for everyday use because it is potent, rapid in onset, relatively inexpensive, and enjoys a comfort level with clinicians based on years of clinical experience.
Pharmacy Department, Morriston Hospital, Swansea Copyright © 2020 BMJ Publishing Group Ltd 京ICP备15042040号-3 Furosemide is eliminated from the body, primarily through excretion in the urine. A better approach, although problematic in terms of owner compliance, is to administer multiple doses throughout the day. Good information from the front lines of healthcare is really hard to find, and that is what I try to provide day after day. If resistance to furosemide results or other factors (eg, a high salt meal) dictate that more diuresis is needed, another approach (versus the 2 strategies demonstrated in Figure 5) would be to change to a longer-acting diuretic, such as torsemide (yellow curve). Furosemide has an oral bioavailability of around 60%. polyuria. More studies are needed to establish comparative aspects of the undesirable adverse effects and the efficacy of various loop diuretics.Read Part 2 of this article series—a discussion on spironolactone—in an upcoming issue of ACE = angiotensin-converting enzyme; BUN = blood urea nitrogen; CHF = congestive heart failure; MR = mineralocorticoid receptor; RAAS = renin–angiotensin–aldosterone systemGet the latest peer-reviewed clinical resources delivered to your inbox.https://todaysveterinarypractice.com/table-of-contents-september-october-2020/ You may... The increase in dosage increases the urine level of the diuretic but provides only a small increase in time in the effective range, enhancing diuresis (red arrow) but increasing risk for toxicity. Serum aldosterone concentrations in normal dogs receiving placebo, furosemide, or torsemide on days 1 (white bar) and 14 (green bar). With furosemide, since it is Enjoy the blog? However, negative effects are associated with any potent diuretic (FIGURE 1. The only down side is that if I take it every day I get very painful cramps in my thighs.
Now I'm taking Nitrofurantoin Monohyd Mac for infection. ** The Controlled Substances Act (CSA) schedule information displayed applies to substances regulated under federal law. In UK practice, some patients experiencing a poor response to oral furosemide have their loop diuretic changed to oral bumetanide in the mistaken belief (see box 4 of paper: ‘Common myths about loop diuretics’) that bumetanide is better absorbed in patients with significant oedema, and a dose equivalence of 1:40 orally is often used to guide this change.If a 1:40 dose equivalence is used (and the 1:80 equivalence quoted in this paper and UpToDate are more realistic), changing patients from oral furosemide 40mg to oral bumetanide 1mg represents an approximate doubling of the dose of loop diuretic. I figured I would use the blog to cover some of those differences.When comparing two agents in the same class, one of the first characteristics to consider is I don’t think that there is a strong clinical impact because of this modest difference. I’ve had a lot of really kind people help me along the way, and I wanted a way for myself and others to give back some of the things we’ve learned about medication management and healthcare. This could be a significant clinical interaction to think about. Lower potential for drug interactions. However, we believe that changes in drugs or dosages based simply on serum creatinine concentration should not be made unless levels increase at least 35%.Most often, the loop diuretic will be temporarily discontinued or have its dosage reduced first, with the ACE inhibitor being manipulated last.Unfortunately, the data available on diuretics in veterinary patients are still limited. This does allow for a little easier conversion as torsemide is closer to a 1:1 ratio of oral to IV. If resistance to furosemide results or other factors (eg, a high salt meal) dictate that more diuresis is needed, 1 of 2 strategies may be used: First is to administer a higher dosage, as shown with the red pharmacodynamic curve. Compared with furosemide, torsemide has longer half-life, longer duration of action, and higher and less-variable bioavailability. The equivalent maximal doses are 1 mg for bumetanide and 15 to 20 mg for either oral or intravenous torsemide since these agents are almost completely absorbed. May I congratulate Dr Anisman and colleagues on their excellent and thought-provoking paper and podcast: ‘How to prescribe loop diuretics in oedema’. Prescribed for Heart Failure, Edema, Renal Failure, Ascites, High Blood Pressure, Nonobstructive Oliguria. I guess I'd say it is helping but watch out for the bladder infection.I find that torsemide works very well for me.