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Myocarditis
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
George Lazaros, Emilia Lazarou, Dimitris Tousoulis
Concerning other medication classes, digoxin has been shown to increase the release of proinflammatory cytokines in animal studies, with detrimental effects on left ventricular function and mortality.8,14 Among diuretics, used to relieve congestion, torasemide appears to reduce progression from myocarditis to dilated cardiomyopathy independently of its diuretic properties.54
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Torasemide. This is a new loop diuretic with a longer elimination half-life and possibly fewer side effects. Although torasemide has been studied in the immature animal [2], its use in paediatrics has not been properly evaluated, and the manufacturer therefore does not recommend its use in patients below 12 years of age.
Antihypertensive Drug Classes
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Engi Abdel-Hady Algharably, Reinhold Kreutz
All loop diuretics are rapidly absorbed from the gastrointestinal tract, followed by extensive binding to plasma proteins. They exert their peak effect after 1–1.5 h. Oral absorption of bumetanide and torsemide is high even in patients with severe oedema so that their effects are more predictable than those of furosemide; the latter shows variable gastrointestinal absorption (3). Elimination varies also between loop diuretics (Table 40.6). Furosemide is predominantly eliminated by the kidney, while torsemide is significantly metabolized by CYP450 enzymes and eliminated by the hepatic route. Consequently, the half-life of furosemide is prolonged in advanced renal dysfunction, while the half-life of torsemide is doubled in hepatic dysfunction. Torsemide can be administered once daily (1).
Quality of oral anticoagulation control in Chinese patients with non-valvular atrial fibrillation: a prospective controlled study
Published in Current Medical Research and Opinion, 2020
Yaqian Li, Jingjing Yu, Yun Kuang, Chengkun Wu, Liu Yang, Qiulian Fang, Qi Pei, Guoping Yang
Another interesting finding in the current study is that concomitant torasemide increased the risk of inadequate TTR. It is probable that an interaction between warfarin and torasemide exists, as torasemide is a substrate of CYP2C9 and competes for the enzyme to cause lower warfarin clearance; it was also expected that warfarin metabolism through CYP2C9 could be inhibited by concurrent use of torasemide. Torasemide was found to be highly bound to plasma proteins, and the volume of distribution could be increased by protein-binding replacement30–32. Although the percentage of concomitant torasemide was low (4.5%), it showed a significant role in the multivariate analysis, while other diuretics, including furosemide and spironolactone, did not show the same influence; this factor is worth discussing, but further research and confirmation is required.
Negotiating renal dysfunction when treating patients with heart failure
Published in Expert Review of Cardiovascular Therapy, 2018
Valentina Carubelli, Marco Metra, Lars H. Lund
In patients with advanced HF and/or with renal impairment, furosemide may be not enough to relieve signs and symptoms of congestion. Torasemide has a favorable pharmacological profile, with a better absorption and higher bioavailability compared to furosemide, and has anti-fibrotic properties [114,115]. Since torasemide is frequently used when patients develop tolerance to furosemide, it is not surprising that in observational studies, torasemide-treated patients are sicker and have worse outcomes [116,117]. However, findings from the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial showed that although torasemide was administered in a minority of patients (13%) with more advanced HF and renal dysfunction, it was associated with a nominal improvement of 30-day outcomes [118]. Prospective randomized studies are needed to ascertain if there is a meaningful difference between torsemide and furosemide. An adjunctive therapy to furosemide, widely used in clinical practice in patients with diuretic resistance, is metolazone. However, it is associated with a high risk of adverse events such as renal function deterioration and electrolytes disturbance (hyponatremia, hypokalemia) [119,120], and its clinical efficacy is largely based just on empiric experience. MRAs at ‘diuretic dosage’ are another possible adjunctive therapy and are under investigation in the ATHENA-HF study. The study is a randomized, double-blind, placebo-controlled trial which will investigate the safety and efficacy of spironolactone (100 mg/day) vs. placebo in patients hospitalized for AHF. The primary end point will be the change of natriuretic peptide while secondary end point will include measures of clinical decongestion and outcomes [121].
Evaluating the safety and tolerability of inpatient sacubitril/valsartan initiation in a community hospital
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Katie L. Peppin, Katie B. Tellor, Anastasia L. Armbruster, Martin W. Schwarze
Any patient at least 18 years of age with a diagnosis of HF as evidenced by NYHA class I-IV, a history of HFrEF (ejection fraction ≤ 40%), and was initiated on sacubitril/valsartan for at least 24 hours during hospital admission from 1 August 2015 through 31 March 2018 was screened for enrollment. Only patients who had not previously been treated with sacubitril/valsartan were considered for inclusion. The starting date of this time period was chosen because sacubitril/valsartan was approved by the FDA in July 2015, and adequate time was allowed for hospital acquisition of the medication and for prescriber familiarity. The primary outcome was the incidence of hypotensive events during hospitalization, defined as a systolic blood pressure < 90 mmHg. This definition differs slightly from the PIONEER-HF AND PARADIGM-HF study that includes symptomatic hypotension as it is difficult to measure this outcome retrospectively from chart review. Additionally, PIONEER-HF was not published until 2019 which was after completion of the present study. Secondary safety outcomes included the incidence of inpatient acute kidney injury (AKI), rate of inpatient discontinuation and rationale, HF readmission at 30 days, and incidence of hyperkalemia, defined as a serum potassium > 5 mEq/L. AKI was assessed using the KGIGO 2012 definition of a decline in renal function as an increase in serum creatinine ≥ 0.3 mg/dL within 48 hours of sacubitril/valsartan initiation [8]. Secondary efficacy outcomes included the change in diuretic dose upon admission and discharge, ejection fraction within 30 days before and ≥ 30 days after initiation, and sacubitril/valsartan continuation and dose at 6 month follow-up. The secondary efficacy outcomes were collected as data became available. Oral furosemide equivalent dosing was based on those used in the DOSE trial, where 40 mg furosemide was considered to be equivalent to 20 mg torsemide or 1 mg bumetanide [9].