A Systematic Critical Review of Clinical Pharmacokinetics of Torasemide

Abstract

Purpose: Torasemide is a potassium-sparing loop diuretic used to treat fluid retention associated with congestive heart failure and kidney and hepatic diseases. This systematic review was conducted to combine all accessible data on the pharmacokinetics (PK) of torasemide in healthy and diseased populations, which may help clinicians avert adverse drug reactions and determine the correct dosage regimen. Methods: Four databases were systematically searched to screen for studies associated with the PK of torasemide, and 21 studies met the eligibility criteria. The review protocol was registered in the PROSPERO database (CRD42023390178). Results: A decrease in maximum plasma concentration (Cmax) was observed for torasemide after administration of the prolonged-release formulation in comparison to that after administration of the immediate-release formulation, that is, 1.12 ± 0.17 versus 1.6 ± 0.2 mcg/mL. After administering an oral dose of torasemide, a 2-fold increase in the area under the concentration–time curve (AUC) was reported in patients with congestive heart failure compared with the healthy population. Moreover, the patients with renal failure (clearance < 30 mL/min) showed an increase in value of AUC0–∞ that is, 42.9 versus 8.091 mcg.h−1.mL−1 compared with healthy subjects. In addition, some studies have reported interactions with different drugs, in which irbesartan showed a slight increase in the AUC0–∞ of torasemide, whereas losartan and empagliflozin did not. Conclusions: The current review summarizes all available PK parameters of torasemide that may be beneficial for avoiding drug–drug interactions in subjects with renal and hepatic dysfunction and for predicting doses in patients with different diseases.