Bumetanide
Bumetanide
CLINICAL USE
Loop diuretic
DOSE IN NORMAL RENAL FUNCTION
Oral: 1–10 mg daily, may be given in 2 divided dosesInjection: IV 1–2 mg repeated after 20 minutes; IM if necessary, 1 mg then adjust according to responseIV 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)       :0.2–0.5half-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 functionHDF/high flux   :Unknown dialysability. Dose as in normal renal functionCAV/VVHD      :Not dialysed. Dose as in normal renal function IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsAnalgesics: increased risk of nephrotoxicity with NSAIDs; antagonism of diuretic effect with NSAIDsAnti-arrhythmics: risk of cardiac toxicity with anti-arrhythmics if hypokalaemia occurs; effects of lidocaine and mexiletine antagonisedAntibacterials: increased risk of ototoxicity with aminoglycosides, polymyxins and vancomycin; avoid concomitant use with lymecyclineAntidepressants: increased risk of hypokalaemia with reboxetine; enhanced hypotensive effect with MAOIs; increased risk of postural hypotension with tricyclicsAnti-epileptics: increased risk of hyponatraemia with carbamazepineAntifungals: increased risk of hypokalaemia with amphotericinAntihypertensives: enhanced hypotensive effect; increased risk of first dose hypotensive effect with alpha-blockers; increased risk of ventricular arrhythmias with sotalol if hypokalaemia occursAntipsychotics: increased risk of ventricular arrhythmias with amisulpride, sertindole or pimozide if hypokalaemia occurs – avoid with pimozide; enhanced hypotensive effect with phenothiazinesAtomoxetine: increased risk of ventricular arrhythmias if hypokalaemia occursCardiac glycosides: increased toxicity if hypokalaemia occursLithium: 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 dosesIn patients with severe chronic renal failure given high doses of bumetanide there are reports of musculoskeletal pain and muscle spasmOrally: diuresis begins within 30 minutes, peaks after 1–2 hours, lasts 3 hoursIV: diuresis begins within few minutes and ceases in about 2 hoursUse with caution in patients receiving nephrotoxic or ototoxic drugsSmaller doses may be sufficient in the elderly and cirrhotics (500 micrograms)Use twice daily for higher doses .
See how to identify renal failure stages according to GFR calculation
See how to diagnose irreversible renal disease
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