bumetanide

bumetanide /bu·met·a·nide/ (bu-met´ah-nīd) a loop diuretic used in the treatment of edema, including that associated with congestive heart failure or hepatic or renal disease, and hypertension.

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bu·met·a·nide (by-mt-nd)

n.

A diuretic used in the treatment of edema associated with congestive heart failure, hepatic cirrhosis, and renal disease.

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bumetanide

[bo̅o̅met′ənīd]

a loop (high ceiling) diuretic related to furosemide.

indications It is prescribed for edema caused by cardiac, hepatic, or renal disease.

contraindications Anuria, electrolyte depletion, or known sensitivity to this drug prohibits its use.

adverse effects Among the most serious adverse reactions are hypokalemia, hyperuricemia, and azotemia.

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bumetanide [bu-met´ah-nīd]

a loop diuretic used in treatment of edema, such as that associated with congestive heart failure or hepatic or renal disease, treatment of hypertension, usually in association with other drugs, and as an adjunct in treatment of acute pulmonary edema; administered orally, intramuscularly, or intravenously.

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bumetanide (byōōmet´nīd´),

n brand name: Bumex;
drug class: loop diuretic;
action: acts on the loop of Henle to decrease reabsorption of chloride and sodium with resultant diuresis;
uses: treatment of edema in chronic heart disease, renal disease, pulmonary edema, ascites, and hypertension.

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bumetanide

a loop diuretic, with actions similar to furosemide.

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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.

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bumetanide

Bumex^® Cardiology A loop diuretic with a rapid onset but short duration of action indicated for Pts with HTN and CHF Contraindications Not indicated due to hypovolemia and fetal hypoxia. See Diuretic, Loop diuretic.