Class: Loop diuretic
- Tablets 0.5 mg
- Tablets 1 mg
- Tablets 2 mg
- Injection 0.25 mg/mL
Inhibits reabsorption of sodium and chloride in proximal tubules and loop of Henle.
Bumetanide is 72% to 96% protein bound.
Oxidation of the N-butyl side chain.
The t ½ is 60 to 90 min; 81% is excreted in urine, 45% as unchanged drug, and 2% in bile.
30 to 60 min.IV
1 to 2 h.IV
15 to 30 min.
4 to 6 h.
Special PopulationsRenal Function Impairment
The t ½ is prolonged.Children
Elimination is considerably slower in neonates.
Indications and Usage
Treatment of edema associated with CHF, hepatic cirrhosis, and renal disease.
Relief of adult nocturia.
Hypersensitivity to other loop diuretics or to sulfonylureas; anuria; hepatic coma or states of severe electrolyte depletion until condition is improved or corrected.
Dosage and AdministrationAdults
PO 0.5 to 2 mg/day as single dose. If inadequate response, give second or third dose at 4 to 5 h intervals up to max 10 mg/day.
IM / IV 0.5 to 1 mg/day over 1 to 2 min. May repeat at 2- to 3-h intervals, up to max 10 mg/day. Reserve parenteral route for situations in which GI absorption is impaired or when oral administration is not practical; replace with oral therapy as soon as possible.
If given by IV infusion, use solution within 24 h of preparation. Store at room temperature in tightly closed container.
Increased auditory toxicity.Cisplatin
Additive ototoxicity.Digitalis glycosides
Electrolyte disturbances may predispose to digitalis-induced arrhythmias.Lithium
Increased plasma lithium levels and toxicity.NSAIDs
Decreased effects of bumetanide.Salicylates
Impaired diuretic response in patients with cirrhosis and ascites.Thiazide diuretics
Synergistic effects that may result in profound diuresis and serious electrolyte abnormalities.
Laboratory Test Interactions
None well documented.
Hypotension; ECG changes; chest pain.
Asterixis; encephalopathy with pre-existing liver disease; vertigo; headache; dizziness.
Hives; pruritus; itching; nipple tenderness; rash; photosensitivity.
Impaired hearing; ear discomfort; tinnitus; deafness.
Upset stomach; dry mouth; nausea; vomiting; diarrhea; pain.
Premature ejaculation; difficulty maintaining erection; renal failure.
Thrombocytopenia; deviations in Hgb, Hct, prothrombin time and WBC, platelets, and differential counts.
Glucosuria and proteinuria; hyperuricemia; gout; hypochloremia; hypokalemia; azotemia; hyponatremia; increased serum creatinine; hyperglycemia; variations in phosphorus, CO 2 content, bicarbonate, and calcium; increases in LDL, total cholesterol, and triglycerides; decreases in HDL cholesterol.
Musculoskeletal weakness; arthritic pain; pain; muscle cramps; fatigue; dehydration; sweating.
Excessive amounts may cause profound diuresis and water/electrolyte depletion. Careful medical supervision required with dosage adjustment and schedule to individual patient need.
Check that baseline creatine, BUN, calcium, uric acid, and CBC have been obtained before beginning therapy and monitor throughout therapy. Observe for ototoxicity, especially in patients receiving drug via IV infusion and in those taking other ototoxic drugs. If tinnitus, hearing impairment, or fullness in ears is reported, notify health care provider.
Category C .
Safety and efficacy not established in children under 18 yr of age.
In severe chronic renal insufficiency, patients may benefit from continuous infusion (12 mg over 12 h), rather than from intermittent bolus therapy. Monitor renal function and discontinue drug if renal function decreases further.
Excessive diuresis may cause dehydration and decreased blood volume with circulatory collapse and possible vascular thrombosis and embolism, especially in elderly patients.
Hepatic cirrhosis and ascites
Sudden alterations of electrolyte balance may precipitate hepatic encephalopathy and coma.
Associated with rapid injection, very large doses or concurrent use of other ototoxic drugs.
Systemic lupus erythematosus
May be exacerbated or activated.
Profound water loss, volume and electrolyte depletion (characterized by weakness, dizziness, mental confusion, anorexia, lethargy, vomiting, cramps), dehydration, reduction in blood volume, circulatory collapse with possible thrombosis and embolism.
- Instruct patient to take as single dose early in day. Drug can be taken with food or milk to reduce GI upset.
- Advise patient to drink adequate fluids to prevent dehydration unless fluid restrictions apply.
- Caution patient to get out of bed slowly on arising, and to avoid sudden position changes to prevent orthostatic hypotension.
- If patient is not taking a potassium supplement, advise patient to increase potassium-rich foods in daily diet.
- Instruct patient to report the following symptoms to health care provider: signs of bleeding, weakness, cramps, nausea or dizziness.
- Caution patient to avoid exposure to sunlight, and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
- Advise diabetic patients to monitor blood glucose carefully because drug may cause loss of glycemic control.
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