An evaluation of torsemide in patients with heart failure and renal disease

• Published in: Expert review of cardiovascular therapy Vol. 20; no. 1; p. 5
• Main Authors: Peters, Anthony E, Mentz, Robert J, DeWald, Tracy A, Greene, Stephen J
• Format: Journal Article
• Language: English
• Published: England 2022
• Subjects: Diuretics - therapeutic use; Furosemide - therapeutic use; Heart Failure - drug therapy; Humans; Multicenter Studies as Topic; Sodium Potassium Chloride Symporter Inhibitors - therapeutic use; Torsemide; drug profile; comparative analysis; heart failure; Torsemide; diuretics; renal disease
• ISSN: 1744-8344
• DOI: 10.1080/14779072.2022.2022474

Torsemide is a loop diuretic that inhibits the Na+/K+/2Cl- cotransporter type 2 in the thick ascending loop of Henle, leading to increased excretion of urinary sodium and chloride and associated diuresis. While furosemide remains the dominant diuretic utilized in current practice, increasing evidence supports potential advantages of torsemide in heart failure (HF) and/or renal disease. This narrative review covers the evidence for use of torsemide in HF and renal disease. Comparative effectiveness with regards to clinical outcomes is reviewed, as well as the ongoing multicenter trial, TRANSFORM-HF, comparing the effect of torsemide versus furosemide among patients with HF. Compared with furosemide, torsemide has favorable pharmacodynamics/pharmacokinetics including higher bioavailability, longer duration of effect, minor renal excretion, decreased kaliuresis, and enhanced natriuresis/diuresis. These properties may be further supported by differential effects on RAAS regulation and fibrosis modulation as compared with other diuretics. The limited current body of evidence indicates that torsemide may be superior to furosemide with respect to improving HF functional status and reducing HF hospitalization, and there are mixed data regarding effect on reducing overall cardiovascular hospitalizations/mortality. Further, randomized data are necessary to definitively determine if torsemide can reduce risk of mortality and hospitalization among patients with HF.