Bumetanide

CLINICAL USE

Loop diuretic

DOSE IN NORMAL RENAL FUNCTION

Oral: 1–10 mg daily, may be given in 2 divided doses

Injection: IV 1–2 mg repeated after 20 minutes; IM if necessary, 1 mg then adjust according to response

IV infusion : 2–5 mg over 30–60 minutes

PHARMACOKINETICS

Molecular weight :364.4

%Protein binding :95

%Excreted unchanged in urine : 50

Volume of distribution (L/kg) :0.2–0.5

half-life – normal/ESRD (hrs) :0.75–2.6/1.5

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Unknown dialysability. Dose as in normal renal function

CAV/VVHD :Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Analgesics: increased risk of nephrotoxicity with NSAIDs; antagonism of diuretic effect with NSAIDs

Anti-arrhythmics: risk of cardiac toxicity with anti-arrhythmics if hypokalaemia occurs; effects of lidocaine and mexiletine antagonised

Antibacterials: increased risk of ototoxicity with aminoglycosides, polymyxins and vancomycin; avoid concomitant use with lymecycline

Antidepressants: increased risk of hypokalaemia with reboxetine; enhanced hypotensive effect with MAOIs; increased risk of postural hypotension with tricyclics

Anti-epileptics: increased risk of hyponatraemia with carbamazepine

Antifungals: increased risk of hypokalaemia with amphotericin

Antihypertensives: enhanced hypotensive effect; increased risk of first dose hypotensive effect with alpha-blockers; increased risk of ventricular arrhythmias with sotalol if hypokalaemia occurs

Antipsychotics: increased risk of ventricular arrhythmias with amisulpride, sertindole or pimozide if hypokalaemia occurs – avoid with pimozide; enhanced hypotensive effect with phenothiazines

Atomoxetine: increased risk of ventricular arrhythmias if hypokalaemia occurs

Cardiac glycosides: increased toxicity if hypokalaemia occurs

Lithium: risk of toxicity

ADMINISTRATION

Reconstition

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Route

Oral, IV, IM

Rate of Administration

IV infusion

: 2–5 mg in 500 mL of infusion fluid over 30–60 minutesIV bolus: 1–2 mg over 3–4 minutes

Comments

Compatible with glucose 5% or sodium chloride 0.9%

OTHER INFORMATION

1 mg bumetanide ≡ 40 mg furosemide at low doses, but avoid direct substitution at high doses

In patients with severe chronic renal failure given high doses of bumetanide there are reports of musculoskeletal pain and muscle spasm

Orally: diuresis begins within 30 minutes, peaks after 1–2 hours, lasts 3 hours

IV: diuresis begins within few minutes and ceases in about 2 hours

Use with caution in patients receiving nephrotoxic or ototoxic drugs

Smaller doses may be sufficient in the elderly and cirrhotics (500 micrograms)

Use twice daily for higher doses .

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