Demadex, also known as torsemide (USAN) or toresemide (rINN), is a pyridine-sulfonylurea type loop diuretic mostly used in the management of edema symptoms linked directly to congestive heart failure. At lowered doses, it can also be used for high blood pressure management. Compared to other loop diuretics, Demadex has a lengthier diuretic effect than equipotent doses of furosemide and relatively reduced potassium loss. There is no evidence or clinical reports of ototoxicity occurences caused by Demadex intake in humans.
Unlike many other drugs, intravenous and oral doses of Demadex are therapeutically equivalent because of the high bioavailability of the torsemide-based medication, thus patients can switch from IV to tablet form with no change of dose. Furthermore, Demadex IV injections should be taken as a continuous infusion or administered slowly as a bolus over a period of two minutes.
The recommended initial dose of Demadex is 20 milligrams of daily intravenous or oral medication routes. Demadex tablets may be administered at any time in relation to a meal as convenient—in other words, they can be taken after every meal with no problems whatsoever. There is no need for a special dosage adjustment for the elderly as well. As indicated above, Demadex must be injected gradually after two minutes, and single doses shouldn't exceed 200 milligrams.
Just like with other IV injections, if Demadex is given through an IV line, it is advised that the IV be flushed with Normal Saline—or Sodium Chloride Injection, USP—before and after administration. The Demadex injection product is formulated above pH 8.3, so flushing the line is required in order to prevent the chances for incompatibilities caused by the variation in pH that could be indicated by haziness, formation of a precipitate in the solution, and color change.
People suffering from hepatic disease with acites and cirrhosis should be cautious when using Demadex because sudden alterations of fluid and electrolyte balance may precipitate hepatic coma. In such patients, diuresis with Demadex or any other diuretic should be started in the hospital first and foremost. To avoid the onset of metabolic alkalosis and hypokalemia, a potassium-sparing drug or aldosterone antagonist is best used in tandem with Demadex treatment.
The occurrence of hearing loss (usually reversible) and tinnitus after rapid IV injection of other loop diuretics have also been attributed to oral Demadex intake. It is currently unknown whether or not these happenings are directly connected to Demadex. Ototoxicity has also been reported in animal studies when very high plasma levels of torsemide were induced in them.
Patients receiving diuresis with Demadex or diuretics treatment in general should be examined and observed for clinical evidence of prerenal azotemia, hypvolemia, or electrolyte imbalance. Symptoms of these maladies include any or a combination of the following: vomiting, nausea, tachycardia, oliguria, hypotension or low blood pressure, muscular fatigue, cramps or muscle pains, restlessness, drowsiness, lethargy, weakness, thirst, and dryness of the mouth.
Finally, in studies conducted in Europe and the United States, discontinuation rates due to side effects were found to be lower with Demadex than with furosemide overall aside from patients suffering from cirrhosis (Demadex had a high 7.6% discontinuation rate compared to furosemide's 0% at that particular case group).
The most common reasons for discontinuing Demadex therapy were the following side effects: dyspepsia, esophegeal hemorrhage, excessive urination, hyperglycemia, vomiting, weakness, nausea, headache, and dizziness.
The most serious side effects reported in the clinical studies of Demadex includes ventricular tachycardia, syncope, rectal bleeding, rash, shunt thrombosis, hypovolemia, hypotension, hypokalemia, hyperuricemia, hyperglycemia, gastrointestinal hemorrhage, digitalis intoxication, diarrhea, chest pain, and atrial fibrillation.
Demadex has the following structural formula:
• Molecular formula of demadex is C16H20N4O3S
• Chemical IUPAC Name is 3-[4-[(3-methylphenyl)amino]pyridin-3-yl]sulfonyl-1-propan-2-ylurea
• Molecular weight is 348.4200 g/mol
Generic name: Torasemide
Brand name(s): Luprac, Torasemida, Torasemidum, Torsemide
Review published on: 01 August 2009
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