bumetanide

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.

Is bumetanide available as a generic drug?

Yes

Do I need a prescription for bumetanide?

Yes

Potent diuretics like bumetanide can cause low blood levels of potassium, magnesium, sodium and calcium. Additionally, fluid losses 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,
• nausea, and
• vomiting.

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.

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.

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.

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.

It is not known if bumetanide is excreted into breast milk. Thus, it should be used in women who are breastfeeding only if its potential benefits outweigh the unknown risks.

What preparations of bumetanide are available?

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

How should I keep bumetanide stored?

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