bumetanide, Bumex, Burinex

 Indications

Edema due to heart failure, hepatic disease, or renal

impairment. Unlabeled Use: Reversal of oliguria in

preterm neonates.

Action

Inhibits the reabsorption of sodium and chloride from

the loop of Henle and distal renal tubule. Increases renal

excretion of water, sodium chloride, magnesium,

potassium, and calcium. Effectiveness persists in impaired

renal function. Therapeutic Effects: Diuresis

and subsequent mobilization of excess fluid (edema,

pleural effusions).

Pharmacokinetics

Absorption: Well absorbed after oral or IM administration.

Distribution: Widely distributed.

Protein Binding: 72–96%.

Metabolism and Excretion: Partially metabolized

by liver; 50% eliminated unchanged by kidneys and

20% excreted in feces.

Half-life: 60–90 min (6 hr in neonates).

TIME/ACTION PROFILE (diuretic effect)

ROUTE ONSET PEAK DURATION

PO 30–60 min 1–2 hr 4–6 hr

IM 30–60 min 1–2 hr 4–6 hr

IV 2–3 min 15–45 min 2–3 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Cross-sensitivity

with thiazides and sulfonamides may occur; Hepatic

coma or anuria.

Use Cautiously in: Severe liver disease (may precipitate

hepatic coma; concurrent use with potassiumsparing

diuretics may be necessary); Electrolyte depletion;

Diabetes mellitus; Increasing azotemia; Lactation,

Pedi: Safety not established; bumetanide is a potent displacer

of bilirubin and should be used cautiously in

critically ill or jaundiced neonates because of risk of

kernicterus. Injection contains benzyl alcohol, which

may cause gasping syndrome in neonates; Geri: May

haveqrisk of side effects, especially hypotension and

electrolyte imbalance, at usual doses.

Adverse Reactions/Side Effects

CNS: dizziness, encephalopathy, headache. EENT:

hearing loss, tinnitus. CV: hypotension. GI: diarrhea,

dry mouth, nausea, vomiting. GU:qBUN, excessive

urination. Derm: STEVENS-JOHNSON SYNDROME, TOXIC

EPIDERMAL NECROLYSIS, photosensitivity, pruritis, rash.

Endo: hyperglycemia, hyperuricemia. F and E: dehydration,

hypocalcemia, hypochloremia, hypokalemia,

hypomagnesemia, hyponatremia, hypovolemia, metabolic

alkalosis. MS: arthralgia, muscle cramps, myalgia. 

Interactions

Drug-Drug:qrisk of hypotension with antihypertensives,

nitrates, or acute ingestion of alcohol.

qrisk of hypokalemia with other diuretics, amphotericin

B, stimulant laxatives, and

corticosteroids. Hypokalemia mayqrisk of digoxin

toxicity.plithium excretion, may cause lithium toxicity.

qrisk of ototoxicity with aminoglycosides. NSAIDSpeffects

of bumetanide.

Route/Dosage

PO (Adults): 0.5–2 mg/day given in 1–2 doses; titrate

to desired response (maximum daily dose10

mg/day).

PO (Infants and Children): 0.015–0.1 mg/kg/dose

every 6–24 hrs (maximum: 10 mg/day).

PO (Neonates): 0.01–0.05 mg/kg/dose every 12–24

in term neonates or every 24–48 hrs in preterm neonates.

IM, IV (Adults): 0.5–1 mg/dose, may repeat q 2–3

hr as needed (up to 10 mg/day).

IM, IV (Infants and Children): 0.015–0.1 mg/kg/

dose every 6–24 hrs (maximum: 10 mg/day).

IM, IV (Neonates): 0.01–0.05 mg/kg/dose every 12–

24 in term neonates or every 24–48 hrs in preterm neonates.

Availability (generic available)

Tablets: 0.5 mg, 1 mg, 2 mg, 5 mg. Cost: Generic—

0.5 mg $30.20/100, 1 mg $44.52/100, 2 mg

$75.18/100. Injection: 0.25 mg/mL.