Bumetanide

Bumetanide is used to reduce extra fluid in the body (edema) caused by conditions such as congestive heart failure, liver disease, and kidney disease. Getting rid of extra water helps to reduce fluid in the lungs so that you can breathe easier. It also helps to decrease swelling of the arms, legs, and stomach/abdomen. Bumetanide is known as a diuretic (the same kind of drug as a "water pill"). It causes your body to get rid of extra water by increasing the amount of urine you make.

• Bumetanide is available under the following different brand names: Bumex, and Burinex.

Adult and pediatric dosages:

Injectable solution

• 0.25 mg/ml

Tablet

• 0.5 mg
• 1 mg
• 2 mg

Dosage Considerations – Should be Given as Follows:

Edema in Adults

• Orally: 0.5-2 mg once; may be repeated in 4-5 hours for up to 2 doses; not to exceed 10 mg/day
• Intramuscular: 0.5-1 mg once; may be repeated in 2-3 hours for up to 2 doses; not to exceeded 10 mg/day
• Intravenously: 1 mg initially, then 0.5-2 mg/hour

Pediatric (off-label)

• Infants under 6 months: 0.01-0.05 mg/kg once daily or every other day; the optimum diuretic effect is reported at 0.04 mg/kg; lower dosages have been shown to have greater efficacy
• Infants 6 months and older: 0.015-.01 mg/kg once daily or every other day; not to exceed 10 mg/day

Hypertension (off-label)

• 1 mg intravenous loading dose, then 0.5-2 mg/day orally divided every 12 hours

Geriatric

Dosing Considerations

1 mg bumetanide is roughly equivalent to 40 mg furosemide

• Edema due to congestive heart failure, hepatic disease, or nephrotic syndrome
  • Use with fluid retention refractory to thiazides or with impaired renal function
  • It may be tried if the patient is allergic to furosemide

Overdose Management

• Normal saline may be used for volume replacement
• Dopamine or norepinephrine may be used to treat hypotension
• Treat hyperkalemia with intravenous glucose (D25W) with rapid-acting insulin and concurrent intravenous sodium bicarbonate; use oral and rectal solutions of sodium polystyrene in sorbitol if needed
• If dysrhythmia due to decreased potassium or magnesium is suspected, replace aggressively
• Discontinue treatment if no symptoms are apparent after 6 hours

Side effects of bumetanide include:

• high blood uric acid levels
• low blood calcium levels
• low blood potassium levels
• high blood urea nitrogen (BUN)
• low blood sodium
• high blood sugar (hyperglycemia)
• increased serum creatinine
• variations in phosphorus
• variations in CO2 content
• variations in bicarbonate
• variations in calcium
• variations in protein in the red blood cells
• clotting time for the blood
• red blood cell count
• low platelet count
• dizziness
• muscle cramps
• damage to the inner ear
• tremor of the hand
• dehydration
• low blood pressure (hypotension)
• dizziness upon standing
• itching
• rash
• kidney (renal) failure
• serious skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis)
• spinning sensation (vertigo)
• vomiting
• headache
• nausea
• brain disease
• electrocardiogram changes
• weakness
• abdominal pain
• arthritic pain
• musculoskeletal pain
• chest pain
• sweating
• hyperventilation
• dry mouth
• nipple tenderness
• diarrhea
• premature ejaculation
• difficulty maintaining an erection

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Bumetanide has no known severe interactions with other drugs.
• Serious Interactions of bumetanide include:
  • amikacin
  • amisulpride
  • cisapride
  • gentamicin
  • kanamycin
  • neomycin (oral)
  • netilmicin
  • paromomycin
  • squill
  • streptomycin
  • tobramycin
• Bumetanide has moderate interactions with at least 148 different drugs.
• Bumetanide has mild interactions with at least 86 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns, or for more information about this medicine.

Warnings

• Bumetanide is a potent diuretic that, if given in excessive amounts, may lead to a profound diuresis with water and electrolyte depletion
• Careful medical supervision is required; dosing must be adjusted to the patient's needs
• This medication contains bumetanide. Do not take Bumex or Burinex if you are allergic to bumetanide or any ingredients contained in this drug
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

• Documented hypersensitivity to bumetanide or sulfonamides
• Severe uncorrected electrolyte depletion, anuria, hepatic coma

Effects of Drug Abuse

• No information available

Short-Term Effects

• See "What Are Side Effects Associated with Using Bumetanide?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Bumetanide?"

Cautions

• Risk of electrolyte imbalance, alterations in glucose metabolism, blood dyscrasias, development of oliguria or increased blood urea nitrogen (BUN) or creatinine, hepatic disease, hyperuricemia, hypokalemia, hypomagnesemia, hypovolemia, neonates at risk for kernicterus
• Risk of ototoxicity with rapid intravenous (IV) administration
• Fluid status and renal function should be monitored to prevent oliguria, increased creatinine and BUN, and azotemia
• Asymptomatic hyperuricemia is reported
• Use with caution in patients with cirrhosis
• Coadministration with an antihypertensive agent may increase the risk of hypotension

Pregnancy and Lactation

• Use bumetanide during pregnancy with caution if benefits outweigh risks
• Animal studies show risk and human studies are not available, or neither animal nor human studies were done
• It is unknown if bumetanide is excreted in breast milk; use with caution if breastfeeding