Bumetanide

1. Introduction

Bumetanide, commonly marketed under brand names such as Bumex and Burinex, is a potent loop diuretic used to treat fluid retention (oedema) associated with heart failure, liver disease, kidney disease, and other conditions. It works by inhibiting sodium and chloride reabsorption in the loop of Henle, leading to increased urine output.

2. Indications

  • Approved Indications:
    • Oedema associated with:
      • Congestive heart failure.
      • Liver cirrhosis.
      • Renal disease, including nephrotic syndrome.
  • Off-Label Uses:
    • Acute hypercalcaemia (as part of a diuretic protocol).
    • Acute pulmonary oedema (as an adjunctive therapy).

3. Dosage

  • Adults:
    • Oral: 0.5–2 mg once daily, may be increased to a maximum of 10 mg daily in divided doses.
    • Intravenous (IV)/Intramuscular (IM): 0.5–1 mg administered over 1–2 minutes; may be repeated every 2–3 hours if needed (maximum 10 mg/day).
  • Paediatric Dosage:
    • Oral: 0.015–0.1 mg/kg/dose once or twice daily (maximum 10 mg/day).
    • IV: 0.015–0.1 mg/kg/dose, repeated as necessary (maximum 10 mg/day).

4. Administration

  • Oral: Take with or without food.
  • IV/IM: Administer slowly to prevent ototoxicity.

5. Forms Available

  • Tablets: 0.5 mg, 1 mg, 2 mg.
  • Injectable solution: 0.25 mg/mL (2 mL ampoule).

6. Side Effects

6.1. Common Side Effects

  • Electrolyte imbalances (e.g., hypokalaemia, hypomagnesaemia).
  • Dizziness.
  • Dehydration.

6.2. Less Common Side Effects

  • Muscle cramps.
  • Nausea or vomiting.

6.3. Rare but Serious Side Effects

  • Ototoxicity (hearing loss, tinnitus, especially with high doses or rapid IV administration).
  • Severe hypovolaemia.
  • Hyperuricaemia leading to gout.

7. Warnings

  • Use cautiously in patients with severe electrolyte depletion or dehydration.
  • Avoid in patients with anuria (complete inability to produce urine).
  • Risk of ototoxicity is increased with rapid IV administration or concomitant use of other ototoxic drugs (e.g., aminoglycosides).

8. Precautions

  • Monitor electrolytes, especially potassium, sodium, and magnesium, during therapy.
  • Avoid prolonged use in patients with liver disease to prevent hepatic encephalopathy.
  • Ensure adequate hydration to prevent excessive diuresis.

9. Interactions

  • Drug-Drug Interactions:
    • Increased risk of ototoxicity when used with aminoglycosides or vancomycin.
    • Increased risk of hypokalaemia with corticosteroids or amphotericin B.
    • Reduced efficacy of diuretics with NSAIDs.
  • Drug-Food Interactions:
    • No significant interactions.

10. Monitoring Parameters

  • Electrolyte levels (potassium, sodium, magnesium).
  • Renal function (serum creatinine, blood urea nitrogen).
  • Blood pressure and fluid balance.
  • Hearing function with high doses or prolonged IV use.

11. Use in Children

  • Safe for use in paediatric patients under medical supervision.
  • Dosage must be adjusted based on weight and renal function.

12. Use in Pregnancy

  • Category C: Use only if the potential benefit outweighs the risk to the foetus.
  • May cause foetal electrolyte imbalances or affect maternal hydration.

13. Use in Elderly

  • Use with caution due to increased susceptibility to dehydration, electrolyte imbalances, and hypotension.

14. Use in Kidney Disease

  • Effective in treating oedema in renal disease.
  • Use with caution in advanced renal failure to avoid excessive electrolyte loss.

15. Use in Liver Disease

  • Effective for oedema due to liver cirrhosis but use cautiously to avoid hepatic encephalopathy.

16. Patient Counselling Points

  • Take the medication as prescribed, preferably in the morning to avoid nocturia.
  • Maintain adequate hydration but avoid excessive fluid intake unless directed.
  • Inform patients about signs of electrolyte imbalance (e.g., muscle weakness, irregular heartbeat) and when to seek medical advice.
  • Avoid over-the-counter medications such as NSAIDs without consulting a healthcare provider.
  • Advise patients to attend regular follow-up appointments for electrolyte and renal monitoring.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
BumexValidus Pharmaceuticals$20–30 (30 tablets, 1 mg)
BurinexLeo Pharma$25–35 (30 tablets, 1 mg)
Generic OptionsVarious$5–10 (30 tablets, 1 mg)

18. FAQs (15 Questions)

  1. What is bumetanide used for?
    Bumetanide is used to treat fluid retention (oedema) caused by heart failure, liver disease, or kidney disease.
  2. How does bumetanide work?
    It works as a loop diuretic, increasing urine production by inhibiting sodium and chloride reabsorption in the kidneys.
  3. How quickly does bumetanide work?
    Oral bumetanide begins working within 30–60 minutes, while IV administration acts within 2–3 minutes.
  4. Can bumetanide cause dehydration?
    Yes, excessive diuresis can lead to dehydration, especially with prolonged use or high doses.
  5. Is bumetanide safe for children?
    Yes, but only under medical supervision with weight-adjusted dosing.
  6. Can pregnant women use bumetanide?
    It should only be used if the benefits outweigh the risks, as it may affect foetal electrolyte balance.
  7. What are the common side effects of bumetanide?
    Electrolyte imbalances, dizziness, and dehydration.
  8. Can bumetanide cause hearing loss?
    Yes, ototoxicity is a rare side effect, especially with rapid IV administration or high doses.
  9. Does bumetanide interact with other medications?
    Yes, it can interact with NSAIDs, corticosteroids, aminoglycosides, and other diuretics.
  10. How should bumetanide be taken?
    Take it with or without food, preferably in the morning to reduce night-time urination.
  11. What should I do if I miss a dose?
    Take it as soon as you remember, but skip it if it’s close to the next dose.
  12. How long can I take bumetanide?
    The duration depends on the underlying condition and is determined by the healthcare provider.
  13. Can bumetanide cause weight loss?
    It may cause temporary weight loss due to fluid removal, but it does not reduce body fat.
  14. What should I avoid while taking bumetanide?
    Avoid excessive salt intake, NSAIDs, and over-the-counter medications without medical advice.
  15. Do I need regular tests while taking bumetanide?
    Yes, regular monitoring of electrolytes, kidney function, and blood pressure is essential.