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- What is bumetanide, and how does it work (mechanism of action)?
- Is bumetanide available as a generic drug?
- Do I need a prescription for bumetanide?
- What are the side effects of bumetanide?
- What is the dosage for bumetanide?
- Which drugs or supplements interact with bumetanide?
- Is bumetanide safe to take if I'm pregnant or breastfeeding?
- What else should I know about bumetanide?
What is bumetanide, and how does it work (mechanism of action)?
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.
What are the side effects of bumetanide?
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,
- reduced kidney function,
- heart arrhythmias,
- muscle aches and pains,
- nausea, and
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.
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What is the dosage for bumetanide?
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.
Which drugs or supplements interact with bumetanide?
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.
Is bumetanide safe to take if I'm pregnant or breastfeeding?
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 else should I know about bumetanide?
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).
Bumetanide, Bumex (discontinued brand) is a "loop diuretic" medication prescribed for the management of edema associated with congestive heart failure, liver and kidney disease, and off-label treatment for high blood pressure. Side effects, dosage, drug interactions, and pregnancy safety information should be reviewed prior to taking this medication.
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CirrhosisCirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections.
Symptoms include yellowing of the skin (jaundice), itching, and fatigue.
The prognosis is good for some people with cirrhosis of the liver, and the survival can be up to 12 years; however the life expectancy is about 6 months to 2 years for people with severe cirrhosis with major complications.
Congestive Heart Failure (CHF) OverviewCongestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Congestive Heart Failure MedicationsThere are a variety of medications to treat congestive heart failure. Most medicaiton regimines for patients with congestive heart failure are tailored to each patient. Examples of medicaitons prescribed for congestive heart failure include ACE inhibitors (for example, Altace, Capoten, Vasotec); beta blockers; digoxin (Lanoxin); and diuretics. Side effects, drug interactions, dosage, storage, and pregnancy safety information should be reviewed before taking any medication.
Drug InteractionsDrug interactions occur frequently. Get facts about the types of drug interactions, what substances or other things that may interact with drugs such as OTC drug and prescription drugs, vitamins, food(s) (grapefruit), and laboratory tests. Find out how to protect yourself from potential drug interactions.
Drugs: What You Should Know About Your DrugsImportant information about your drugs should be reviewed prior to taking any prescription drug. Side effects, drug interactions, warnings and precauctions, dosage, what the drug is used for, what to do if you miss a dose, how the drug is to be stored, and generic vs. brand names.
Edema is the swelling of tissues as a result of excess water accumulation. Peripheral edema occurs in the feet and legs. There are two types of edema, non-pitting edema and pitting edema. Causes of pitting edema is caused by systemic diseases (most commonly involving the heart, liver, and kidneys), and medications. Local conditions that cause edema are thrombophlebitis and varicose veins. Edema or swelling of the legs, feet, ankles, and face are common during pregnancy. Idiopathic edema is edema in which the cause is not known. Pitting edema is scored on pitting edema measurement scales. Edema is generally treated with medication.
Lasix is the brand name for the generic drug furosemide. Lasix is a diuretic medicine that doctors prescribe to treat excess accumulation of fluid or swelling of the body (edema) caused by:
- Chronic kidney failure
- Heart failure
- Nephrotic syndrome.
Doctors also prescribe Lasix in conjunction with other high blood pressure pills to patients to treat high blood pressure (hypertension).
Profound diuresis with water and electrolyte depletion can occur if Lasix drug is given in excess amounts. Other side effects and adverse effects of this medicine include:
- Gut (gastrointestinal or GI) reactions like pancreatitis, jaundice, anorexia, cramping, diarrhea, constipation , nausea, and vomiting.
- Systemic hypersensitivity reactions like severe anaphylactic shock, necrotizing angiitis, and interstitial nephritis.
- CNS (central nervous system) reactions like vertigo, headaches, blurred vision, tinnitus, and hearing loss.
- Blood reactions like anemia, leukopenia, thrombocytopenia, and eosinophilia.
- Hypersensitive skin reactions like rash, itching, hives, photosensitivity, exfoliative dermatitis, and Steven-Johnson syndrome.
- Heart reactions like orthostatic hypotension (fainting or dizziness when standing up) and an increase in triglyceride and cholesterol levels
Other reactions include weakness, muscle spasms, thrombophlebitis, fever, and hyperglycemia (high blood sugar). Furosemide is available as tablets of 20 mg to 80 mg, and IV form. Your doctor will determine your dosage based on your medical condition. This medication interacts with certain with drugs like cisplatin (Platinol-AQ)), cyclosporine, lithium (Eskalith, Lithobid), methotrexate (Rheumtrex, Trexall), phenytoin, antibiotics, heart and blood pressure medications, laxatives, steroids, and salicylates like aspirin. Tell your doctor or other health care professional about any vitamins or supplements you are taking. Researchers don't know if Lasix harms the fetus so talk with your doctor if you are pregnant or planning to get pregnant. This drug can be passed on to your newborn while breastfeeding and may harm your baby. It also may slow breast milk production so talk with your doctor before breastfeeding.
High Blood Pressure Hypertension
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms.
Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure.
The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater.
If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.
REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
High Blood Pressure TreatmentHigh blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
Pulmonary EdemaPulmonary edema (swelling or fluid in the lungs) can either be caused by cardiogenic causes (congestive heart failure, heart attacks, abnormal heart valves) or noncardiogenic causes such as:
- kidney failure,
- high altitude,
- pleural effusion,
- aspirin overdose,
- pulmonary embolism, and
Torsemide (Demadex) is a prescription drug used to treat:
- Water retention from congestive heart failure
- Kidney disease
- Liver disease
- Chronic kidney failure.
Side effects may include:
- Joint pain Stomach upset
- Sore throat
- Muscle pain
Drug interactions, dosing, storage, and pregnancy and breastfeeding safety information should be reviewed prior to taking this medication.