Clinical effect of torsemide in a horse with congestive heart failure and atrial fibrillation.
Authors: Ferlini Agne G, Kapusniak A E, Wooldridge A A, Jung S W
Journal: Journal of equine veterinary science
Summary
# Editorial Summary A mature horse presenting with congestive heart failure and atrial fibrillation was treated with escalating oral doses of torsemide (beginning at 6 mg/kg twice daily, increasing to 12 mg/kg twice daily from day 4 onwards) over a seven-day period, with plasma drug concentrations, clinical signs, electrocardiographic findings, and serum biochemistry monitored throughout. The drug was well absorbed orally, achieving a peak plasma concentration of 15.41 µg/mL by day 5, and clinical improvement was evident by day 7, with marked reduction in ventral oedema and venous congestion; however, the treatment course was associated with mild hyponatremia and hypochloraemia, moderate hypokalaemia, and elevated renal markers requiring close monitoring. Whilst this single case suggests torsemide warrants consideration as an oral alternative to intravenous furosemide in equine CHF management—potentially offering practical advantages for chronic outpatient therapy—the high doses employed here should be reserved for cases refractory to lower dosing regimens, given the electrolyte disturbances observed. The findings indicate a need for larger, prospective investigations with longer follow-up periods to establish torsemide's efficacy and safety profile in equine cardiac patients before it becomes standard practice in clinical settings.
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Practical Takeaways
- •Oral torsemide may offer a viable alternative to intravenous furosemide for managing equine CHF, with apparent clinical benefit demonstrated in this case
- •High-dose torsemide should be reserved for cases unresponsive to lower doses and requires close monitoring of electrolyte panels and renal function throughout treatment
- •Expect electrolyte disturbances (hypokalemia particularly) with high-dose loop diuretic therapy and plan supplementation or dietary adjustments accordingly
Key Findings
- •Torsemide was absorbed after oral administration with peak plasma concentration of 15.41 µg/mL at day 5
- •Clinical improvement in ventral edema and venous congestion was subjectively noted by day 7
- •Treatment resulted in mild hyponatremia and hypochloremia, and moderate hypokalemia
- •High-dose torsemide (up to 12 mg/kg every 12 hours) was well tolerated with no electrocardiographic changes related to drug administration