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bumetanide, Bumex

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GENERIC NAME: bumetanide

BRAND NAME: Bumex

DRUG CLASS AND MECHANISM: Bumetanide is a potent diuretic (water pill) that causes a profound increase in urine output (diuresis) by preventing the kidney from retaining fluid. (Specifically, it blocks the reabsorption of sodium and fluid from the kidney's tubules.) It is in a class of diuretics called "loop" diuretics which also includes furosemide (Lasix) and torsemide (Demadex). One mg of bumetanide is approximately equivalent to 10-20 mg of torsemide and 40 mg of furosemide. The potent diuretic effect of bumetanide can cause the loss of large amounts of body water leading to dehydration as well as the loss of electrolytes (e.g., sodium, potassium, magnesium, calcium. Therefore, careful medical supervision is necessary during treatment. Bumetanide was approved for use by the FDA in 1983.

GENERIC AVAILABLE: yes

PRESCRIPTION: yes

PREPARATIONS: Tablets: 0.5mg, 1mg, 2mg.

STORAGE: Tablets should be stored at room temperature, between 15-30°C (59-86°F).

PRESCRIBED FOR: Bumetanide is used in the treatment of mild to moderate hypertension (high blood pressure), and in the management of edema (excessive fluid accumulation) associated with congestive heart failure, renal disease and liver cirrhosis.

DOSING: Dosing of bumetanide and other loop diuretics vary greatly among patients, and doses are carefully adjusted by physicians. Bumetanide may be taken with or without food.

DRUG INTERACTIONS: Bumetanide can cause low blood potassium, calcium, and magnesium levels. These changes can increase the risk of toxicity from digoxin (Lanoxin). Combining bumetanide with other diuretics such as metolazone (Zaroxolyn), hydrochlorothiazide, or chlorthalidone (Hygroton) can exaggerate the losses of potassium and magnesium.

The body's ability to eliminate lithium may decrease in patients receiving bumetanide. Therefore, careful monitoring of lithium levels in blood is recommended when bumetanide and lithium are taken together in order to prevent increases in lithium levels and lithium toxicity.

Indomethacin (Indocin) can reduce the diuretic and blood pressure-lowering effects of other loop diuretics (e.g. furosemide) and it probably can do the same with bumetanide. Other non-steroidal anti-inflammatory drugs, e.g., ibuprofen (Motrin), naproxen (Naprosyn) may interact similarly.

PREGNANCY: There have been no adequate studies on the effects of bumetanide on the fetus. Thus, the physician must carefully weigh the potential but unknown risks and benefits of bumetanide before prescribing it for pregnant women.

NURSING MOTHERS: It is not known if bumetanide is excreted into breast milk. Thus, it should be used in nursing women only if its potential benefits outweigh the unknown risks.

SIDE EFFECTS: Potent diuretics like bumetanide can cause low blood levels of potassium, magnesium, sodium and calcium. Additionally, fluid loses can occur leading to dehydration. The symptoms of dehydration may include dry mouth, thirst, weakness, drowsiness, reduced kidney function, heart arrhythmias, muscle aches and pains, and/or nausea and vomiting.

Toxicity to the inner ear in the form of tinnitus (ringing in the ear) and hearing loss have been associated with other loop diuretics. High plasma levels of bumetanide are toxic to the inner ear of animals. These effects on the inner ear are far more common with intravenous use of the drugs.

High uric acid concentrations in the blood leading to attacks of gouty arthritis may occur during diuretic therapy.

Reference: FDA Prescribing Information

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