Lasix (furosemide) vs. bumetanide

• Lasix (furosemide) and bumetanide are potent diuretics (water pills) used treat excess accumulation of fluid or swelling of the body (edema) caused by heart failure, kidney disease, chronic kidney failure, or liver disease.
• Lasix is also used with other high blood pressure medications to treat high blood pressure (hypertension), and bumetanide is used off-label to treat hypertension.
• Lasix is a brand name for furosemide.
• Side effects of Lasix and bumetanide that are similar include dehydration, nausea, and ringing in the ears.
• Side effects of Lasix that are different from bumetanide include low blood pressure, electrolyte depletion, yellowing skin and eyes (jaundice), sensitivity to light, rash, pancreatitis, diarrhea, abdominal pain, dizziness, increased blood sugar, and increased uric acid levels.
• Side effects of bumetanide that are different from Lasix include dry mouth, thirst, weakness, drowsiness, reduced kidney function, heart arrhythmias, muscle aches and pains, and vomiting.

Lasix is a “loop” diuretic (water pill) that is used to eliminate water and salt (composed of sodium and chloride) from the body. In the kidneys, salt, water, and other small molecules are filtered out of the blood and into the kidney tubules. This filtered fluid ultimately becomes urine. Most of the sodium, chloride, and water filtered out of the blood are reabsorbed back into the blood before the fluid becomes urine. Lasix works by blocking the absorption of salt and water from the filtered fluid in the kidney tubules, causing an increase in the output of urine (diuresis).

Bumetanide is a potent diuretic (water pill) that causes a profound increase in urine output (diuresis) by preventing the kidney from retaining fluid prescribed for the management of edema associated with congestive heart failure, liver and kidney disease, and off-label treatment for high blood pressure. 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 Lasix (furosemide) and torsemide (Demadex).

Lasix

Common side effects of furosemide are:

• Low blood pressure
• Dehydration
• Electrolyte depletion (for example, sodium, potassium)

Other important side effects include:

• Jaundice
• Ringing in the ears (tinnitus)
• Sensitivity to light (photophobia)
• Rash
• Pancreatitis
• Nausea
• Diarrhea
• Abdominal pain
• Dizziness

Increased blood sugar and uric acid levels also may occur.

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
• Thirst
• Weakness
• Drowsiness
• Reduced kidney function
• Heart arrhythmias
• Muscle aches and pains
• Nausea
• 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.

Lasix

The usual starting oral dose for treatment of edema in adults is 20-80 mg as a single dose. The same dose or an increased dose may be administered 6-8 hours later. Doses may be increased 20-40 mg every 6-8 hours until the desired effect occurs. The effective dose may be administered once or twice daily. Some patients may require 600 mg daily.

The starting oral dose for children is 2 mg/kg. The starting dose may be increased by 1-2 mg/kg every 6 hours until the desired effect is achieved. Doses greater than 6 mg/kg are not recommended.

The recommended dose for treating hypertension is 40 mg twice daily. The dose of other blood pressure medications should be reduced by half when furosemide is added.

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.

Lasix

• Administration of Lasix with aminoglycoside antibiotics (for example, gentamicin) or ethacrynic acid (Edecrin, another diuretic) may cause hearing damage.
• Lasix competes with aspirin for elimination in the urine by the kidneys. Concomitant use of Lasix and aspirin may, therefore, lead to high blood levels of aspirin and aspirin toxicity.
• Lasix also may reduce excretion of lithium (Eskalith, Lithobid) by the kidneys, causing increased blood levels of lithium and possible side effects from lithium.
• Sucralfate (Carafate) reduces the action of Lasix by binding Lasix in the intestine and preventing its absorption into the body. Ingestion of Lasix and sucralfate should be separated by two hours.
• When combined with other antihypertensive drugs there is an increased risk of low blood pressure or reduced kidney function.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) -- for example, ibuprofen, indomethacin (Indocin, Indocin-SR) -- may interfere with the blood pressure-reducing effect of Lasix.

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 Lasix) and it probably can do the same with bumetanide. Other nonsteroidal anti-inflammatory drugs (NSAIDs) -- 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.

Lasix

Lasix is secreted in breast milk. Nursing mothers should avoid breastfeeding while taking Lasix.

Bumetanide

There have been no adequate studies on the effects of bumetanide on the fetus. Thus, the doctor 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, the doctor must carefully weigh its potential benefits against the unknown risks before prescribing it to women who are breastfeeding.