Eplerenone + Torsemide
Find more information about this combination medication at the webpages for Eplerenone and Torsemide
Hypertension, Systolic Heart Failure ... show more
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Advisory
- This medicine contains a combination of 2 drugs Eplerenone and Torsemide.
- Eplerenone and Torsemide are both used to treat the same disease or symptom but work in different ways in the body.
- Most doctors will advise making sure that each individual medicine is safe and effective before using a combination form.
Drug Status
Government Approvals
None
WHO Essential Medicine
NO
Known Teratogen
NO
Pharmaceutical Class
Aldosterone Antagonist and Loop Diuretic
Controlled Drug Substance
NO
Summary
Eplerenone is primarily used to treat high blood pressure, which is a condition where the force of the blood against the artery walls is too high, and heart failure after a heart attack, which is when the heart can't pump blood as well as it should. Torsemide is used to treat high blood pressure and edema, which is swelling caused by excess fluid trapped in the body's tissues, often associated with heart, kidney, or liver disease. Both medications help manage high blood pressure, but Eplerenone is specifically indicated for heart failure management, while Torsemide is primarily used for fluid retention conditions.
Eplerenone works by blocking aldosterone, which is a hormone that increases blood pressure by causing the body to retain sodium and water. By inhibiting aldosterone, Eplerenone helps lower blood pressure and reduce the risk of cardiovascular events. Torsemide is a diuretic, which means it helps the kidneys remove excess fluid and salt from the body by increasing urine production. This action reduces fluid retention and lowers blood pressure. While both medications help manage high blood pressure, Eplerenone targets hormonal pathways, whereas Torsemide increases urine production to reduce fluid retention.
For Eplerenone, the usual starting dose for high blood pressure is 50 mg once daily, which can be increased to 50 mg twice daily if needed. For heart failure after a heart attack, the starting dose is 25 mg once daily, titrated to 50 mg once daily. Torsemide's usual dose for treating edema is 10 mg or 20 mg once daily, which can be increased if necessary. For high blood pressure, the starting dose is 5 mg once daily, which can be increased to 10 mg if needed. Both medications are taken orally, which means by mouth, and can be taken with or without food.
Common side effects of Eplerenone include headache, which is pain in the head, dizziness, diarrhea, which is loose or watery stools, and stomach pain. Serious side effects can include chest pain, irregular heartbeat, and high potassium levels, which is an electrolyte imbalance. Torsemide may cause frequent urination, dizziness, and headache, with serious side effects including dehydration, which is a lack of fluids, electrolyte imbalance, and hearing loss. Both medications can cause dizziness and require monitoring for electrolyte imbalances. Patients should report any severe or persistent side effects to their healthcare provider.
Eplerenone should not be taken with potassium supplements or salt substitutes containing potassium, as it can lead to high potassium levels. It is contraindicated in patients with high potassium levels, severe kidney impairment, or those taking strong CYP3A inhibitors, which are drugs that can increase Eplerenone's blood levels. Torsemide is contraindicated in patients with anuria, which is the inability to urinate, or hepatic coma, which is a severe liver condition. It requires caution in those with electrolyte imbalances or kidney disease. Both medications require careful monitoring of potassium levels and kidney function, and patients should inform their healthcare provider of all medications they are taking to avoid potential interactions.
Indications and Purpose
How does combination of Eplerenone and Torsemide work?
Eplerenone works by blocking the action of aldosterone, a hormone that increases blood pressure by causing the body to retain sodium and water. By inhibiting aldosterone, Eplerenone helps lower blood pressure and reduce the risk of cardiovascular events. Torsemide, on the other hand, is a diuretic that acts on the kidneys to increase the excretion of sodium, chloride, and water, thereby reducing fluid retention and lowering blood pressure. Both medications help manage high blood pressure, but Eplerenone targets hormonal pathways, while Torsemide increases urine production.
How effective is combination of Eplerenone and Torsemide?
Eplerenone's effectiveness is supported by clinical trials showing its ability to lower blood pressure and improve survival in patients with heart failure post-myocardial infarction. It has been shown to reduce the risk of cardiovascular events. Torsemide's efficacy is demonstrated through its ability to reduce blood pressure and edema in patients with heart failure, renal, or hepatic disease. Both medications have been proven effective in managing high blood pressure, with Eplerenone focusing on hormonal pathways and Torsemide acting as a diuretic. Clinical trials and studies provide evidence for their respective benefits in treating these conditions.
Directions for Use
What is the usual dose of combination of Eplerenone and Torsemide?
For Eplerenone, the usual starting dose for hypertension is 50 mg once daily, which can be increased to 50 mg twice daily if needed. For heart failure post-myocardial infarction, the starting dose is 25 mg once daily, titrated to 50 mg once daily. Torsemide's usual dose for treating edema is 10 mg or 20 mg once daily, which can be increased if necessary. For hypertension, the starting dose is 5 mg once daily, which can be increased to 10 mg if needed. Both medications are used to manage high blood pressure, but Eplerenone is also used for heart failure, while Torsemide is primarily for edema.
How does one take combination of Eplerenone and Torsemide?
Eplerenone can be taken with or without food, but patients should avoid salt substitutes containing potassium and discuss grapefruit juice consumption with their doctor. Torsemide should also be taken around the same time each day, with or without food. Patients on Torsemide may need to follow a low-salt diet and increase potassium-rich foods if advised by their doctor. Both medications require adherence to dietary instructions to avoid potential interactions and side effects, and patients should consult their healthcare provider for personalized dietary advice.
For how long is combination of Eplerenone and Torsemide taken?
Eplerenone is typically used as a long-term treatment for managing high blood pressure and heart failure, as it does not cure these conditions but helps control them. Patients are advised to continue taking it even if they feel well. Similarly, Torsemide is used for long-term management of high blood pressure and edema, as it controls but does not cure these conditions. Both medications require ongoing use to maintain their therapeutic effects, and patients should not stop taking them without consulting their doctor.
How long does it take for combination of Eplerenone and Torsemide to work?
Eplerenone typically takes about 4 weeks or longer to show its full benefits in controlling high blood pressure. It works by blocking aldosterone, a natural substance that raises blood pressure. On the other hand, Torsemide, a diuretic, starts working within 1 hour of oral administration, with its peak effect occurring within 1 to 2 hours. It helps reduce fluid retention by increasing urine production. Both medications are used to manage high blood pressure, but they work through different mechanisms and have different onset times. Eplerenone is slower to show effects, while Torsemide acts quickly to reduce fluid retention.
Warnings and Precautions
Are there harms and risks from taking combination of Eplerenone and Torsemide?
Common side effects of Eplerenone include headache, dizziness, diarrhea, and stomach pain. Serious side effects can include chest pain, irregular heartbeat, and high potassium levels. Torsemide may cause frequent urination, dizziness, and headache, with serious side effects including dehydration, electrolyte imbalance, and hearing loss. Both medications can cause dizziness and require monitoring for electrolyte imbalances. Patients should report any severe or persistent side effects to their healthcare provider. While both medications share some common side effects, each has unique adverse effects related to their specific mechanisms of action.
Can I take combination of Eplerenone and Torsemide with other prescription drugs?
Eplerenone should not be used with strong CYP3A inhibitors like ketoconazole, as they can increase its blood levels. It also interacts with ACE inhibitors and ARBs, increasing the risk of high potassium levels. Torsemide can interact with NSAIDs, reducing its diuretic effect, and with other diuretics, increasing the risk of dehydration and electrolyte imbalance. Both medications require careful monitoring when used with other drugs that affect kidney function or electrolyte balance. Patients should inform their healthcare provider of all medications they are taking to avoid potential interactions.
Can I take combination of Eplerenone and Torsemide if I am pregnant?
Eplerenone's safety during pregnancy is not well-established, and it should be used only if the potential benefits justify the risks to the fetus. Torsemide has shown no teratogenic effects in animal studies at low doses, but high doses have caused fetal harm in animals. Both medications should be used during pregnancy only if clearly needed, and healthcare providers should carefully consider the potential risks and benefits. Pregnant women should consult their healthcare provider before using these medications to ensure the safety of both mother and fetus.
Can I take combination of Eplerenone and Torsemide while breastfeeding?
There is limited information on the safety of Eplerenone during breastfeeding, and it is unclear if it is excreted in human milk. Caution is advised, and breastfeeding mothers should consult their healthcare provider. Torsemide's presence in human milk is also unknown, but diuretics can suppress lactation. Breastfeeding mothers should avoid using Torsemide or consult their healthcare provider for advice. Both medications require careful consideration during lactation, and healthcare providers should weigh the benefits against potential risks when prescribing these medications to breastfeeding mothers.
Who should avoid taking combination of Eplerenone and Torsemide?
Eplerenone is contraindicated in patients with high potassium levels, severe kidney impairment, or those taking strong CYP3A inhibitors. It requires caution in patients with diabetes or liver disease. Torsemide is contraindicated in patients with anuria or hepatic coma and requires caution in those with electrolyte imbalances or kidney disease. Both medications can cause significant electrolyte disturbances and require regular monitoring. Patients should be aware of the risk of dehydration and report any symptoms of dizziness or muscle weakness to their healthcare provider. Both drugs require careful use in patients with renal or hepatic conditions.
