At a glance
Bumetanide is a loop diuretic used in the treatment of hypertension, heart failure, edema, and nephrotic syndrome. It induces diuresis by inhibiting reabsorption of water and electrolytes (sodium and chloride) in the ascending loop of Henle.
Indications
- Hypertension
- Heart failure (edema)
- Edema
- Nephrotic syndrome
Pharmacology
Bumetanide is a potent loop diuretic that inhibits the Na⁺/K⁺/2Cl⁻ co-transporter in the ascending loop of Henle and proximal renal tubule, preventing reabsorption of sodium and chloride. This increases water and electrolyte excretion in the distal tubule, producing powerful diuresis, lowering blood pressure, and reducing edema.
Dosage
Adults (Oral, Edema): 1 mg once daily. Give 2nd dose 6-8 hours later if necessary.
Refractory edema: Initially 5 mg/day, increased by 5 mg every 12-24 hours as required (high doses divided into 2-3 doses). Max: 10 mg/day.
Hypertension: 0.5-1 mg daily. Max: 5 mg/day.
Parenteral (Emergency cases of edema): 0.5-1 mg slow IV/IM injection, then adjust dose according to response.
Pulmonary edema (IV): 1-2 mg IV, repeated 20 minutes later if necessary; or 2-5 mg in 500 mL infusion fluid over 30-60 minutes.
Elderly: 0.5 mg daily.
Hepatic disease: Risk of encephalopathy (caution in pre-existing liver disease).
Renal impairment: Contraindicated in progressive renal failure and anuria.
Side effects
>10%: Hyperuricemia (18%), Hypochloremia (15%), Hypokalemia (15%), Azotemia (11%).
1-10%: Hyponatremia (9%), Hyperglycemia (7%), Increased serum creatinine (7%), Variations in phosphorus (5%), Variations in CO₂ content (4%), Variations in bicarbonate (3%), Variations in calcium (2%), Dizziness (1%), Muscle cramps (1%), Ototoxicity (1%).
<1%: Asterixis, Dehydration, Hypotension, Orthostatic hypotension, Pruritus, Rash, Renal failure, Serious skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), Vertigo, Vomiting.
Potentially Fatal: Encephalopathy (in patients with pre-existing liver disease).
Use in pregnancy
May be unsafe during pregnancy (Category C). Limited human studies available; animal studies have shown harmful effects on the developing baby. Your doctor will weigh benefits and risks before prescribing.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Precautions & warnings
- Caution during pregnancy and lactation (Category C).
- Regular monitoring of serum electrolytes (especially potassium, calcium, magnesium). In case of hypokalemia, potassium supplements/potassium-sparing diuretics added.
- Monitor blood glucose, BUN, creatinine levels, and blood counts.
- Sulfonamide allergy.
- Caution in CHF patients on digitalis, K-losing nephropathy, hepatic cirrhosis and ascites, diarrheal states.
- Risk of encephalopathy in patients with liver disease.
Overdose effects
Overdose may cause severe electrolyte imbalance, dehydration, hypotension, ototoxicity. Consult your doctor immediately if overdose is suspected.
Storage conditions
Store below 30°C, away from light and moisture. Keep out of reach of children.