Drug reference

Bumetanide

Loop Diuretic · Diuretic

Loop DiureticDiuretic

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Should not be used to treat gestational hypertension because of the maternal hypovolaemia associated with this condition.

FDA category + note

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Mechanism

Bumetanide is a loop diuretic that primarily acts by inhibiting the Na+-K+-2Cl− symporter in the thick ascending limb of the loop of Henle. This action leads to increased excretion of sodium, potassium, and chloride, resulting in diuresis and reduction of fluid retention. It is used to relieve breathlessness and oedema in patients with fluid retention.

Indications

OedemaPulmonary oedema due to left ventricular failureChronic heart failureDiuretic-resistant oedemaHypertension (in resistant cases or those with impaired renal function/heart failure)acute pulmonary edemachronic congestive heart failurehypertension (in patients with GFR <30 mL/min or resistant hypertension)edema of nephrotic syndromeedema of liver cirrhosisascites of liver cirrhosisdrug overdose (to induce forced diuresis)hypercalcemia (with isotonic saline)life-threatening hyponatremia (with hypertonic saline)edema associated with chronic kidney diseaseacute pulmonary edema (intravenous)edema associated with congestive heart failureliver cirrhosischronic kidney diseasenephrotic syndromehyponatremiahypercalcemiahypertension with renal insufficiencyEdema associated with heart failureEdema associated with liver cirrhosisEdema associated with nephrotic syndromeHypertension (especially in patients with azotemia or severe edema associated with vasodilators like minoxidil)Malignant hypertension (acutely)GFR <30-40 mL/minmobilizing edema fluid in CHFEdemaPulmonary edemaSevere CHF (oral use)Cases not responding to furosemidePatients allergic to furosemide

Dosing

Adult: For oedema: 1 mg orally in the morning, then 1 mg after 6–8 hours if required. Alternatively, initially 5 mg daily, increased in steps of 5 mg every 12–24 hours, adjusted according to response.
Renal adjustment: Avoid if eGFR less than 30 mL/minute/1.73 m2. High doses may occasionally be needed in renal impairment, but there is a risk of hyperkalaemia. Monitor plasma-potassium concentration and electrolytes during treatment. High doses or rapid intravenous administration can cause tinnitus and deafness.
Max dose: 15 mg/day (in renal failure)

Pharmacokinetics

Onset

Within 1 hour (oral)

Duration

Within 6 hours (oral)

Half-life

~0.8

Bioavailability

~80%

Protein binding

extensively bound to plasma proteins

Metabolism

~38% metabolism

Excretion

~62% renal excretion of intact drug

Contraindications

Gestational hypertension (due to risk of maternal hypovolaemia)
eGFR less than 30 mL/minute/1.73 m2
severe Na+ depletion
severe volume depletion
hypersensitivity to sulfonamides
anuria unresponsive to a trial dose of loop diuretic
sulfonamide hypersensitivity

Side effects

Common

DehydrationHypotensionSkin reactionsDizzinessElectrolyte imbalanceFatigueHeadacheMetabolic alkalosisMuscle spasmsNauseaBreast painChest discomfortEar painVertigoasymptomatic hyperuricemiatinnitushearing impairmentsense of fullness in the earshyperglycemia (infrequently precipitating diabetes mellitus)increased plasma LDL cholesterolincreased plasma triglyceridesdecreased plasma HDL cholesterolskin rashesphotosensitivityparesthesiasGI disturbanceshypokalemiahyponatremiahypomagnesemiahyperuricemiahypocalcemiaglucose intolerancereduction in GFRelectrolyte disturbanceHyperuricaemia (claimed less marked)K+ loss (claimed less marked)Glucose intolerance (claimed less marked)Ototoxicity (claimed less marked)

Serious

Hearing impairment
Encephalopathy
Gynaecomastia
Hyperglycaemia
Hyperuricaemia
Arthralgia
Muscle cramps
Musculoskeletal pain (with high doses in renal failure)
Bone marrow depression
Photosensitivity reaction
Deafness (more common in renal impairment)
Leucopenia
Paraesthesia
Severe cutaneous adverse reactions (SCARs)
Thrombocytopenia
Tinnitus (more common with rapid intravenous administration and in renal impairment)
Urinary retention (less likely with small initial doses, if enlarged prostate)
depletion of total-body Na+
hyponatremia
extracellular fluid volume depletion
hypotension
reduced GFR
circulatory collapse
thromboembolic episodes
hepatic encephalopathy (in liver disease)
hypochloremic alkalosis
hypokalemia
cardiac arrhythmias (particularly with cardiac glycosides)
hypomagnesemia
hypocalcemia (rarely leading to tetany)
ototoxicity (usually reversible, most frequently with rapid intravenous administration)
gout (rarely)
nephrotoxicity
ototoxicity
Myopathy (rarely)