Table 1.

Potential advantages of torsemide over furosemide in the treatment of heart failure

Pharmacologic properties better suited for managing congestion   • More predictable and reliable diuretic effect  - Near 100% bioavailability compared with variable furosemide bioavailability (i.e. 10–100%)  - Absorption not affected by food  - 2–4 times more potent than furosemide  - May be less vulnerable to diuretic resistance   • Longer half-life (3.5h vs. 2h) and duration of effect (6–16h vs. 6–8h) than furosemide   • Less prone to hypokalaemia Favourable effects on neurohormones   • Renin-angiotensin-aldosterone system inhibition  - Decreased aldosterone secretion from adrenal cells  - Aldosterone antagonist-like blockade of aldosterone receptors  - Inhibition of downstream effects of angiotensin II   • Decreased sympathetic activation Favourable effects on cardiac remodelling   • Slows or reverses development of myocardial fibrosis   • Attenuates progressive ventricular dilation and hypertrophy