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bumetanide (Rx)Brand and Other Names:Bumex, Burinex

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 0.25mg/mL

tablet

  • 0.5mg
  • 1mg
  • 2mg
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Edema

PO: 0.5-2 mg once; may be repeated in 4-5 hours for up to 2 doses; not to exceed 10 mg/day

IM: 0.5-1 mg once; may be repeated in 2-3 hours for up to 2 doses; not to exceed 10 mg/day

IV: 1 mg initially, then 0.5-2 mg/hr

Hypertension (Off-label)

I mg IV loading dose, then 0.5-2 mg/day PO divided q12hr

Dosing Considerations

1 mg bumetanide is roughly equivalent to 40 mg furosemide

Edema due to congestive heart failure, hepatic disease, or nephrotic syndrome

  • Use with fluid retention refractory to thiazides or with impaired renal function
  • May be tried if patient is allergic to furosemide

Overdose management

  • Normal saline may be used for volume replacement
  • Dopamine or norepinephrine may be used to treat hypotension
  • Treat hyperkalemia with IV glucose (D25W) with rapid-acting insulin and concurrent IV sodium bicarbonate; use oral or rectal solutions of sodium polystyrene in sorbitol if needed
  • If dysrhythmia due to decreased potassium or magnesium is suspected, replace aggressively
  • Discontinue treatment if no symptoms are apparent after 6 hours

Dosage Forms & Strengths

injectable solution

  • 0.25mg/mL

tablet

  • 0.5mg
  • 1mg
  • 2mg
more...

Edema (Off-label)

<6 months: 0.01-0.05 mg/kg once daily or every other day; optimum diuretic effect is reported at 0.04 mg/kg; lower dosages have been shown to have greater efficacy 

≥6 months: 0.015-0.1 mg/kg once daily or every other day; not to exceed 10 mg/day

In general, dosage selection for elderly should be cautious, usually starting at low end of dosing range, in view of higher incidence of decreased hepatic, renal, or cardiac function and greater frequency of concomitant disease or other drug therapy

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Interactions

Interaction Checker

bumetanide and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Hyperuricemia (18%)

            Hypochloremia (15%)

            Hypokalemia (15%)

            Azotemia (11%)

            1-10%

            Hyponatremia (9%)

            Hyperglycemia (7%)

            Increased serum creatinine (7%)

            Variations in phosphorus (5%)

            Variations in CO2 content (4%)

            Variations in bicarbonate (3%)

            Variations in calcium (2%)

            Dizziness (1%)

            Muscle cramps (1%)

            Ototoxicity (1%)

            <1%

            Asterixis

            Dehydration

            Hypotension

            Orthostatic hypotension

            Pruritus

            Rash

            Renal failure

            Serious skin reactions (ie, Stevens-Johnson syndrome, toxic epidermal necrolysis)

            Vertigo

            Vomiting

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            Warnings

            Black Box Warnings

            Agent is potent diuretic that, if given in excessive amounts, may lead to profound diuresis with water and electrolyte depletion

            Careful medical supervision is required; dosing must be adjusted to patient's needs

            Contraindications

            Documented hypersensitivity to bumetanide or sulfonamides

            Severe uncorrected electrolyte depletion, anuria, hepatic coma

            Cautions

            Risk of electrolyte imbalance, alterations in glucose metabolism, blood dyscrasias, development of oliguria or increased blood urea nitrogen (BUN) or creatinine, hepatic disease, hyperuricemia, hypokalemia, hypomagnesemia, hypovolemia, neonates at risk for kernicterus

            Risk of ototoxicity with rapid IV administration

            Fluid status and renal function should be monitored to prevent oliguria, increased creatinine and BUN, and azotemia

            Asymptomatic hyperuricemia is reported

            Use with caution in patients with cirrhosis

            Coadministration with antihypertensive agent may increase risk of hypotension

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Unknown whether drug is excreted in breast milk; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Inhibits reabsorption of sodium and chloride in ascending loop of Henle, thereby causing excretion of water and sodium, chloride, calcium, magnesium, potassium, and hydrogen ions

            Absorption

            Bioavailability: 59-89%

            Onset: IV, 2-3 min; PO/IM, 30-60 min

            Duration: 4-6 hr

            Peak plasma time: IV, 5 min; IM, 30 min; PO, 1-2 hr

            Distribution

            Protein bound: 94-96%

            Vd: Adults, 9-25 L; neonates and infants, 0.26-0.39 L/kg

            Metabolism

            Partially metabolized in liver

            Metabolites: Bumetanide conjugates, desbutyl bumetanide, primary alcohols, aliphatic acid metabolite (inactive)

            Elimination

            Half-life: Adults, 1-1.5 hr; infants >1 month, 2.4 hr; neonates, 6 hr

            Excretion: Urine (81%), feces (2%)

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            Administration

            IV Incompatibilities

            Additive: Dobutamine

            Y-site: Fenoldopam, midazolam

            IV Compatibilities

            Solution: D5W

            Additive: Floxacillin, furosemide

            Syringe: Doxapram

            Y-site: Check with manufacturer

            IV/IM Administration

            May be administered by IM injection, by IV injection over 1-2 minutes, or by IV infusion

            If glass ampoules are used, filter to remove particles

            Storage

            Store at room temperature

            Protect from light; drug discolors when exposed to light

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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