Bumex


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bumetanide

(byoo-met-a-nide) ,

Bumex

(trade name),

Burinex

(trade name)

Classification

Therapeutic: diuretics
Pharmacologic: loop diuretics
Pregnancy Category: C

Indications

Edema due to heart failure, hepatic disease, or renal impairment.Reversal of oliguria in preterm neonates.

Action

Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule.
Increases renal excretion of water, sodium chloride, magnesium, potassium, and calcium.
Effectiveness persists in impaired renal function.

Therapeutic effects

Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions).

Pharmacokinetics

Absorption: Well absorbed after oral or IM administration.
Distribution: Widely distributed.
Protein Binding: 72–96%.
Metabolism and Excretion: Partially metabolized by liver; 50% eliminated unchanged by kidneys and 20% excreted in feces.
Half-life: 60–90 min (6 hr in neonates).

Time/action profile (diuretic effect)

ROUTEONSETPEAKDURATION
PO30–60 min1–2 hr4–6 hr
IM30–60 min1–2 hr4–6 hr
IV2–3min15–45 min2–3 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Cross-sensitivity with thiazides and sulfonamides may occur;Hepatic coma or anuria.
Use Cautiously in: Severe liver disease (may precipitate hepatic coma; concurrent use with potassium-sparing diuretics may be necessary);Electrolyte depletion;Diabetes mellitus;Increasing azotemia; Lactation / Pediatric: Safety not established; bumetanide is a potent displacer of bilirubin and should be used cautiously in critically ill or jaundiced neonates because of risk of kernicterus. Injection contains benzyl alcohol, which may cause gasping syndrome in neonates; Geriatric: May have ↑ risk of side effects, especially hypotension and electrolyte imbalance, at usual doses.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • encephalopathy
  • headache

Ear, Eye, Nose, Throat

  • hearing loss
  • tinnitus

Cardiovascular

  • hypotension

Gastrointestinal

  • diarrhea
  • dry mouth
  • nausea
  • vomiting

Genitourinary

  • ↑ BUN
  • excessive urination

Dermatologic

  • stevens-johnson syndrome (life-threatening)
  • toxic epidermal necrolysis (life-threatening)
  • photosensitivity
  • pruritis
  • rash

Endocrinologic

  • hyperglycemia
  • hyperuricemia

Fluid and Electrolyte

  • dehydration (most frequent)
  • hypocalcemia
  • hypochloremia (most frequent)
  • hypokalemia (most frequent)
  • hypomagnesemia (most frequent)
  • hyponatremia (most frequent)
  • hypovolemia (most frequent)
  • metabolic alkalosis (most frequent)

Musculoskeletal

  • arthralgia
  • muscle cramps
  • myalgia

Interactions

Drug-Drug interaction

↑ risk of hypotension with antihypertensives, nitrates, or acute ingestion of alcohol.↑ risk of hypokalemia with other diuretics, amphotericin B, stimulant laxatives, and corticosteroids.Hypokalemia may ↑ risk of digoxin toxicity.↓ lithium excretion, may cause lithium toxicity.↑ risk of ototoxicity with aminoglycosides.NSAIDS ↓ effects of bumetanide.

Route/Dosage

Oral (Adults) 0.5–2 mg/day given in 1–2 doses; titrate to desired response (maximum daily dose = 10 mg/day).
Oral (Infants and Children) 0.015–0.1 mg/kg/dose every 6–24 hrs (maximum: 10 mg/day).
Oral (Neonates) 0.01–0.05 mg/kg/dose every 12-24 in term neonates or every 24–48 hrs in preterm neonates.
Intramuscular Intravenous (Adults) 0.5–1 mg/dose, may repeat q 2–3 hr as needed (up to 10 mg/day).
Intramuscular Intravenous (Infants and Children) 0.015–0.1 mg/kg/dose every 6–24 hrs (maximum: 10 mg/day).
Intramuscular Intravenous (Neonates) 0.01–0.05 mg/kg/dose every 12-24 in term neonates or every 24–48 hrs in preterm neonates.

Availability (generic available)

Tablets: 0.5 mg, 1 mg, 2 mg, 5 mg Cost: Generic — 0.5 mg $30.20 / 100, 1 mg $44.52 / 100, 2 mg $75.18 / 100
Injection: 0.25 mg/mL

Nursing implications

Nursing assessment

  • Assess fluid status during therapy. Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes. Notify health care professional if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs.
  • Monitor blood pressure and pulse before and during administration. Monitor frequency of prescription refills to determine compliance.
  • Assess patients receiving digoxin for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion; ↑ risk of digoxin toxicity due to potassium-depleting effect of diuretic. Potassium supplements or potassium-sparing diuretics may be used concurrently to prevent hypokalemia.
  • Assess patient for tinnitus and hearing loss. Audiometry is recommended for patients receiving prolonged high-dose IV therapy. Hearing loss is most common after rapid or high-dose IV administration in patients with decreased renal function or those taking other ototoxic drugs.
  • Assess for allergy to sulfonamides.
  • Assess patient for skin rash frequently during therapy. Discontinue bumetanide at first sign of rash; may be life-threatening. Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. Treat symptomatically; may recur once treatment is stopped.
  • Geriatric: Diuretic use is associated with increased risk for falls in older adults. Assess falls risk and implement fall prevention strategies.
  • Lab Test Considerations: Monitor electrolytes, renal and hepatic function, serum glucose, and uric acid levels before and periodically during therapy. May cause ↓ serum sodium, potassium, calcium, and magnesium concentrations. May also cause ↑ BUN, serum glucose, creatinine, and uric acid levels.

Potential Nursing Diagnoses

Excess fluid volume (Indications)
Risk for deficient fluid volume (Side Effects)

Implementation

  • If administering twice daily, give last dose no later than 5 pm to minimize disruption of sleep cycle.
    • IV is preferred over IM for parenteral administration.
  • Oral: May be taken with food to minimize gastric irritation.
  • Intravenous Administration
  • Diluent: Administer undiluted.Concentration: 0.25 mg/mL.
  • Rate: Administer slowly over 1–2 min.
  • Continuous Infusion: Diluent: May dilute in D5W or 0.9% NaCl. May also administer as undiluted drug. Protect from light.Concentration: Not to exceed 0.25 mg/mL.
  • Rate: Infuse over 5 min. May be administered over 12 hr for patients with renal impairment.
  • Y-Site Compatibility: acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaprocic acid, aminophylline, amiodarone, amphotericin B lipid complex, amphotericin B liposome, anadulifungin, argatroban, ascorbic acid, atropine, azithromycin, aztreonam, benztropine, bivalirudin, bleomycin, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefazolin, cefepime, cefotaxime, cefoxitin, ceftaroline, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, cisatracurium, cisplatin, cladribine, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doripenem, doxorubicin, doxorubicin liposomal, doxycycline, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fentanyl, filgrastim, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hetastarch, hydrocortisone sodium succinate, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, indomethacin, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin calcium, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, methotrexate, methyldopate, methylprednisolone sodium succinate, metoclopramide, metoprolol, metronidazole, micafungin, milrinone, mitoxantrone, morphine, moxifloxacin, multivitamins, mycophenolate, nafcillin, nalbuphine, naloxone, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxcel, palonosetron, pamidronate, pancuronium, pantoprazole, pemetrexed, penicillin G, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium acetate, potassium chloride, procainamide, promethazine, propofol, propranolol, protamine, pyridoxime, ranitidine, remifentanil, rifampin, rituximab, rocuronium, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trastuzumab, vancomycin, vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zoledronic acid
  • Y-Site Incompatibility: alemtuzumab, amphotericin B colloidal, azathioprine, chlorpromazine, dantrolene, diazepam, diazoxide, fenoldopam, ganciclovir, haloperidol, papaverine, pentamidine, phenytoin, quinupristin/dalfopristin, trimethoprim/sulfamethoxazole

Patient/Family Teaching

  • Instruct patient to take bumetanide as directed. Take missed doses as soon as possible; do not double doses.
    • Caution patient to change positions slowly to minimize orthostatic hypotension. Caution patient that drinking alcohol, exercising during hot weather, or standing for long periods may enhance orthostatic hypotension.
    • Instruct patient to consult health care professional regarding a diet high in potassium. See.
    • Advise patient to contact health care professional of gain more than 3 lbs in one day.
    • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any OTC medications concurrently with this therapy.
    • Instruct patient to notify health care professional of medication regimen before treatment or surgery.
    • Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
    • Advise patient to contact health care professional immediately if rash, muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities occurs.
    • Advise patients with diabetes to monitor blood glucose closely; may cause increased levels.
    • Emphasize the importance of routine follow-up examinations.
    • Geriatric: Caution older patients or their caregivers about increased risk for falls. Suggest strategies for fall prevention.

Evaluation/Desired Outcomes

  • Decrease in edema.
    • Decrease in abdominal girth and weight.
    • Increase in urinary output.

Bumex

(byo͞o′mĕks′)
A trademark for the drug bumetanide.

Bumex

a trademark for a diuretic (bumetanide).

bumetanide

A potent loop diuretic with a rapid onset but short duration of action, which is used for patients with congestive heart failure who respond poorly to furosemide.
 
Adverse effects
Hypotension (especially orthostatic), drowsiness, headache.
References in periodicals archive ?
Bumetanide, the fourth identified pharmaceutical, is the active ingredient in the prescription diuretic Bumex.