Precautions and Warnings With Torsemide

Being aware of the precautions and warnings with torsemide before starting the medication can help minimize risks and help ensure a safe treatment process. There are certain people who should not take torsemide, including those who are allergic to sulfonamide drugs, are not producing any urine, or are allergic to any ingredient used to make torsemide. Other precautions and warnings with torsemide include the potential of extremely low blood pressure and the danger of hearing loss.

Torsemide: What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to taking torsemide (Demadex®) if you have:
  • Liver disease, including cirrhosis
  • Kidney disease or kidney failure
  • Diabetes
  • Gout
  • Fluid or electrolyte problems
  • Any allergies, including allergies to sulfa drugs, foods, dyes, or preservatives.
Also, let your healthcare provider know if you:
Tell your healthcare provider about all of the medicines you are currently taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Some Precautions and Warnings With Torsemide

Some torsemide warnings and precautions to be aware of include:
  • Torsemide should be started cautiously when treating cirrhosis or ascites (fluid retention in the abdominal cavity). In general, people who are taking torsemide for these conditions should start the medication in the hospital so that they can closely be monitored.
  • If kidney problems seem to be getting worse (especially for those with very severe kidney disease), torsemide should be stopped because the medication can make kidney problems worse.
  • Torsemide can cause hearing loss. Sometimes this hearing loss is permanent. It is more common when high doses of torsemide are given intravenously or when combined with other medications that can cause hearing loss. Let your healthcare provider know right away if you notice hearing loss or ringing in the ears (tinnitus).
  • There are a number of medicines that torsemide can interact with (see Drug Interactions With Torsemide).
  • Torsemide may cause extremely low blood pressure in some people. Extremely low blood pressure is more likely to happen when the medicine is first started or the dosage is changed. It is also more likely to happen in people who are on dialysis, who have congestive heart failure, who have diarrhea or vomiting, or who have excessive sweating. This is why it is important to drink fluids regularly while taking torsemide. If you have any possible symptoms of low blood pressure (such as dizziness, lightheadedness, or fainting), contact your healthcare provider. If you have fainted, stop taking torsemide until you have talked to your healthcare provider. 
Also, make sure not to drive, operate any heavy machinery, or perform any other tasks that require alertness until you know how torsemide affects you.
  • Torsemide may affect electrolytes in the blood (including sodium, calcium, potassium, magnesium, and chloride). Therefore, your healthcare provider will regularly check these levels. If you notice any symptoms of a possible electrolyte imbalance, contact your healthcare provider. These symptoms may include:
o Dry mouth
o Thirst
o Weakness
o Lethargy
o Drowsiness
o Restlessness
o Muscle pain or muscle cramps
o Low blood pressure (hypotension)
o Decreased urination
o A rapid heart rate (tachycardia) or irregular heart rhythms (arrhythmia)
o Nausea or vomiting. 
  • Torsemide is also known to worsen gout.
  • Torsemide may cause high blood sugar (hyperglycemia) in diabetics or, in some cases, even cause diabetes in people without a history of the condition.
  • Torsemide is considered a pregnancy Category B medication. This means that torsemide is probably safe to use during pregnancy, although the full risks are not known. Talk to your healthcare provider about the risks and benefits of using torsemide during pregnancy (see Demadex and Pregnancy for more information).
  • It is not known if torsemide passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about using torsemide (see Demadex and Breastfeeding for more information).
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