ESTIMATION OF THE MARKET POTENTIAL OF FUROSEMIDE AND

TORASEMIDE IN THE MANAGEMENT OF HYPERTENSION

BY - PRATEEK KUMAR

INTRODUCTION

• Hypertension is defined as a sustained increase in blood pressure ≥140/90 mm Hg.

• In 2000 the number of people with hypertension in India was 60.4 million males and 57.8 million females.

• Loop diuretics are drugs which are used in the treatment of hypertension.

OBJECTIVES

1) To study the position of diuretics in general and loop diuretics in particular, in the antihypertensive drugs’ market.

2) To estimate the market potential of Furosemide and its combinations in the antihypertensive drugs’ market.

3) To estimate the market potential of Torasemide and its combinations in the antihypertensive drugs’ market.

4) To arrive at the top brands of Furosemide and Torasemide and their combinations

5) To estimate and compare the prescribing of Torasemide for Hypertension, Liver Cirrhosis , Congestive Heart failure and Nephrotic syndrome.

6) To prepare a training manual for the promotion of Torasemide to Doctors.

REVIEW OF LITERATURE

FUROSEMIDE

• Furosemide - orally and rapidly acting highly efficacious diuretic was a break-through.

• The Diuretic action goes on increasing with increasing dose: upto 10 L of urine may be produced in a day. The major site of action is the thick AscLH where furosemide inhibits Na+-K+-2Cl- symporter (co-transporter).

• Blocks positive as well as negative free water clearance. K+ excretion is increased mainly due to Na+ load reaching Distal tubule.

TORASEMIDE

• Torsemide is a pyridine-sulfonyl urea type loop diuretic mainly used in the management of edema associated with congestive heart failure. It is also used at low doses for the management of hypertension.

• Torasemide- Properties similar to furosemide but it is three times more potent.

• Torasemide is well absorbed from gastrointestinal tract. Torasemide is extensively bound to plasma proteins .

Market of Diuretics

• Diuretics market 774 crores. • Diuretic combinations 587 crores • Plain diuretics around 188 crores.• Loop Diuretics’ 110 crores in 2010 and recorded a

14 crores growth over previous year.• Furosemide and its combinations had a market

share of around 47 crores with Torasemide and its combinations having around 62 crores.

• Torasemide is a loop diuretic with similar properties as furosemide but 3 times more potent. Oral absorption is more rapid and more complete. It has been used in several indications.

METHODOLOGY

• Primary data source

– DOCTORS: Inclusion criteria:-Cardiologists, Physicians, Nephrologists, Diabetologists and Gastroenterologists were included in the survey. Exclusion criteria:-Doctors of the other specialties’ were excluded from the study.

– CHEMISTS: Inclusion criteria:- Allopathic retail medical stores and Pharmacy in Hospitals were included in the survey. Exclusion criteria:-Homeopathic, Ayurvedic and Unani medical stores were excluded from the survey.

METHODOLOGY

2) Secondary data source-A) Textbooks on PharmacologyB) Pharma magazinesC) Pharmaceutical journals 

•Method of data collection• Sampling technique: convenience sampling

– Doctors: 103 doctors– Chemists: 100 retail pharmacists– Survey area: The survey was carried out in Bangalore and

Hyderabad.– The data obtained was tabulated and graphed using Microsoft

Excel and various aspects were analyzed and compared.

DOCTORS

• Ranking of drugs used in first line therapy of Hypertension.• Specific indication in which Loop Diuretic is used.• Advantages and disadvantages of Torasemide over Furosemide• Ranking of Furosemide and Torasemide Combination• Top prescribing Brands • Other conditions and number of prescriptions / week.

CHEMISTS

• Name of drugs• Brands of Anti-Hypertensive drugs• Other condition where Torasemide is prescribed• Brands of Furosemide and Torasemide

DOCTOR ANALYSIS

Graph 1: Number of patients treated per day

Graph 2: Number of Hypertensive patients treated per day

DOCTOR ANALYSIS

CONTD…

Graph 3: Preferred classes of drugs/drug combinations as first line therapy of Hypertension - Bangalore

Data

Graph 4: Preferred classes of drugs/drug combinations as first line therapy of Hypertension - Hyderabad

Data

CONTD…

Table 8 – Conditions where loop diuretics are specifically used

Conditions when Loop

Diuretics are specifically

used

Number of respondents

Bangalore(27) Hyderabad(48)

Hypertension with edema 17 14

CHF and CRF with edema 4 9

CHF + edema 3 2

CRF 0 2

Elderly patient with Renal

Impairment

0 15

Others Elderly patients, Diabetes

with Stage 2

Hypertension, Resistant

Hypertension

Diabetes with Stage 2

Hypertension, Primary

Hypertension, As a second

line additive to first line

antihypertensive.

CONTD…

Graph 5: Preferred choice of combination therapy (Bangalore Data)

Graph 6: Preferred choice of combination therapy (Hyderabad Data)

Graph 8 – Most Commonly prescribed

Brands of Loop Diuretics (Hyderabad

Data)

Graph 7 – Most Commonly prescribed Brands of Loop Diuretics (Bangalore Data)

Use of Torasemide for conditions other than Hypertension

Speciality Liver Cirrhosis Congestive heart failure

Nephrotic Syndrome

Cardiologists 29% 71% 29%

Diabetologists 61% 69% 29% Gastroenterologists 100% 0% 0%

Nephrologists 0% 37% 100%

Physicians 69% 85% 71%

Average Number of prescriptions for various disorders

Specialty Bangalore Hyderabad

Liver Cirrhosi

s

Congestive Heart Failure

Nephrotic

Syndrome

Liver Cirrhosi

s

Congestive Heart Failure

Nephrotic

Syndrome

Cardiologists 1 2.7 1 0.6 15.8 6.3

Diabetologists 0.4 0.6 0.3 3.1 2.3 0.8

Gastroenterologists

60 0 0 26.6 0 0

Nephrologists 0 0 9 0 0 15

Physicians 0.7 2.6 1.8 2.4 5.3 1.9

CHEMIST ANALYSIS

Number of prescriptions dispensed per day

Anti-Hypertensive prescriptions

dispensed per day

CONTD…

Drugs commonly prescribed for Hypertension

(Hyderabad Data)

Drugs commonly prescribed for Hypertension

(Bangalore Data)

CONTD…

Most widely dispensed brands of Anti-Hypertensive drugs (Bangalore Data)

Most widely dispensed

brands of Anti-Hypertensive

drugs (Hyderabad

Data)

Conditions where Torasemide is prescribed

CONTD…Commonly prescribed brands of Furosemide

Brand Names Bangalore Average No. of Strips/day

Hyderabad Average No. of Strips/day

Lasix 40 10.6 Frusenex 11.7 1.08 Fruselac 12.6 1.4 Amifru 14.6 1.2

Fruselac DS 11.6 0.2

Commonly prescribed brands of Torasemide

Brand Names Bangalore Average No. of Strips/day

Hyderabad Average No. of Strips/day

Dytor 11.1 5.3 Tide 2.7 1.5

Torget 2.4 0.1 Toride 4 0.1 Torsea 2.3 0

TRAINING MANUAL

• Hypertension and classes of drug used in Hypertension.

• Renin-Angiotensin-Aldosterone System• Loop Diuretics – Torasemide drug

information and packaging. Dosage and Administration.

• A visual aid was prepared for X-TOR and X-TOR PLUS

CONCLUSION

• Based on our findings and secondary data we decided to position Torasemide for the treatment of Hypertension, Edema with CHF and CRF and a combination of Torsemide+Spironolactone for hypertension with Hyperaldosteronism in the treatment of Edema associated with Secondary Hyperaldosteronism, CHF and Nephrotic Syndrome, Liver Cirrhosis.

• Our brands are called X-TOR and X-TOR PLUS. A training manual and a visual aid have been prepared for the brand. The main Doctors which are to be targeted for X-TOR and X-TOR PLUS are Physicians, Cardiologists, Nephrologists, Diabetologists and Gastroenterologists. The USP for X-TOR will be potency, safety flexibility in dosing.