Torsemide or Furosemide

Mechanistic Differences between Torsemide and Furosemide - PubMed

So in heart failure patients, which diuretic will be better? 

Furosemide or Torsemide 

Results of study led by Dr Testani from Yale med school was recently published in Journal of American Society of nephrology

This was a multicenter, prospective, observational mechanistic study evaluating patients with heart failure-randomized 1:1 to oral furosemide versus oral torsemide

Key findings from the study: 

1. More torsemide was recovered in the urine then furosemide suggesting higher bioavailability of furosemide

2. Natriuresis (salt excretion) was substantially greater in the torsemide group (FENa) 4.1%63.5% versus 2.5%62.4%, P , 0.001)

3. There was a greater neurohormonal activation seen with Torsemide compared to Furosemide thus limiting the actual benefits derived from greater salt loss with Torsemide

The study highlights the empirical observation that it not the type of diuretic that achieves the results but the "right dose" that matters the most.