Bumex

Bu·mex (bymks)

A trademark for the drug bumetanide.

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Bumex,

trademark for a diuretic (bumetanide).

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bumetanide

Bumetanide Injection, Bumex

Pharmacologic class: Loop diuretic

Therapeutic class: Antihypertensive

Pregnancy risk category C

FDA Boxed Warning

• Drug is a potent diuretic; excessive amounts may cause profound diuresis with fluid and electrolyte depletion. Give only under careful medical supervision; adjust dosage and dosing schedule to patient's needs.

Action

Inhibits reabsorption of sodium and chloride in distal renal tubules and ascending limb of loop of Henle; increases renal excretion of water, sodium, chloride, magnesium, hydrogen, and calcium. Also reduces increased fluid volume caused by renal vasodilation.

Availability

Injection: 0.25 mg/ml

Tablets: 0.5 mg, 1 mg, 2 mg

⊘Indications and dosages

➣ Edema caused by heart failure or hepatic or renal disease; adult nocturia

Adults: 0.5 to 2 mg/day P.O. as a single dose; up to two additional doses may be given q 4 to 5 hours (up to 10 mg/day). Or 0.5 to 1 mg I.V. or I.M., repeated q 2 to 3 hours as needed, up to 10 mg/day.

➣ Hypertension

Adults: 0.5 mg/day P.O. Maximum dosage is 5 mg/day.

Dosage adjustment

• Renal impairment
• Elderly patients

Off-label uses

• Drug-related edema
• Hypercalcemia

Contraindications

• Hypersensitivity to drug or sulfonamides
• Uncorrected electrolyte imbalances
• Hepatic coma
• Anuria and oliguria

Precautions

Use cautiously in:
• severe hepatic disease, electrolyte depletion, diabetes mellitus, worsening azotemia
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 18.

Administration

• Know that oral or I.V. route is preferred, because I.M. administration may cause pain at injection site.
• Be aware that drug may be given alone or with other antihypertensives.
• Dilute with dextrose 5% in water, normal saline solution, or lactated Ringer's injection.
• Give I.V. dose slowly over 2 minutes.
• Give P.O. form with food or milk.

Route	Onset	Peak	Duration
P.O.	30-60 min	1 hr	3-6 hr
I.V.	Within min	15-45 min	3-6 hr
I.M.	40 min	1-2 hr	4-6 hr

Adverse reactions

CNS: dizziness, headache, insomnia, nervousness, vertigo, weakness, paresthesia, confusion, fatigue, hand-flapping tremor, encephalopathy

CV: hypotension, ECG changes, chest pain, thrombophlebitis, arrhythmias

EENT: blurred vision, nystagmus, hearing loss, tinnitus

GI: nausea, vomiting, diarrhea, constipation, dyspepsia, gastric irritation, dry mouth, anorexia, acute pancreatitis

GU: polyuria, nocturia, glycosuria, premature ejaculation, difficulty maintaining erection, oliguria, renal failure

Hepatic: jaundice

Metabolic: dehydration, hyperglycemia, hyperuricemia, hypokalemia, hypomagnesemia, hypochloremic alkalosis

Musculoskeletal: arthralgia; muscle cramps, aching, or tenderness

Skin: photosensitivity, hives, rash, pruritus, urticaria, diaphoresis

Other: pain, nipple tenderness

Interactions

Drug-drug. Aminoglycosides, cisplatin: increased risk of ototoxicity

Amphotericin B, corticosteroids, mezlocillin, other diuretics, piperacillin, stimulant laxatives: additive hypokalemia

Anticoagulants, thrombolytics: increased bumetanide effects

Antihypertensives, nitrates: additive hypotension

Cardiac glycosides: increased risk of digoxin toxicity

Lithium: decreased lithium excretion, possible lithium toxicity

Neuromuscular blockers: prolonged neuromuscular blockade

Nonsteroidal anti-inflammatory drugs, probenecid: inhibition of diuretic response

Drug-diagnostic tests. Blood urea nitrogen (BUN), cholesterol, creatinine, glucose, nitrogenous compounds: increased levels

Calcium, magnesium, platelets, potassium, sodium: decreased levels

Drug-herbs. Dandelion: interference with diuretic activity

Ginseng: resistance to diuresis

Licorice: rapid potassium loss

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Patient monitoring

• Weigh patient at start of therapy, and monitor weight throughout therapy.
• Monitor blood pressure regularly.
• Monitor serum electrolyte, uric acid, glucose, and BUN levels.
• Monitor elderly patients for extreme blood pressure changes, orthostatic hypotension, and dehydration.

Patient teaching

• Advise patient to take drug in morning to prevent nocturia, and to take second dose (if required) in late afternoon.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness or light-headedness from sudden blood pressure drop.
• Caution patient to avoid alcohol because of increased risk of hypotension.
• Advise patient to eat foods high in potassium. Provide other dietary counseling as appropriate to help prevent or minimize electrolyte imbalances.
• Instruct patient to weigh himself often to help detect fluid retention.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.