[Update: prolonged-release torasemide]

Abstract

Chronic heart failure (CHF) is the cause of significant morbimortality all over the world and its incidence and prevalence are increasing. Fluid retention and volume overload are responsible of large part of morbility related to heart failure. There are a variety of therapy options for CHF, but loop diuretics play an essential role. Furosemide is the most commonly used loop diuretic. Torasemide is a loop diuretic belonging to the pyridine sulfonylurea class. It is a high-ceiling diuretic that has a longer half-life, longer duration of action and higher bioavailability compared to furosemide. It has additional actions such as antialdosterone and vasodilatation effects. It is the only loop diuretic for which it has been shown to effectively lower high blood pressure even with low doses. Thus, torasemide is recommended for CHF treatment instead of furosemide. Clinical trials have indicated that torasemide improves left ventricular function, reduces mortality as well as the frequency and duration of heart failure-related hospitalization. It also increases exercise tolerance, improves New York Heart Association functional classification and quality of life in patients with CHF. In addition, torasemide is a very safe drug. In a postmarketing surveillance study (TORIC) of 1,377 patients with CHF, torasemide significantly reduced cardiovascular mortality in comparison to furosemide. Torasemide reversed myocardial fibrosis and reduced collagen type I synthesis, improving cardiac remodeling in patients with CHF. Torasemide prolonged-release (PR) is a new formulation that, compared with torasemide immediate-release, has a similar systemic exposure but significantly slower rates of absorption and lower fluctuations in plasma concentrations. Its natriuretic efficiency is higher and diuresis is more constant, with a better tolerability.