High doses of torasemide in the doctor’s practice: obvious benefits

Abstract

Today, torasemide is the most prescribed loop diuretic in clinical practice. Its high doses are used mainly in two clinical situations accompanied by hyperhydration: chronic heart failure (CHD) and chronic kidney disease (CKD). The latest guidelines on CHD management, 2019, have defined a clear algorithm for the use of large doses of torasemide, given that the large doses have a lasting diuretic effect. The daily dose is in the range of 50–300 mg of torasemide per day, prescribed continuously and for a long time. The clinical practice evidence demonstrates a high level of natriuretic peptide B to be usually accompanied by a large diuresis. With CKD, large doses of torasemide are in the range of 40–100 mg (200 mg) per day. Given the limitations of the renal water function, which increases proportionally with the degree of CKD, the mode and efficacy of torasemide is different from CHD. With CKD, torasemide is prescribed in doses up to 100 mg 6 days a week, the seventh is a break. When using doses of 100–200 mg, torasemide is prescribed for two days of intake — two days of break. Large doses of torasemide demonstrate high efficacy in reducing/eliminating hyperhydration in CHD and CKD. Their long-term administration reduces overall and cardiovascular mortality rates. The effect of torasemide is enhanced by the simultaneous administration of xipamide. The combination of torasemide and furosemide was determined to be impractical.