Bumetanide

(byoo met' a nide)

PCaution when used during lactation : Caution when used during pregnancy

LCaution when used during lactation : Caution when used during lactation

Molecule Info

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WARNING

Bumetanide is a potent diuretic which, if given in excessive amounts, can lead to a profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required, and dose and dosage schedule have to be adjusted to the individual patient’s needs.

Indication(s) & Dosage

Bumetanide is indicated whenever diuretic therapy is required in the treatment of oedema, e.g. that associated with congestive heart failure, cirrhosis of the liver and renal disease including the nephrotic syndrome.

In oedema of cardiac or renal origin where high doses of a potent short acting diuretic are required, Bumetanide 5 mg tablets may be used.

Most patients require a daily dose of 1 mg which can be given as a single morning or early evening dose. Depending on the patient's response, a second dose can be given six to eight hours later. In refractory cases, the dose can be increased until a satisfactory diuretic response is obtained, or infusions of Bumetanide can be given.

Children: Not recommended for children under 12 years of age.

Dosage in the elderly: Adjust dosage according to response. A dose of 0.5 mg bumetanide per day may be sufficient in some elderly patients.

Oedema  Adult: 1 mg orally once daily.  Give 2nd dose 6-8 hr later if necessary. Elderly: 0. 5 mg daily. Refractory oedema  Adult: Initially, 5 mg  orally daily increased by 5 mg every 12-24 hr as required.  High doses may be divided in 2-3 doses.  Max: 10 mg/day. Hypertension  Adult: 0. 5-1 mg  orally daily.  Max: 5 mg/day.

Parenteral formulation

Emergency cases of oedema  Adult: 0. 5-1 mg via slow IV/IM inj, subsequently adjust dose according to response.  Intravenous  Pulmonary oedema  Adult: 1-2 mg IV repeated 20 min later if necessary, or 2-5 mg in 500 ml of a suitable infusion fluid given over 30-60 min.

Administration

May be taken with or without food.  May be taken w/ meals to reduce GI discomfort.

Overdosage

Symptoms would be those caused by excessive diuresis. Empty stomach by gastric lavage or emesis. General measures should be taken to restore blood volume, maintain blood pressure and correct electrolyte disturbance.

Contraindications

Although Bumetanide can be used to induce diuresis in renal insufficiency, any marked increase in blood urea or the development of oliguria or anuria during treatment of severe progressing renal disease are indications for stopping treatment with Bumetanide.

Hypersensitivity to Bumetanide. Bumetanide is contraindicated in hepatic coma and care should be taken in states of severe electrolyte depletion.

As with other diuretics, Bumetanide should not be administered concurrently with lithium salts. Diuretics can reduce lithium clearance resulting in high serum levels of lithium.

Special Precautions

Excessively rapid mobilisation of oedema, particularly in elderly patients, may give rise to sudden changes in cardiovascular pressure-flow relationships with circulatory collapse. This should be borne in mind when Bumetanide is given in high doses intravenously or orally. Electrolyte disturbances may occur, particularly in those patients taking a low salt diet. Regular checks of serum electrolytes, in particular sodium, potassium, chloride and bicarbonate, should be performed and replacement therapy instituted where indicated.

Encephalopathy may be precipitated in patients with pre-existing hepatic impairment.

Bumetanide should be used with caution in patients already receiving nephrotoxic or ototoxic drugs.

Adverse Drug Reaction(s)

Reported reactions include abdominal pain, vomiting, dyspepsia, diarrhoea, stomach and muscle cramps, arthralgia, dizziness, fatigue, hypotension, headache, nausea, encephalopathy (in patients with pre-existing hepatic disease), fluid and electrolyte depletion, dehydration, hyperuricaemia, raised blood urea and serum creatinine, hyperglycaemia, abnormalities of serum levels of hepatic enzymes, skin rashes, pruritus, urticaria, thrombocytopenia, gynaecomastia and painful breasts. Bone marrow depression associated with the use of Bumetanide has been reported rarely but it has not been proven definitely to be attributed to the drug. Hearing disturbance after administration of Bumetanide is rare and reversible.

High dose therapy:

In patients with severe chronic renal failure given high doses of Bumetanide, there have been reports of severe, generalised musculoskeletal pain sometimes associated with muscle spasm, occurring one to two hours after administration and lasting up to 12 hours. The lowest reported dose causing this type of adverse reaction was 5 mg by intravenous injection and the highest was 75 mg orally in a single dose. All patients recovered fully and there was no deterioration in their renal function. The cause of this pain is uncertain but it may be a result of varying electrolyte gradients at the cell membrane level.

Experience suggests that the incidence of such reactions is reduced by initiating treatment at 5-10 mg daily and titrating upwards using a twice daily dosage regimen at doses of 20 mg per day or more.

Drug Interactions

Like other diuretics, Bumetanide shows a tendency to increase the excretion of potassium which can lead to an increase in the sensitivity of the myocardium to the toxic effects of digitalis. Thus the dose may need adjustment when given in conjunction with cardiac glycosides.

Bumetanide may potentiate the effects of antihypertensive drugs. Therefore, the dose of the latter may need adjustment when Bumetanide is used to treat oedema in hypertensive patients.

As with other diuretics, Bumetanide may cause an increase in blood uric acid. Periodic checks on urine and blood glucose should be made in diabetics and patients suspected of latent diabetes.

Patients with chronic renal failure on high doses of Bumetanide should remain under constant hospital supervision.

Certain non-steroidal anti-inflammatory drugs have been shown to antagonise the action of diuretics.

Pregnancy Category (FDA)

Category C: Either studies in animals have revealed adverse effects on the foetus and there are no controlled studies in women or studies in women and animals are not available.  Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Pharmacology

Bumetanide is a potent, high ceiling loop diuretic with a rapid onset and a short duration of action. The primary site of action is the ascending limb of the Loop of Henle where it exerts inhibiting effects on electrolyte reabsorption causing the diuretic and natriuretic action observed.

After oral administration of 1 mg Bumetanide, diuresis begins within 30 minutes with a peak effect between one and two hours. The diuretic effect is virtually complete in three hours after a 1 mg dose.

Bumetanide induces diuresis by inhibiting reabsorption of water and electrolytes in the ascending loop of Henle and proximal renal tubule.  Absorption: Almost completely and rapidly absorbed from the GIT.  Distribution: 95% bound to plasma proteins.  Excretion: Elimination half-life: about 1-2 hr.  About 80% excreted in the urine; 50% as unchanged drug.

ATC Classification

C03CA02 - bumetanide; Belongs to the class of high-ceiling sulfonamide diuretics.

 

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Brand/Product Info


Total Products : 5     
Brand Name Manufacturer/Marketer Composition Dosage Form Pack Size & Price
Bumecard 1 Incepta Pharmaceuticals Limited Bumetanide BP 1 mg Tablet 10x3's:MRP 150 Tk
Bumecard 2 Incepta Pharmaceuticals Limited Each 4 ml ampoule contains Bumetanide BP 2 mg Injection 1x5's:MRP 150 Tk
Bumecard 5 Incepta Pharmaceuticals Limited Bumetanide BP 5 mg Tablet 10x3's:MRP 540 Tk
CONART ACI Ltd. Bumetanide BP 1mg Tablet 1mg x 30's: 60.30 MRP
URINIDE Navana Pharmaceuticals Limited Bumetanide BP 1mg Tablet 1mg x 20's: 200.80 MRP

Gen. MedInfo

IMPORTANT WARNING:

Bumetanide is a strong diuretic.  It is important that you take it exactly as prescribed by your doctor.

 

Why is Bumetanide prescribed?

Bumetanide, a 'water pill,' is used to reduce the swelling and fluid retention caused by various medical problems, including heart or liver disease.  It also is used to treat high blood pressure.  It causes the kidneys to get rid of unneeded water and salt from the body into the urine.

This medicine is sometimes prescribed for other uses; ask your Doctor for more information.

How should this medicine be used?

Bumetanide comes as a tablet to take by mouth.  It usually is taken once a day, in the morning.  Follow the directions on your prescription label carefully, and ask your Doctor to explain any part you do not understand.  Take bumetanide exactly as directed.  Do not take more or less of it or take it more often than prescribed by your doctor.

Bumetanide controls high blood pressure but does not cure it.  Continue to take bumetanide even if you feel well.  Do not stop taking bumetanide without talking to your doctor.

What Special Precautions to follow?

Before taking bumetanide, 

  • tell your Doctor if you are allergic to bumetanide, sulfa drugs, or any other drugs.
  • tell your Doctor what prescription and nonprescription medications you are taking, especially other medications for high blood pressure, corticosteroids, digoxin, indomethacin, lithium, probenecid, and vitamins.
  • tell your doctor if you have or have ever had diabetes, gout, or kidney or liver problems.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding.  Do not breast-feed while taking this medicine.  If you become pregnant while taking bumetanide, consult your doctor.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking bumetanide.

What special dietary instructions to follow?

Follow your doctor's directions.  They may include a daily exercise program and a low-sodium or low-salt diet, potassium supplements, and increased amounts of potassium-rich foods in your diet.

What to do if I forget a dose?

Take the missed dose as soon as you remember it.  However, if it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule.  Do not take a double dose to make up for a missed one.

What side effects can Bumetanide cause?

Frequent urination may last for up to 6 hours after a dose and should decrease after you take bumetanide for a few weeks. Tell your doctor if any of these symptoms are severe or do not go away:

  • muscle cramps
  • weakness
  • dizziness
  • faintness
  • thirst
  • upset stomach
  • vomiting
  • diarrhea
  • rapid, excessive weight loss
  • sore throat with fever
  • ringing in ears
  • loss of hearing
  • unusual bleeding or bruising
  • severe rash with peeling skin
  • difficulty breathing or swallowing

If you have any of the following symptoms, consult your doctor immediately:

If you experience a serious side effect, you or your doctor may send a report to the Office of Directorate General, Drugs Administration.

What Storage conditions are needed?

Keep this medicine in the container it came in, tightly closed, and out of reach of children.  Store it at room temperature and away from excess heat and moisture.  Throw away any medicine that is outdated or no longer needed.  Talk to your Doctor about the proper disposal of your medicine.

In case of emergency/overdose 

In case of overdose, consult your Doctor.  If the victim has collapsed or is not breathing, consult local medical emergency services..

What other information to know?

Keep all appointments with your doctor and the laboratory.  Your blood pressure should be checked regularly, and blood tests should be done occasionally.

Do not let anyone else take your medicine.

It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements.  You should bring this list with you each time you visit a doctor or if you are admitted to a hospital.  It is also important information to carry with you in case of emergencies.

Before Calling Emergency 

Determine the following information:

  • Patient's age, weight and condition
  • Name of the product/medicine (ingredients and strengths, if known)
  • Time it was swallowed/taken
  • Amount swallowed/taken

What to Expect at the Emergency Room

The Health Care Provider/ Emergency Doctor will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The patient may receive:

  • Antidote, gastric lavage, activated charcoal or other drugs/procedures as required
  • Blood tests to determine body chemical levels and blood acid/base balance
  • EKG/ECG test
  • Medicines to correct fluid and electrolyte imbalances 

Ref: U.S. Natl. Library of Medicine

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