Torsemide vs. furosemide: Differences, similarities, and which one is better for you

In this article:

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated
• Efficacy
• Coverage and cost
• Side effects
• Interactions
• Warnings
• FAQs

If you’re struggling with fluid retention due to heart failure, your healthcare provider might prescribe a diuretic or “water pill” like torsemide or furosemide. These prescription drugs can help the body get rid of excess fluid by increasing urine production. Both medications can also be helpful for those with high blood pressure (hypertension).

While torsemide and furosemide are used for similar purposes, they differ in many ways, such as dosages, potential side effects, and drug interactions. For example, torsemide has less frequent dosing, which some people might prefer. The medications might also differ in price, influencing how you decide on a medication with your healthcare provider.

Continue reading to learn more about the similarities and differences between torsemide and furosemide.

What are the main differences between torsemide and furosemide?

The main difference between torsemide and furosemide is in their absorption and half-life. Torsemide has higher bioavailability than furosemide. In other words, the body absorbs torsemide more efficiently than furosemide. As a result, torsemide may have more consistent effects. 

Torsemide has a longer half-life than furosemide, with torsemide’s half-life at around four hours and furosemide’s at around two hours. Therefore, torsemide works longer before it’s cleared from the system. Torsemide is generally given once daily, while furosemide often needs to be given twice daily.

Main differences between torsemide and furosemide
	Torsemide	Furosemide
Drug class	Diuretic	Diuretic
Brand/generic status	Brand and generic version available	Brand and generic version available
What is the brand name?	Demadex Soaanz	Furoscix Lasix
What form(s) does the drug come in?	Oral tablet Solution for injection	Oral tablet Oral solution Solution for injection
What is the standard dosage?	Edema: 5 to 20 mg once daily, up to 200 mg per day. Hypertension: 5 to 10 mg once daily	Edema: 20 to 80 mg single dose. The second dose can be given 6 to 8 hours later. The dose may be increased on an individual basis, at the physician’s discretion, to 600 mg per day. Hypertension: 40 mg twice daily
How long is the typical treatment?	Short-term or long-term treatment, depending on the condition being treated	Short-term or long-term treatment, depending on the condition being treated
Who typically uses the medication?	Adults	Adults and certain children based on weight

Conditions treated by torsemide and furosemide

Torsemide and furosemide are loop diuretics approved by the U.S. Food and Drug Administration (FDA) for fluid retention, also known as edema. Symptoms of edema might include swelling in the legs, ankles, and feet, as well as abdominal swelling. Edema is most commonly associated with acute and chronic heart failure. However, it can also arise as a liver and kidney disease symptom. 

Torsemide and furosemide are also approved to treat high blood pressure. By getting rid of extra fluid, these medications can help lower blood pressure. Healthcare providers often prescribe them alongside other blood pressure medications to improve results and keep blood pressure healthy.

Conditions treated by torsemide and furosemide
Condition	Torsemide	Furosemide
Edema	Yes	Yes
Hypertension	Yes	Yes

Is torsemide or furosemide more effective?

Both torsemide and furosemide are effective diuretics for edema and hypertension. Furosemide is one of the most commonly used loop diuretics. However, torsemide is considered to be absorbed better by the body, bind more effectively to proteins, and stay in the system longer than furosemide. Still, the research is conflicting. 

The TRANSFORM-HF trial compared torsemide and furosemide, involving nearly 2,900 patients in the hospital for heart failure. The results showed that there was no noticeable difference in how well the two medications worked to improve symptoms or quality of life over a year for patients who were discharged. The torsemide and furosemide groups reported similar health scores, with a slight difference of 0.06 points on a scale from 0 to 100.

One meta-analysis analyzed 15 randomized trials comparing torsemide and furosemide for the management of heart failure. It found that torsemide reduced rehospitalization rates, with around 9% of patients needing to return to the hospital compared to around 13% for those on furosemide. Additionally, torsemide was linked to lower all-cause mortality, with only around 2% of patients dying from heart-related issues compared to around 4% for those taking furosemide.

More research is needed to compare the clinical outcomes of torsemide and furosemide. It’s important to discuss treatment options with a doctor or healthcare provider. Clinicians will look at a patient’s health, medical history, and any other medications they are taking before suggesting the best treatment option.

Coverage and cost comparison of torsemide vs. furosemide

Torsemide and furosemide are both available in generic forms, which typically makes them more affordable. Most insurance plans, including Medicare, cover these medications. However, the exact prices often depend on your insurance plan and the pharmacy you use. 

Retail costs for torsemide and furosemide are generally similar but can differ based on the prescribed quantity and strength. For instance, a higher strength or larger quantity may cost more. Different pharmacies may have varying prices, so it’s a good idea to compare them. 

Patients may save money on these prescriptions using coupons from services like SingleCare. These coupons offer discounts on medications even without insurance. For more savings, check the torsemide and furosemide coupon options on SingleCare.

Torsemide vs. furosemide costs
	Torsemide	Furosemide
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	Yes	Yes
Quantity	30 tablets (20 mg)	30 tablets (20 mg)
Typical Medicare copay	Varies	Varies
SingleCare cost	$6	$3

Common side effects of torsemide vs. furosemide

Both torsemide and furosemide can cause similar side effects, such as needing to urinate more often, upset stomach, dizziness, nausea, diarrhea, and constipation. These side effects are usually mild and temporary, often going away as the body adjusts to the medication.

In addition, both drugs may cause low blood pressure and changes in electrolyte levels (like sodium and potassium). These side effects happen because these medications increase the amount of urine produced, which can lead to imbalances in the body. Other potentially serious side effects may include inflammation of the pancreas (pancreatitis) and temporary hearing loss. 

Side effects of torsemide and furosemide
	Torsemide	Furosemide
Side Effect	Applicable?	Applicable?
Frequent urination	Yes	Yes
Upset stomach	Yes	Yes
Dizziness	Yes	Yes
Loss of appetite	Yes	Yes
Inflammation of the pancreas	Yes	Yes
Hypotension	Yes	Yes
Changes in electrolytes	Yes	Yes
Photosensitivity	Yes	Yes
Hearing loss	Yes	Yes
Constipation	Yes	Yes
Diarrhea	Yes	Yes
Nausea	Yes	Yes

This may not be a complete list of adverse effects that can occur. Please refer to your healthcare provider to learn more. 

Source: DailyMed (Torsemide), DailyMed (Furosemide)

Drug interactions of torsemide vs. furosemide

Torsemide and furosemide may have differences in what drugs they interact with. For example, torsemide is affected by drugs that influence the CYP2C9 enzyme in the liver, such as certain antifungals, antibiotics, anticoagulants, and anticonvulsants. The CYP2C9 enzyme helps break down torsemide in the body. Medications that affect this enzyme can change how well torsemide works, potentially leading to unwanted side effects or making it less effective.

As loop diuretics, torsemide, and furosemide also share many of the same drug interactions. For example, both torsemide and furosemide can be less effective when taken with NSAIDs like Advil (ibuprofen), Naprosyn (naproxen), and Celebrex (celecoxib). That’s because NSAIDs may contribute to fluid retention as a side effect. 

In addition, combining either torsemide or furosemide with blood pressure medications like angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) may increase the risk of severely low blood pressure and kidney problems. 

Both diuretics can reduce how quickly the body clears lithium, increasing the risk of lithium toxicity. Monitoring lithium levels is recommended when combined with either medication.

Torsemide and furosemide increase the risk of hearing damage (ototoxicity) when taken with aminoglycoside antibiotics (like gentamycin). This combination should be avoided unless absolutely necessary. 

Torsemide vs. furosemide interactions
Drug	Drug Class	Torsemide	Furosemide
Indocin (indomethacin) Naprosyn (naproxen) Voltaren (diclofenac) Advil (ibuprofen) Celebrex (celecoxib).	NSAID	Yes	Yes
Diflucan (fluconazole) Lamisil (terbinafine) Monistat (miconazole)	Antifungal	Yes	No
Rifadin (rifampin) Bactrim (sulfamethoxazole/trimethoprim) Edecrin (ethacrynic acid)  Garamycin (gentamicin) Tobramycin (tobramycin) Amikacin (amikacin)	Antibiotic	Yes	Yes
Coumadin (warfarin)	Anticoagulant	Yes	No
Dilantin (phenytoin)	Anticonvulsant	Yes	No
Questran (cholestyramine)	Bile acid sequestrant	Yes	Yes
Prinivil (lisinopril) Norvasc (amlodipine) Cozaar (losartan) Lopressor (metoprolol tartrate)	Antihypertensive	Yes	Yes
Deltasone (prednisone) Decadron (dexamethasone) Medrol (methylprednisolone)	Corticosteroid	Yes	Yes
Lithobid (lithium)	Mood stabilizer	Yes	Yes

This is not a complete list of drug interactions. Please consult your doctor before taking these medications.

Warnings of torsemide and furosemide

If too much fluid is lost, both torsemide and furosemide can cause dehydration, low blood pressure, and worsening kidney problems. They may also lead to imbalances in important electrolytes like potassium and sodium. In addition, both medications can cause hearing problems, such as ringing in the ears (tinnitus) or hearing loss. However, the risk of hearing damage is higher with high doses.

Torsemide and furosemide can increase blood sugar levels and, in some cases, increase uric acid levels, which could trigger gout. Although rare, liver damage is also possible with both medications. 

It’s important to mention other medical conditions or medications being taken to a healthcare provider before taking torsemide or furosemide. They can also go over other warnings and precautions to be aware of. 

Frequently asked questions about torsemide vs. furosemide

What is torsemide?

Torsemide is a diuretic medication often prescribed to reduce fluid retention in conditions like heart failure. It works by increasing the amount of urine your body produces, which helps to lower blood pressure and reduce swelling. Torsemide is particularly useful for heart failure patients who need to manage fluid buildup.

What is furosemide?

Furosemide is another diuretic medication that is commonly used to treat fluid retention and swelling caused by various medical conditions, including acute heart failure. Like torsemide, it helps the body eliminate excess fluid by increasing urine production. Furosemide is widely prescribed and has been in use for many years.

Are torsemide and furosemide the same?

No, torsemide and furosemide are not the same, although they are both diuretics used to treat fluid retention. They differ in their chemical structure and duration of action. Some studies suggest that torsemide may have a longer-lasting effect than furosemide, making it a potentially better option for some heart failure patients.

Is torsemide or furosemide better?

The comparative effectiveness of torsemide and furosemide can vary depending on the person and their overall condition. Some research suggests that torsemide may be more effective in certain cases, particularly for chronic heart failure patients. However, a healthcare provider should make the best choice based on a complete medical history.

Can I use torsemide or furosemide while pregnant?

Using torsemide during pregnancy may be relatively safe, as it is classified as Category B, while furosemide is Category C. However, both medications should be closely monitored by a healthcare provider, as they can potentially affect an unborn baby. Always consult a healthcare provider to weigh the benefits and risks of taking any medication while pregnant.

Can I use torsemide or furosemide with alcohol?

When taking medications like torsemide or furosemide, it’s usually best to stay away from alcohol. Drinking alcohol while using these medicines may increase the risk of experiencing side effects, such as dizziness and dehydration. Always listen to your doctor’s advice about whether it’s safe to drink alcohol when you’re on these medications.