Effects of torsemide: A Synthesis of Findings from 21 Studies

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Original Abstract of the Article

Major Research Findings

Torsemide, a loop diuretic, has shown to have longer and more potent diuretic and natriuretic effects compared to furosemide in short-term studies. 1 However, its long-term effects and complications are not fully understood yet. 1 In patients with acute heart failure, torsemide has been shown to be associated with similar outcomes to furosemide in unadjusted analysis, but with nominally lower events in adjusted analysis. 10 Despite the limited evidence, some studies have suggested potential advantages of torsemide in improving heart failure management. 17

Torsemide has demonstrated efficacy in managing congestive heart failure in dogs. 12 While the use of torsemide in cats with spontaneous CHF is less well-established, a retrospective study documented its therapeutic use and potential adverse effects. 12 Torsemide has been evaluated for its impact on warfarin therapy in both humans and rats. In rats, high doses of torsemide were found to increase the pharmacodynamic response of warfarin. 20 In humans, a retrospective study suggested a potential interaction with warfarin, potentially leading to the need for dose adjustments. 20 3

A meta-analysis comparing torsemide to furosemide in patients with heart failure revealed that torsemide was associated with a numerical reduction in heart failure hospitalization, a statistically significant improvement in functional status, and a lower risk of cardiac mortality. 8 However, there was no significant difference in all-cause mortality or medication side effects. 8 A separate meta-analysis of 10 randomized controlled trials found that torsemide was associated with a reduced risk of hospitalizations compared to furosemide, without any difference in mortality. 5

Benefits and Risks

Benefits Summary

Torsemide appears to offer potential benefits in managing heart failure, including a lower risk of hospitalizations and improved functional status. 8 5

Risks Summary

Torsemide may have a greater impact on the cardiovascular system compared to furosemide, requiring careful monitoring and potential dose adjustments. 5 Furthermore, torsemide may increase the risk of renal dysfunction and interact with warfarin, leading to increased bleeding risk. 20 3

Comparison Across Studies

Similarities Across Studies

Several studies consistently demonstrate that torsemide provides longer and more potent diuretic and natriuretic effects compared to furosemide. 1 17 8

Differences Across Studies

While some studies suggest a potentially greater impact on the cardiovascular system with torsemide, 5 others highlight a potential benefit in reducing the risk of atrial fibrillation and a safer profile compared to furosemide. 8 The optimal choice between torsemide and furosemide may vary depending on individual patient factors and their specific needs.

Consistency and Contradictions

There are some contradictions in the findings regarding the cardiovascular impact of torsemide. While certain studies point to a greater risk, 5 other research suggests a lower risk of atrial fibrillation and a safer profile compared to furosemide. 8 Further research is needed to clarify these inconsistencies and establish the optimal choice between torsemide and furosemide.

Real-World Application Considerations

When considering torsemide, it is crucial to be aware of its potential impact on the cardiovascular system and the possibility of increased risk of renal dysfunction and interactions with other medications like warfarin. 20 3 5 Close monitoring and careful consideration of individual patient factors are essential when using torsemide.

Limitations of Current Research

Several limitations exist in the existing research on torsemide, including the relatively small sample sizes of some studies, the lack of long-term follow-up, and the non-randomized selection of patients in some cases. 10 6 17 8 Larger, longer-term, randomized controlled trials are needed to provide more definitive evidence on the benefits and risks of torsemide compared to furosemide.

Future Research Directions

Large-scale, long-term, randomized controlled trials are necessary to provide conclusive evidence on the efficacy and safety of torsemide in comparison to furosemide. 17 8 Furthermore, research is needed to evaluate the effects of torsemide in patients with varying heart failure severity and comorbidities. 10 6

Conclusion

Torsemide shows promise as a potent loop diuretic with potential benefits for patients with heart failure, including reduced hospitalizations and improved functional status. 8 5 However, it is essential to carefully consider the potential risks associated with torsemide, including its impact on the cardiovascular system and the potential for drug interactions. 20 3 5 Further research is needed to provide a more definitive understanding of torsemide's effects and to determine its optimal use in clinical practice.

Literature analysis of 21 papers
Positive Content
17
Neutral Content
1
Negative Content
3
Article Type
3
2
1
4
21
1.

Long-term efficacy of torsemide compared with frusemide in cirrhotic patients with ascites.

Author: AbecasisR, GuevaraM, MiguezC, CobasS, TergR

Diuretic action
Natriuretic action
Long-term effects unknown

Torsemide is a new loop diuretic that has shown, in short-term studies, to induce a longer and higher diuretic and natriuretic action than frusemide. However, torsemide long-term effects and complications have not been sufficiently investigated. The aim was to compare the efficacy and safety of torsemide versus frusemide in cirrhotic patients with uncomplicated ascites.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

2.

Comparative evaluation of torasemide and spironolactone on adverse cardiac remodeling in a rat model of dilated cardiomyopathy.

Author: ArumugamSomasundaram, SreedharRemya, KaruppagounderVengadeshprabhu, HarimaMeilei, NakamuraMasahiko, SuzukiHiroshi, SoneHirohito, WatanabeKenichi

Cardiac function
Fluid retention

Chronic heart failure (CHF) often involves fluid retention and volume overload. This study examines the common use of diuretics in treating CHF, focusing on their effects on edema reduction and their potential benefits beyond urinary excretion.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

3.

Evaluation of the effect of torsemide on warfarin dosage requirements.

Author: LaiSophia, MomperJeremiah D, YamFelix K

Warfarin potentiation

This retrospective cohort study evaluated the impact of torsemide initiation on warfarin dosage requirements in patients taking warfarin. The results showed that most patients did not require any warfarin dosage adjustments after torsemide was initiated. However, the potential for interaction still exists, and increased monitoring is warranted to minimize the risk of adverse effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Observational StudyResearch that observes and collects data on participants' behavior and outcomes in their natural state, without intervention.

Language : English

4.

The Art and Science of Using Diuretics in the Treatment of Heart Failure in Diverse Clinical Settings.

Author: IslamMd Shahidul

Improved heart failure care
Diuretic misuse

This article emphasizes the importance of understanding the rationale for appropriate use of diuretics in heart failure patients. It provides guidance on selecting the right diuretic, appropriate dosage, methods of administration, monitoring of responses, and managing side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

8.

Meta-Analysis Comparing Torsemide Versus Furosemide in Patients With Heart Failure.

Author: AbrahamBishoy, MegalyMichael, SousMina, FransawyalkomosMina, SaadMarwan, FraserRobert, TopfJoel, GoldsmithSteven, SimegnMengistu, BartBradley, AzzoZain, MesihaNancy, SharmaRajaninder

Heart failure treatment
Side effects

Torsemide and furosemide are diuretics for heart failure. This study found torsemide was associated with a lower risk of heart failure hospitalization, more improvement in functional status, and lower risk of cardiac mortality compared to furosemide.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

9.

A Case of Pulmonary Hypertension in a 67-Year-Old Woman with Thiamine Deficiency Following Partial Gastrectomy and Exacerbated by Diuretics.

Author: ShibayamaJunichi, TadaHayato, MoritaMayumi, YoshidaShohei, SakataKenji, UsuiSoichiro, KawashiriMasa-Aki, TakamuraMasayuki

Pulmonary hypertension reversal

This case report describes a 67-year-old woman who presented with pulmonary hypertension and thiamine deficiency following partial gastrectomy and exacerbated by diuretics. The study highlights the importance of recognizing that thiamine deficiency can be a cause of pulmonary hypertension, which is completely reversible.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

10.

Torsemide Versus Furosemide in Patients With Acute Heart Failure (from the ASCEND-HF Trial).

Author: MentzRobert J, HasselbladVic, DeVoreAdam D, MetraMarco, VoorsAdriaan A, ArmstrongPaul W, EzekowitzJustin A, TangW H Wilson, SchultePhillip J, AnstromKevin J, HernandezAdrian F, VelazquezEric J, O'ConnorChristopher M

HF treatment
Torsemide benefit

This study investigated whether torsemide, a loop diuretic, is better than furosemide for treating heart failure. The study found that torsemide was associated with similar outcomes as furosemide.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

12.

Tolerance of torasemide in cats with congestive heart failure: a retrospective study on 21 cases (2016-2019).

Author: PoissonnierCamille, GhazalSarra, PassavinPeggy, AlvaradoMaria-Paz, LefortSolène, Trehiou-SechiEmilie, SaponaroVittorio, BarbarinoAlix, Delle CaveJulia, MarchalCharlie-Rose, DepréBoris, VannucciEtienne, TissierRenaud, VerwaerdePatrick, ChetboulValérie

CHF treatment
Adverse effects

This retrospective study examines the use of torasemide, a loop diuretic, in cats with spontaneous congestive heart failure (CHF). The study explores the therapeutic effects of torasemide, potential adverse effects, and the clinical course of cats following its administration.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

13.

The diuretic torasemide does not prevent aldosterone-mediated mineralocorticoid receptor activation in cardiomyocytes.

Author: GravezBasile, TarjusAntoine, Jimenez-CaninoRuben, El MoghrabiSoumaya, MessaoudiSmail, Alvarez de la RosaDiego, JaisserFrederic

Torasemide, a diuretic, does not block aldosterone binding to the mineralocorticoid receptor (MR) in cardiomyocytes. Although it doesn't act as an MR antagonist, its use in combination with MR antagonists in heart failure may provide additional benefits by targeting complementary pathways.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

14.

Hypokalaemic quadriparesis following torsemide and spironolactone use.

Author: KaurUpinder, ChakrabartiSankha Shubhra, ChoudhuryAshis Kumar, GambhirIndrajeet Singh

Electrolyte abnormalities
Hypokalaemia

Torsemide is a medication used to treat high blood pressure and fluid retention. It can cause low potassium levels (hypokalemia), which can lead to muscle weakness and heart problems. This case study describes a patient who developed severe muscle weakness and other health problems due to low potassium levels caused by torsemide and spironolactone, another medication used to treat high blood pressure.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

15.

Pharmacokinetic and pharmacodynamic properties of orally administered torasemide in healthy cats.

Author: Roche-CatholyMarine, PaepeDominique, DevreeseMathias, BroeckxBart J G, WoehrléFrederique, SchneiderMarc, de Salazar AlcalaAndrea Garcia, HellemansArnaut, SmetsPascale

Diuresis increase
RAAS activation
Electrolyte imbalance

Torasemide exhibits high bioavailability and a longer duration of action in cats, effectively increasing diuresis and activating the renin-angiotensin-aldosterone system (RAAS) without significant adverse effects. Once daily dosing of 0.27 mg/kg may be appropriate in clinical settings.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

16.

Diuretic response in acute heart failure: clinical characteristics and prognostic significance.

Author: ValenteMattia A E, VoorsAdriaan A, DammanKevin, Van VeldhuisenDirk J, MassieBarrie M, O'ConnorChristopher M, MetraMarco, PonikowskiPiotr, TeerlinkJohn R, CotterGad, DavisonBeth, ClelandJohn G F, GivertzMichael M, BloomfieldDaniel M, FiuzatMona, DittrichHoward C, HillegeHans L

Improved diuretic response
Heart failure mortality
Heart failure rehospitalization

A study of 1,745 hospitalized acute heart failure patients found that worse diuretic response was independently associated with low systolic blood pressure, high blood urea nitrogen, diabetes, and atherosclerotic disease. Worse diuretic response independently predicted 180-day mortality, 60-day death or renal or cardiovascular rehospitalization, and 60-day HF rehospitalization.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

17.

Torasemide versus furosemide in treatment of heart failure: A systematic review and meta-analysis of randomized controlled trials.

Author: SherifNourin Ali, MorraMostafa Ebraheem, ThanhLe Van, ElsayedGhadeer Gamal, ElkadyAya Hesham, ElshafayAbdelrahman, KienNguyen Dang, Al-HabbaaAhmed, MinhLe Huu Nhat, YMai Nhu, NghiaThai Le Ba, MohammedAbdelrhman Tarek, EidPeter Samuel, TurkTarek, HirayamaKenji, HuyNguyen Tien

Improved ejection fraction
Improved heart failure management
Reduced hospital stay

Torasemide, a loop diuretic, may offer potential advantages over furosemide in the management of heart failure (HF). Torasemide demonstrated a significant increase in urine volume, lower potassium excretion, and a shorter hospital stay compared to furosemide. It also showed a superior effect in improving ejection fraction.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

18.

Could torasemide be a prophylactic agent of contrast induced acute kidney injury? A review about this field.

Author: LiX-M, JinD-X, CongH-L

CI-AKI prevention

Contrast-induced acute kidney injury (CI-AKI) is a significant problem for hospitalized patients. The article discusses the role of the renin-angiotensin-aldosterone system (RAAS) in CI-AKI and the potential of torasemide, a loop diuretic, as a preventive agent.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

19.

Diuretic Changes, Health Care Resource Utilization, and Clinical Outcomes for Heart Failure With Reduced Ejection Fraction: From the Change the Management of Patients With Heart Failure Registry.

Author: KhanMuhammad Shahzeb, GreeneStephen J, HellkampAnne S, DeVoreAdam D, ShenXian, AlbertNancy M, PattersonJ Herbert, SpertusJohn A, ThomasLaine E, WilliamsFredonia B, HernandezAdrian F, FonarowGregg C, ButlerJaved

Heart failure hospitalization
Resource utilization

This registry study found that 23% of US patients with heart failure with reduced ejection fraction had outpatient escalation of diuretic therapy over time. These patients were more likely to have signs and symptoms of congestion. Outpatient diuretic dose escalation was associated with heart failure hospitalizations and resource utilization, but not all-cause mortality.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

20.

Effects of torsemide on pharmacodynamics and pharmacokinetics of warfarin in humans and rats.

Author: KimHan Oll, LeeKyung Eun, ParkHee Yoon, LeeNa Ra, OhByeou Ree, ChangByung Chul, GwakHye Sun

Warfarin interaction

Torsemide significantly increased the pharmacodynamic response of warfarin in rats and lowered the stable warfarin dose in humans. This suggests that warfarin dose needs to be adjusted when used concomitantly with diuretics.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

21.

Pharmacokinetic and pharmacodynamic properties of orally administered torsemide in healthy horses.

Author: AgneGustavo F, JungSeung Woo, WooldridgeAnne A, DuranSusan H, RavisWilliam, ToribioRamiro

Effective diuresis
Oral administration
Azotemia
Electrolyte disturbance

Oral torsemide effectively reached therapeutic concentrations in blood, induced clinically relevant diuresis, and could be a useful alternative to injectable diuretics for treating congestive heart failure in horses.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

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