Bumetanide

What is Bumetanide?

• Bumetanide (Bumex) is a loop diuretic used to treat edema caused by various medical problems, including heart, kidney, and liver disease.

Bumetanide structure

What are the uses of this medicine?

• Bumetanide (Bumex) is used for the treatment of edema associated with congestive heart failure, hepatic and renal disease, including the nephrotic syndrome.

Bumetanide ball-and-stick

How does this medicine work?

• Bumetanide is a loop diuretic with a rapid onset and short duration of action.
• The major site of bumetanide action is the ascending limb of the loop of Henle.
• Bumetanide inhibits sodium reabsorption in the ascending limb of the loop of Henle, as shown by marked reduction of free-water clearance (CH2O) during hydration and tubular free-water reabsorption (TCH2O) during hydropenia.
• Reabsorption of chloride in the ascending limb is also blocked by bumetanide, and bumetanide is somewhat more chloruretic than natriuretic.
• Potassium excretion is also increased by bumetanide, in a dose-related fashion.
• Bumetanide may have an additional action in the proximal tubule.
• Since phosphate reabsorption takes place largely in the proximal tubule, phosphaturia during bumetanide induced diuresis is indicative of this additional action.
• Bumetanide decreases uric acid excretion and increases serum uric acid.

Bumetanide Structural Formula V1

Who Should Not Use this medicine ?

This medicine cannot be used in patients with:

• anuria
• renal disease
• hepatic coma
• severe electrolyte depletion
• hypersensitive to this drug

What drug interactions can this medicine cause?

• Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.

Be sure to mention the following:

• medications for high blood pressure
• aminoglycoside antibiotics such as amikacin, gentamicin (Garamycin), or tobramycin (Bethkis, Tobi); corticosteroids (e.g., prednisone), digoxin (Lanoxin)
• indomethacin (Indocin, Tivorbex)
• lithium (Lithobid)
• probenecid (Probalan, Probenemid)

Is this medicine FDA approved?

• Bumetanide (bue met' a nide) is a potent loop diuretic that was approved for use in the United States in 1983 and continues to be used for the treatment of edema.

How should this medicine be used?

Recommended dosage: Oral Administration

• The usual total daily dosage of bumetanide tablets is 0.5 mg to 2 mg and in most patients is given as a single dose.
• If the diuretic response to an initial dose of bumetanide tablets is not adequate, in view of its rapid onset and short duration of action, a second or third dose may be given at 4- to 5- hour intervals up to a maximum daily dose of 10 mg.

Parenteral Administration:

• Bumetanide injection may be administered parenterally (intravenously and intramuscularly) to patients in whom gastrointestinal absorption may be impaired or in whom oral administration is not practical.
• The usual initial dose is 0.5 to 1 mg intravenously or intramuscularly.
• Intravenous administration should be given over a period of 1 to 2 minutes. If the response to an initial dose is deemed insufficient, a second or third dose may be given at intervals of 2 to 3 hours, but should not exceed a daily dosage of 10 mg.

Administration:

• Bumetanide comes as a tablet to take by mouth.
• It usually is taken once a day.
• When used to treat edema, a second or third dose may be given every 4 to 5 hours depending on the amount of swelling.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As tablet for oral administration contains 0.5 mg, 1 mg or 2 mg of bumetanide
• 4 mL and 10 mL vials for intravenous or intramuscular injection

This medicine is available in fallowing brand namesː

• Bumex

What side effects can this medication cause?

The most common side effects of this medicine include:

• muscle cramps
• dizziness
• hypotension
• headache
• nausea
• encephalopathy (in patients with pre-existing liver disease)

• Serious skin reactions (i.e., Stevens-Johnson syndrome, toxic epidermal necrolysis) have been reported.

Less frequent side effects to bumetanide are:

• impaired hearing
• pruritus
• electrocardiogram changes
• weakness
• hives
• abdominal pain
• arthritic pain
• musculoskeletal pain
• rash
• vomiting

What special precautions should I follow?

• The dose of bumetanide should be adjusted to the patient’s need. Excessive doses or too frequent administration can lead to profound water loss, electrolyte depletion, dehydration, reduction in blood volume and circulatory collapse.
• Hypokalemia can occur as a consequence of bumetanide administration. Treatment in such patients is best initiated in the hospital with small doses and careful monitoring of the patient’s clinical status and electrolyte balance. Supplemental potassium and/or spironolactone may prevent hypokalemia and metabolic alkalosis in these patients.
• Patients allergic to sulfonamides may show hypersensitivity to bumetanide.
• Since there have been rare spontaneous reports of thrombocytopenia from postmarketing experience, patients should be observed regularly for possible occurrence of thrombocytopenia.
• Serum potassium should be measured periodically and potassium supplements or potassium sparing diuretics added if necessary. Periodic determinations of other electrolytes are advised in patients treated with high doses or for prolonged periods, particularly in those on low-salt diets.
• Diuretics have been shown to increase the urinary excretion of magnesium; this may result in hypomagnesemia.
• It is not known whether this drug is excreted in human milk.
• Clinically apparent acute liver injury due to the loop diuretics is exceeding rare, if it occurs at all.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• acute profound water loss
• volume and electrolyte depletion
• dehydration
• reduction of blood volume
• circulatory collapse with a possibility of vascular thrombosis
• embolism

• Electrolyte depletion may be manifested by weakness, dizziness, mental confusion, anorexia, lethargy, vomiting and cramps.

Management of overdosage:

• In case of overdose, call the poison control helpline of your country. In the United States, call 1-800-222-1222.

• Overdose related information is also available online at poisonhelp.org/help.
• In the event that the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services. In the United States, call 911.
• Treatment consists of replacement of fluid and electrolyte losses by careful monitoring of the urine and electrolyte output and serum electrolyte levels.

Can this medicine be used in pregnancy?

• There are no adequate and well-controlled studies in pregnant women.
• Bumetanide should be given to a pregnant woman only if the potential benefit justifies the potential risk to the fetus.

Can this medicine be used in children?

• Safety and effectiveness in pediatric patients below the age of 18 have not been established.

What are the active and inactive ingredients in this medicine?

Active ingredient:

• BUMETANIDE

Inactive ingredients:

• ANHYDROUS LACTOSE
• MICROCRYSTALLINE CELLULOSE
• D&C YELLOW NO. 10
• FD&C BLUE NO. 1
• FD&C RED NO. 40
• MAGNESIUM STEARATE
• STARCH, CORN
• TALC

Who manufactures and distributes this medicine?

Manufactured by:

• Sandoz Inc.
• Princeton, NJ

What should I know about storage and disposal of this medication?

• Store at 20° to 25°C (68° to 77°F).
• Dispense contents in a tight, light-resistant container as defined in the USP with a child-resistant closure, as required.

• Dailymed label info on Bumetanide
• FDA Bumetanide

Bumetanide Resources
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