Torsemide in Edema Associated with Hepatic Impairment.

Nitin Zalte, Senthilnathan Mohanasundaram, Rajesh Upadhyay, Mangesh Tiwaskar, Ramesh Dargad, Udas Ghosh, Dev Kumar Jain, Raghu Kishore Galla, Guguloth Haricharan, Jayanta Sharma, Mayank Thakker

Journal: The Journal of the Association of Physicians of India 2024;72(9S):32-34

PMID: 39291571

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Abstract

Hepatic edema is caused by decreased hepatic protein synthesis, a consequence of decompensated liver cirrhosis. Fluid accumulation occurs when there is an increase in hydrostatic pressure in the hepatic sinusoids and splanchnic capillaries, as well as low albumin. The first-line treatment for cirrhosis-related ascites is an aldosterone antagonist (spironolactone); however, in severe and recurring ascites, a combination of aldosterone antagonists and loop diuretics (torsemide, furosemide, and bumetanide) is preferable. Torsemide outperformed furosemide in terms of natriuretic and diuretic effects at an equivalent dose. Pharmacological features of torsemide, such as lesser hypokalemia effect, longer duration of action, higher bioavailability, and extended half-life, make it a better alternative than furosemide. In clinical studies, it is considered a safer and more acceptable choice with fewer complications.

Address: Senior Director and Head, Department of Gastroenterology, Hepatology and Endoscopy, Max Superspeciality Hospital, Delhi, India, Corresponding Author.; Consultant Physician and Diabetologist, Department of Medicine, Shilpa Medical Research Centre, Mumbai, Maharashtra, India.; Senior Consultant Physician, Department of Medicine, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.; Professor, Department of Medicine, Medical College & Hospital, Kolkata, West Bengal, India.; Senior Consulting Physician, Department of Medicine, Apex Hospitals, Jaipur, Rajasthan, India.; Consultant Cardiologist, Department of Cardiology, KIMS Hospitals, Begumpet, Telangana, India.; Consultant General Physician, Department of Medicine, Gleneagles Hospital, Hyderabad, Telangana, India.; Senior Consultant, Department of Internal Medicine, Geriatric and Critical Care, Apollo Gleneagles Hospital, Kolkata, West Bengal, India.; Diabetic Critical Care Specialist, Department of Endocrinology, Shree Giriraj Hospital, Rajkot, Gujarat, India.; Senior Team Lead, Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India.; Country Head, Medical Affairs, Cipla Ltd., Mumbai, Maharashtra, India.

DOI: 10.59556/japi.72.0675

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Medical:

https://medlineplus.gov/edema.html

MeSH Terms: Humans, Ascites, Edema, Liver Cirrhosis, Torsemide, Sodium Potassium Chloride Symporter Inhibitors