Toxicity to the inner ear in the form of tinnitus (ringing in the ear) and hearing loss have been associated with 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.
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 0.5, 1, and 2 mg. Injection: 0.25 mg/ml
STORAGE: Tablets should be stored at room temperature, between 15 C - 30 C (59 F - 86 F).
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.
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