bumetanide, Bumex (discontinued brand) (cont.)

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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.

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.



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