#bumex

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Bumetanide

Common Brand Names: Bumex

Therapeutic Class: A potent, sulfonamide-type, loop diuretic

Common Injectable Dosage Forms:

Injection: 0.25 mg/mL in 2-10 mL vials and amps

Dosage Ranges:

For the management of edema: The usual initial dose is 0.5-1 mg IV or IM. If response is inadequate, repeated doses may be given at 2–3-hour intervals until the desired response is obtained, or until the maximum dose of 10 mg/day is reached. Although safety and efficacy have not been fully established in pediatric use, doses of 0.015 mg/kg up to 0.1 mg/kg/day have been used in cases of pediatric congestive heart failure. Parenteral doses of up to 20 mg/day can be used in patients with renal impairment.

Administration and Stability: Parenteral administration of bumetanide may be accomplished by direct IV injection, IM injection, or by IV infusion. Direct IV injection should be given slowly over a period of 1-2 minutes. Bumetanide may be given undiluted IM deeply into a large muscle. For IV infusion, bumetanide may be diluted with a desired amount of D5W, NS, or Lactated Ringer’s, and administered over 15-30 minutes. When diluted with compatible solution the solution should be used within 24 hours. pH ~7

Pharmacology/Pharmacokinetics: Bumetanide acts directly on the ascending limb of the loop of Henle in the kidney to inhibit sodium and chloride reabsorption. Following administration, the onset of diuresis is approximately 40 minutes for IM, and a few minutes for IV injection; peaks in 1-2 hours (IM) and 15-30 minutes (IV) and lasts approximately 2-6 hours depending on dose and route of administration. The drug is highly protein bound with a volume of distribution between 13-25 liters. Metabolism occurs in the liver with the majority of unchanged drug and metabolites excreted in the urine. The elimination half-life of the parent compound is 1-1.5 hours.

Drug and Lab Interactions: Concomitant use of other HYPOKALEMIC AGENTS may produce dangerously low serum levels of potassium. Also decreases renal clearance of lithium which may result in lithium toxicity. May also enhance ototoxic and nephrotoxic effects of other drugs. My decrease glucose tolerance, requiring adjustments of hypoglycemic agents.

Contraindications/Precautions: Contraindicated in patients with anuria. Should be used with caution in patients with past history of allergy to sulfonamides, in patients with hepatic cirrhosis and ascites, and in patients with diabetes mellitus. Use with caution in geriatric patients as prolonged use may result in profound water loss, electrolyte depletion, dehydration, hypovolemia, and risk of circulation collapse. Pregnancy Category C/D.

Monitoring Parameters: BP, electrolyte, BUN, Cr

Adverse Effects: Hypokalemia, hypochloremia, and hyponatremia are frequently reported along with muscle cramps, dizziness, hypotension, headache, nausea, and encephalopathy. Other effects may include hepatic abnormalities, rare occurrences of blood dyscrasias, dose related ototoxicity, and hyperglycemia.

Common Clinical Applications: Used to treat edema associated with congestive heart failure and renal or liver disease.

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Brand Name: Bumex

Generic Available

Common Dosage Forms:

Tablets: 0.5 mg, 1 mg, and 2 mg.

Injection: 0.25 mg/mL

FDA Indications/Dosages:

Treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease (including the nephrotic syndrome): Oral: 0.5 mg to 2 mg daily given in one to two doses. Maximum of 10 mg per day. Intermittent dose schedule: Give dose on alternate days or for 3 to 4 days with 1 to 2 day rest periods. Parenteral: 0.5 mg to 1 mg I.M. or I.V. (over 1 to 2 minutes). Give a second or third dose at intervals of 2 to 3 hours until desired diuresis occurs. Maximum of 10 mg per day.

Monitor: K.

Pharmacology/Pharmacokinetics: Bumetanide inhibits reabsorption of sodium and chloride in the ascending limb of the loop of Henle. It also exerts a diuretic action in the proximal tubule, but not noticeably in the distal tubule. The onset of diuresis following oral administration is between 30 and 60 minutes. Peak activity is reached between 1 and 2 hours. The duration of action of diuresis is usually around 4 hours. Intravenous administration speeds up the onset of diuresis to within minutes and peaks between 15 to 30 minutes.

Drug Interactions: Auditory toxicity is increased when used with aminoglycosides or cisplatin. Electrolyte disturbances may predispose to digitalis-induced arrhythmias.

Contraindications/Precautions: Contraindicated in patients with uncorrected hepatic coma or severe electrolyte depletion. Use with caution in patients hypersensitive to sulfonamides. Excessive doses or too frequent administration can cause volume and electrolyte depletion. Prevention of hypokalemia is important in patients with cirrhosis or ascites, diarrhea, potassium-losing nephropathy, and in patients receiving digitalis therapy. Pregnancy Category C.

Adverse Effects: DIZZINESS, hypotension, MUSCLE CRAMPS, WEAKNESS, IMPAIRED HEARING, hyperuricemia, hypochloremia, hyponatremia, HYPOKALEMIA, azotemia, and hyperglycemia.

Patient Consultation:

May be taken with food or milk if GI upset occurs.

Timing of dose is important because of increased diuresis. Usually given in a.m.

May cause orthostatic hypotension - use care when standing up.

Store in a cool, dry place away from sunlight and children.

If a dose is missed, take it as soon as possible. If closer to the time of your next dose than the dose you missed, skip the missed dose and return to your dosing schedule. Do not double doses.

Contact a physician if the above side effects are severe or persistent.