Formulary
Bumetanide: Indications, Dosing, Side Effects and Interactions
For all loop diuretics Loop diuretics inhibit reabsorption from the ascending limb of the loop of Henl in the renal tubule and are powerful diuretics.
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Bumetanide: Indications, Dosing, Side Effects and Interactions
For all loop diuretics Loop diuretics inhibit reabsorption from the ascending limb of the loop of Henl in the renal tubule and are powerful diuretics.
Drug action
For all loop diuretics Loop diuretics inhibit reabsorption from the ascending limb of the loop of Henl in the renal tubule and are powerful diuretics.
Indications and dose
**Oedema**
- **Adult** (By Mouth): 1 mg, dose to be taken in the morning, then 1 mg after 6-8 hours if required.
- **Elderly** (By Mouth): 500 micrograms daily, this lower dose may be sufficient in elderly patients.
**Oedema, severe cases**
- **Adult** (By Mouth): Initially 5 mg daily, increased in steps of 5 mg every 12-24 hours, adjusted according to response.
**Oedema in heart failure, renal disease, and hepatic disease, Pulmonary oedema for bumetanide**
- **Child 1 month-11 years** (By mouth): 15-50 micrograms/kg 1-4 times a day (max. per dose 2 mg); maximum 5 mg per day.
- **Child 12-17 years** (By mouth): Initially 1 mg, dose to be taken in the morning, then 1 mg after 6-8 hours if required.
**Oedema in heart failure, renal disease, and hepatic disease (severe cases), Pulmonary oedema (severe cases) for bumetanide**
- **Child 12-17 years** (By mouth): Initially 5 mg daily, increased in steps of 5 mg every 12-24 hours, adjusted according to response.
Cautions
For all loop diuretics Can exacerbate diabetes (but hyperglycaemia less likely than with thiazides); can excacerbate gout; hypotension should be corrected before initiation of treatment; hypovolaemia should be corrected before initiation of treatment; urinary retention can occur in prostatic hyperplasia Cautions, further information Elderly Lower initial doses of diuretics may be necessary in the elderly because they are particularly susceptible to the side-effects. The dose should then be adjusted according to renal function. M Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: as a first-line treatment for hypertension (safer, more effective alternatives available) for treatment of hypertension with concurrent urinary incontinence (may exacerbate incontinence) for dependent ankle oedema without evidence of heart failure, liver failure, nephrotic syndrome, or renal failure (leg elevation and/or compression hosiery usually more appropriate) Potassium loss Hypokalaemia can occur with loop diuretics. Hypokalaemia is dangerous in severe cardiovascular disease and in patients also being treated with cardiac glycosides. Often the use of potassium-sparing diuretics avoids the need to take potassium supplements. In hepatic impairment, hypokalaemia caused by diuretics can precipitate encephalopathy. Urinary retention If there is an enlarged prostate, urinary retention can occur, although this is less likely if small doses and less potent diuretics are used initially; manufacturer advises adequate urinary output should be established before initiating treatment.
Contraindications
For all loop diuretics Anuria; comatose and precomatose states associated with liver cirrhosis; renal failure due to nephrotoxic or hepatotoxic drugs; severe hypokalaemia; severe hyponatraemia
Side effects
For all loop diuretics Common or very common Dizziness; electrolyte imbalance; fatigue; headache; metabolic alkalosis; muscle spasms; nausea Uncommon Diarrhoea Rare or very rare Bone marrow depression; photosensitivity reaction Frequency not known Deafness (more common in renal impairment); leucopenia; paraesthesia; rash; severe cutaneous adverse reactions (SCARs); thrombocytopenia; tinnitus (more common with rapid intravenous administration, and in renal impairment); vomiting Side-effects For bumetanide Common or very common Dehydration; hypotension; skin reactions Uncommon Breast pain; chest discomfort; ear pain; vertigo Rare or very rare Hearing impairment Frequency not known Arthralgia; encephalopathy; gastrointestinal discomfort; gynaecomastia; hyperglycaemia; hyperuricaemia; muscle cramps; musculoskeletal pain (with high doses in renal failure)
Interactions
**Other interactions (7):**
- In common with other diuretics, serum lithium levels may be increased when lithium is given concurrently with bumetanide.
- This may result in increased lithium toxicity, including increased risk of cardiotoxic and neurotoxic effects of lithium.
- Therefore, it is recommended that lithium levels are carefully monitored and where necessary the lithium dosage is adjusted in patients receiving this combination.
- 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.
- 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.
Pregnancy
Bumetanide should not be used to treat gestational hypertension because of the maternal hypovolaemia associated with this condition.
Breast feeding
No information available. May inhibit lactation.
Hepatic impairment
For all loop diuretics Hypokalaemia induced by loop diuretics may precipitate hepatic encephalopathy and coma-potassium-sparing diuretics can be used to prevent this. Diuretics can increase the risk of hypomagnesaemia in alcoholic cirrhosis, leading to arrhythmias.
Renal impairment
For all loop diuretics High doses or rapid intravenous administration can cause tinnitus and deafness. Dose adjustments High doses of loop diuretics may occasionally be needed in renal impairment.
Medicinal forms
Suspension,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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