A loop diuretic - It helps you make more urine and to lose salt and excess water from your body
FDA Alerts
Bumetanide is a potent diuretic which, if given in excessive amounts, can lead to a profound diuresis with water and electrolyte depletion.
Careful medical supervision is required; dosage selection and titration should be adjusted to the individual patient’s needs. (See Dosage and Administration.)
May be effective in some patients whose condition is unresponsive or refractory to other diuretics.
Congestive Heart Failure
Short- and long-term management of edema associated with congestive heart failure. Also relieves other signs and symptoms of congestive heart failure such as dyspnea, rales, and hepatomegaly.
Short- and long-term management of edema and ascites associated with hepatic disease (e.g., cirrhosis).
Appears to be as effective as furosemide in reducing body weight and in causing diuresis and increased urinary excretion of sodium, potassium, and chloride in patients with hepatic cirrhosis and ascites.
Renal Disease
Management of edema in patients with impaired renal function, including nephrotic syndrome.
Appears to be as effective as furosemide in reducing edema, body weight, and abdominal girth in patients with edema secondary to renal disease.
Other Edematous Conditions
Used for the management of postoperative† or premenstrual† edema and edema associated with disseminated carcinoma†.
Hypertension
Management of hypertension† (alone or in combination with other classes of antihypertensive agents).
One of several preferred initial therapies in hypertensive patients with congestive heart failure, acute pulmonary edema, or renal disease.
Can be used as monotherapy for initial management of uncomplicated hypertension. However, JNC 7 recommends that thiazides be used as initial therapy for the treatment of uncomplicated hypertension in most patients, either alone or combined with other classes of antihypertensive drugs with demonstrated benefit (e.g., ACE inhibitors, angiotensin II receptor antagonists, β-blockers, calcium-channel blockers).
Dosage and Administration
General
Excessive fluid and electrolyte loss may be minimized by monitoring the patient carefully and by initiating therapy with small doses, adjusting dosage carefully, and using an intermittent dosage schedule if possible. (See Boxed Warning.)
Supplemental therapy with potassium chloride or potassium-sparing diuretics (e.g., spironolactone) may be necessary for the prevention of hypokalemia and/or metabolic alkalosis in some patients.
Administration
Administer orally, IV, or IM.
Oral Administration
Administer orally as a single daily dose in the morning. May be preferable to administer single daily dose in the evening for a greater diuretic effect. May administer on alternate days or on 3 or 4 consecutive days alternating with drug-free periods of 1 or 2 days.
For optimum therapeutic effect in some patients, may administer twice daily (morning and evening).
Food may delay absorption.
IV or IM Administration
For solution and drug compatibility information, see Compatibility under Stability.
IV or IM administration may be used in patients unable to take oral medication or who have impaired GI absorption; resume oral administration as soon as possible.
Rate of Administration
For direct IV injection, administer slowly over a period of 1–2 minutes.
Dilution
For IV infusion, dilute in 5% dextrose, 0.9% sodium chloride, or lactated Ringer’s injection; use solutions within 24 hours.
When possible, use vials instead of ampuls to prepare large doses to prevent large quantities of glass particles from entering the solutions; if ampuls must be used, filter through a sterile membrane filter before use.
Dosage
Individualize dosage according to individual requirements and response.
Since the diuretic response following oral or parenteral administration is similar, dosage for oral, IV, or IM administration is identical.
Manufacturer states that bumetanide may be substituted for furosemide in furosemide-allergic patients at approximately a 1:40 ratio (cross-sensitivity between the drugs does not appear to occur). (See Sensitivity Reactions under Cautions.)
Pediatric Patients
Congestive Heart Failure
IV
Safety and efficacy not established.†
0.015 mg/kg on alternate days to 0.1 mg/kg daily has been used in a limited number of children with congestive heart failure†.†
In infants 4 days to 6 months of age, maximal diuretic effect was observed at a dosage of 0.035–0.04 mg/kg.†
Adults
Edema
Oral
Initially, 0.5–2 mg daily. Repeat dose at 4- to 5-hour intervals until desired response is obtained or maximum dosage of 10 mg daily is reached.
For maintenance therapy, effective dose may be administered intermittently. (See Administration under Dosage and Administration.)
IV or IM
Initially, 0.5–1 mg. Repeat dose at 2- to 3-hour intervals until desired diuretic response is obtained or a maximum dosage of 10 mg daily is reached.
Hypertension
Oral
Initially, 0.5 mg daily. 0.5–2 mg daily administered in 2 divided doses is recommended by JNC 7.†
Maintenance dosages of 1–4 mg daily have been used. Higher dosages may be necessary in some patients (e.g., those with renal insufficiency). (See Renal Impairment under Dosage and Administration.)†
Prescribing Limits
Adults
Edema
Oral
Maximum recommended by manufacturer: 10 mg daily.
IV or IM
Maximum recommended by manufacturer: 10 mg daily.
Special Populations
Hepatic Impairment
Edema
Use minimum effective dosage; titrate carefully.
Renal Impairment
Edema
Oral or IV
Up to 20 mg daily has been administered. IV doses >2 mg needed to achieve a diuretic response in patients with Clcr <5 mL/minute. High dosages may be needed to produce an adequate diuretic response in patients with severe renal impairment (i.e., GFR <10 mL/minute).
Hypertension
Oral
Dosages >1–2 mg daily may be necessary for the management of hypertension† in adults with renal insufficiency. Dosage may be increased until the desired therapeutic response is achieved, adverse effects become intolerable, or a maximum dosage of 10 mg daily, in 2 divided doses, is attained. If an adequate response is not achieved with this maximum dosage, another hypotensive agent (e.g., an adrenergic inhibitor that preserves glomerular filtration rate and renal blood flow) may be added or substituted. Risk of adverse effects (e.g., ototoxicity) at these high dosages should be considered. (See Ototoxicity under Cautions.)†
Geriatric Patients
Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.
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