Answers to our most frequently asked questions.

UpCard-CA1 is an oral solution containing torsemide, a potent loop diuretic conditionally approved by the FDA for managing pulmonary edema in dogs with congestive heart failure (CHF) caused by myxomatous mitral valve disease (MMVD).1

A conditionally approved animal drug has gone through the FDA drug approval process except the drug has not yet met the effectiveness standard for full approval. FDA’s conditional approval means that when used according to the label, the drug is safe and has a reasonable expectation of effectiveness. FDA’s conditional approval also means that the drug is properly manufactured.

While both are loop diuretics, torsemide, the active ingredient in UpCard-CA1, has a chemical structure different from furosemide. It has a longer half-life, higher bioavailability, greater potency, and longer duration of diuretic action.2

Potent Diuresis IconPotent diuresis: Torsemide is associated with a 2x reduction in risk of reaching cardiac endpoint vs. furosemide.3

Potent Diuresis IconOnce daily dosing: The 8-hr half-life allows for convenient once daily administration.3

 

Potent Diuresis IconEasy titration: The oral solution allows for precise, consistent dosing compared to splitting tablets.

Studies show UpCard-CA1 significantly increases urine output and was shown to be non-inferior to furosemide.1

UpCard-CA1 has a safety profile comparable to other loop diuretics.1 In studies up to 6 months, it was well-tolerated even at 1.5x the maximum conditionally approved dose.1 The safety findings were related to the expected effects of a loop diuretic.1 Torsemide (also known as torasemide) tablets have been approved for use as a veterinary diuretic in the EU since 2015.

UpCard-CA1 should be given at 0.05 to 0.2 mg/lb. (0.11 to 0.44 mg/kg) bodyweight once daily.4 The oral solution allows for easy titration without over or underdosing.

The label indication of UpCard-CA1 includes use with concurrent therapies due to the nature of the disease. In the pre-approval clinical trial, there was a need to include dogs that were already receiving other treatments (ACE inhibitors, pimobendan, spironolactone, and other drugs) prior to enrollment and these drugs were continued during the study to maintain patient safety. Because these study patients were on drugs prior to study enrollment, we had to list the drugs on the label to gain conditional approval.1

As CHF progresses, some dogs may develop diuretic resistance, where they stop responding adequately to their prescribed dose. UpCard-CA1, with its longer half-life, higher potency, and longer duration of action compared to furosemide, may help combat this resistance.1

A pharmacokinetic study demonstrated similar bioavailability between the tablet formulation of torsemide used in earlier studies and the oral solution of UpCard-CA1.1 The solution provides more precise dosing compared to splitting tablets.

In a survey, veterinarians noted that the main barriers were associated with pet owner compliance due to challenging administration and multiple daily dosing.5 The most important factors for choosing a CHF treatment were safety, convenience/compliance, and efficacy.5

The once daily dosing of UpCard-CA1 is more convenient than furosemide which often requires dosing 2-3 times per day. In a study with 319 dogs, torsemide achieved higher owner compliance.2 The oral solution eliminates the need for splitting or crushing pills and enables more precise dosing.

UpCard-CA1 is conditionally approved by the FDA pending a full demonstration of effectiveness under application number 141-577. It is a violation of Federal law to use this product other than as directed in the labeling.

IMPORTANT SAFETY INFORMATION: UpCard-CA1 is for use in dogs only. Do not administer to dogs with renal failure, anuria, severe dehydration, hypovolemia, or hypotension. Do not administer UpCard-CA1 concomitantly with other loop diuretics or to dogs with hypersensitivity to the active substance, torsemide, or to any of the excipients. UpCard-CA1 should be used only in stable dogs with congestive heart failure caused by MMVD which has been diagnosed by means of a comprehensive physical and cardiac examination. This drug has not been evaluated in dogs used for breeding, pregnant, or lactating bitches. The most common side effects seen in dogs with CHF due to MMVD while taking UpCard-CA1 are cough, dyspnea, pulmonary edema, and cardiac arrest. Adverse reactions not related to disease progression in dogs receiving UpCard-CA1 include polyuria and polydipsia, renal insufficiency, increased BUN and serum creatinine, urinary incontinence, hypokalemia, hypochloremia, hypercalcemia, hypomagnesemia, diarrhea, vomiting, and inappetence.  For full prescribing information, visit vetoquinolusa.com/upcard-ca1-info.

References

1UpCard-CA1 Freedom of Information summary.
2Besche B, et al. Efficacy of oral torasemide in dogs with degenerative mitral valve disease and new onset congestive heart failure: The CARPODIEM study. J Vet Intern Med. 2020;34(5):1746–1758.
3Chetboul V, et al. Short-Term Efficacy and Safety of Torasemide and Furosemide in 366 Dogs with Degenerative Mitral Valve Disease: The TEST Study. J Vet Intern Med. 2017;31(6):1629–1642.
4 UpCard-CA1 Product label.
5 UpCard-CA1 Market study.