bumetanide, Bumex (discontinued brand)

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GENERIC NAME: bumetanide

BRAND NAME: Bumex (discontinued brand)

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 (for example, sodium, potassium, magnesium, and calcium). Therefore, careful medical supervision is necessary during treatment. Bumetanide was approved for use by the FDA in 1983.



PREPARATIONS: Tablets: 0.5, 1, and 2 mg. Injection: 0.25 mg/ml

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

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

DOSING: The dose for most patients is 0.5 to 2 mg daily by mouth. Doses may be increased every 4 to 5 hours to a maximum dose of 10 mg daily. Intravenous (IV) or intramuscular (IM) injections may be used in place of tablets when oral administration is not possible. The IV dose is 1 mg initially followed by 0.5 to 2 mg/hour, and the IM dose is 0.5 to 10 mg daily. Dosing of bumetanide and other loop diuretics varies 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 (Lithobid, Eskalith) 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 (for example furosemide) and it probably can do the same with bumetanide. Other nonsteroidal anti-inflammatory drugs, for example, ibuprofen (Motrin), naproxen (Naprosyn) may interact similarly.

Concomitant use of bumetanide and aminoglycosides may increase the risk of hearing impairment since both agents can affect hearing.

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