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 &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :364.4
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :95
  • %Excreted unchanged in urine &nbsp &nbsp : 50

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

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

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
  • 10 to 20 &nbsp &nbsp : Dose as in normal renal function
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Not dialysed. Dose as in normal renal function

  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in normal renal function
  • HDF/high flux &nbsp :Unknown dialysability. Dose as in normal renal function
  • CAV/VVHD &nbsp &nbsp &nbsp: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

    –

    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 .
    Tags:

    • Related News

    sotalol hydrochloride.txt

    tazocin.txt