No

Diuretic, Loop

Management of edema secondary to congestive heart failure or hepatic or renal disease including nephrotic syndrome; may be used alone or in combination with antihypertensives in the treatment of hypertension; can be used in furosemide-allergic patients

C (per manufacturer); D (based on expert analysis)

Hypersensitivity to bumetanide or sulfonylureas; anuria; patients with hepatic coma or in states of severe electrolyte depletion until the condition improves or is corrected; pregnancy (based on expert analysis)

Adjust dose to avoid dehydration. In cirrhosis, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy. Ototoxicity is associated with I.V. rapid administration, renal impairment, excessive doses, and concurrent use of other ototoxins. Hypersensitivity reactions can rarely occur. Monitor fluid status and renal function in an attempt to prevent oliguria, azotemia, and reversible increases in BUN and creatinine. Close medical supervision of aggressive diuresis required. Watch for and correct electrolyte disturbances. Coadministration of antihypertensives may increase the risk of hypotension. Use caution in patients with known hypersensitivity to sulfonamides or thiazides (due to possible cross-sensitivity); avoid in patients with history of severe reactions.

>10%:

Endocrine & metabolic: Hyperuricemia (18%), hypochloremia (14.9%), hypokalemia (14.7%)

Renal: Azotemia (10.6%)

1% to 10%:

Neuromuscular & skeletal: Muscle cramps (1.1%)

Central nervous system: Dizziness (1.1%)

Endocrine & metabolic: Hyponatremia (9.2%), hyperglycemia (6.6%), variations in phosphorus (4.5%), CO₂ content (4.3%), bicarbonate (3.1%), and calcium (2.4%)

Renal: Increased serum creatinine (7.4%)

Otic: Ototoxicity (1.1%)

<1% (Limited to important or life-threatening symptoms): Hypotension, orthostatic hypotension, headache, nausea, encephalopathy (in patients with pre-existing liver disease), impaired hearing, pruritus, weakness, hives, abdominal pain, arthritic pain, musculoskeletal pain, rash, vomiting, vertigo, chest pain, ear discomfort, fatigue, dehydration, sweating, hyperventilation, dry mouth, upset stomach, renal failure, asterixis, itching, nipple tenderness, diarrhea, premature ejaculation

Symptoms of overdose include electrolyte depletion, volume depletion

Treatment is primarily symptomatic and supportive

ACE inhibitors: Hypotensive effects and/or renal effects are potentiated by hypovolemia.

Antidiabetic agents: Glucose tolerance may be decreased.

Antihypertensive agents: Hypotensive effects may be enhanced.

Cholestyramine or colestipol may reduce bioavailability of bumetanide.

Digoxin: Ethacrynic acid-induced hypokalemia may predispose to digoxin toxicity; monitor potassium.

Indomethacin (and other NSAIDs) may reduce natriuretic and hypotensive effects of diuretics.

Lithium: Renal clearance may be reduced. Isolated reports of lithium toxicity have occurred; monitor lithium levels.

NSAIDs: Risk of renal impairment may increase when used in conjunction with diuretics.

Ototoxic drugs (aminoglycosides, cis-platinum): Concomitant use of bumetanide may increase risk of ototoxicity, especially in patients with renal dysfunction.

Peripheral adrenergic-blocking drugs or ganglionic blockers: Effects may be increased.

Salicylates (high-dose) with diuretics may predispose patients to salicylate toxicity due to reduced renal excretion or alter renal function.

Sparfloxacin, gatifloxacin, and moxifloxacin: Risk of hypokalemia and cardiotoxicity may be increased; avoid use.

Thiazides: Synergistic diuretic effects occur.

I.V. infusion solutions should be used within 24 hours after preparation; light sensitive, discoloration may occur when exposed to light

Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and proximal renal tubule, interfering with the chloride-binding cotransport system, thus causing increased excretion of water, sodium, chloride, magnesium, phosphate and calcium; it does not appear to act on the distal tubule

Onset of effect: Oral, I.M.: 0.5-1 hour; I.V.: 2-3 minutes

Duration of action: 6 hours

Distribution: V_d: 13-25 L/kg

Protein binding: 95%

Metabolism: Partial, occurs in the liver

Half-life: Infants <6 months: Possibly 2.5 hours; Children and Adults: 1-1.5 hours

Elimination: Majority of unchanged drug and metabolites excreted in urine

Children (not FDA-approved for use in children <18 years of age):

<6 months: Dose not established

>6 months:

Oral: Initial: 0.015 mg/kg/dose once daily or every other day; maximum dose: 0.1 mg/kg/day

I.M., I.V.: Dose not established

Adults:

Oral: 0.5-2 mg/dose 1-2 times/day; maximum: 10 mg/day

I.M., I.V.: 0.5-1 mg/dose; maximum: 10 mg/day

Continuous I.V. infusions of 0.9-1 mg/hour may be more effective than bolus dosing

This product may cause a potassium loss; your physician may prescribe a potassium supplement, another medication to help prevent the potassium loss, or recommend that you eat foods high in potassium, especially citrus fruits; do not change your diet on your own while taking this medication, especially if you are taking potassium supplements or medications to reduce potassium loss; too much potassium can be as harmful as too little

Blood pressure, serum electrolytes, renal function

Bumetanide is a potent diuretic that may be used in patients who cannot tolerate or who may be allergic to furosemide. It is important that patients be closely followed for hypokalemia, hypomagnesemia, and volume depletion because of significant diuresis.

May cause dizziness

Lithium excretion may be decreased; monitor serum lithium levels

No information available to require special precautions

No effects or complications reported

May be taken with food to reduce GI effects. Take single dose early in day (single dose) or last dose early in afternoon (twice daily) to prevent sleep interruptions. Include orange juice or bananas (or other sources of potassium-rich foods) in your daily diet but do not take supplemental potassium without consulting prescriber. You may experience dizziness, hypotension, lightheadedness, or weakness; use caution when changing position (rising from sitting or lying position), when driving, exercising, climbing stairs, or performing hazardous tasks, and avoid excessive exercise in hot weather. Report swelling of ankles or feet, weight increase or decrease more than 3 pounds in any one day, increased fatigue, muscle cramps or trembling, and any changes in hearing. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant; contraceptives may be recommended. Consult prescriber if breast-feeding.

Be alert to complaints about hearing difficulty

Injection: 0.25 mg/mL (2 mL, 4 mL, 10 mL)

Tablet: 0.5 mg, 1 mg, 2 mg

Montgomery PA and Christen C, "Policy to Restrict Use of I.V. Bumetanide," Am J Health Syst Pharm, 1995, 52(16):1802-4.

Ward A and Heel RC, "Bumetanide: A Review of Its Pharmacodynamic and Pharmacokinetic Properties and Therapeutic Use," Drugs, 1984, 28(5):426-64.

Wells TG, "The Pharmacology and Therapeutics of Diuretics in the Pediatric Patient," Pediatr Clin North Am, 1990, 37(2):463-504.