Long-term efficacy of torsemide compared with frusemide in cirrhotic patients with ascites

Background: Torsemide is a new loop diuretic that has shown, in short-term studies, to induce a longer and higher diuretic and natriuretic action than frusemide. However, torsemide long-term effects and complications have not been sufficiently investigated. The aim was to compare the efficacy and sa fety of torsemide versus frusemide in cirrhotic patients with uncomplicated ascites. Methods: Forty-six patients were randomized in two groups to rece ive torsemide 20 mg/day (n = 22) or frusemide 40 mg/day (n = 24). Both drug s were administered in association with spironolactone 200 mg/day. The init ial doses of diuretics were increased every 3 days up to 60, 120 and 400 mg /day, respectively, if the body weight loss was less than 300 g/day or natr iuresis was below 50 mEq/day. Results: Torsemide induced a significantly gr eater diuretic response than frusemide at 24 h and the maximum diuresis whi le mean diuresis Was similar in bath groups. Natriuresis was also higher wi th torsemide but the difference was not significant, The body weight loss, the treatment period, the ascites resolution and complications were similar in both groups. Diuretic doses were increased in two patients treated with torsemide and in nine patients treated with frusemide (P < 0.05). Conclusi ons: These results show that torsemide is as effective and safe as frusemid e for long-term treatment of cirrhotic patients with ascites.