Bumetanide

Mechanism :

Bumetanide is a loop diuretic with a rapid onset and short duration of action. Bumetanide inhibits sodium reabsorption in the ascending limb of the loop of Henle. Reabsorption of chloride in the ascending limb is also blocked. Potassium excretion is also increased by bumetanide, in a dose-related fashion. Bumetanide may have an additional action in the proximal tubule.

Indication :

Fluid overload
Edema

Contraindications :

Bumetanide is contraindicated in anuria. Although bumetanide can be used to induce diuresis in renal insufficiency, any marked increase in blood urea nitrogen or creatinine, or the development of oliguria during therapy of patients with progressive renal disease, is an indication for discontinuation of treatment with bumetanide. Bumetanide is also contraindicated in patients in hepatic coma or in states of severe electrolyte depletion until the condition is improved or corrected. Bumetanide is contraindicated in patients hypersensitive to this drug.

Dosing :

Oral/IM/IV:

<6 months: 0.01-0.05 mg/kg every 24-48 hours.

>6 months: 0.015-0.1 mg/kg every 24-48 hours. Maximum dose: 10 mg/day.

Adverse Effect :

Muscle cramps, dizziness, hypotension, headache, hyperuricemia, hypochloremia, hypokalemia, azotemia, nausea, encephalopathy, impaired hearing, pruritus, electrocardiogram changes, weakness, abdominal pain, joint pain, musculoskeletal pain, rash, vomiting.

Interaction :

Ototoxic drugs: Especially in the presence of impaired renal function, concurrent use of parenterally administered bumetanide with aminoglycoside antibiotics should be avoided.
Lithium: Reduce its renal clearance and add a high risk of lithium toxicity.
Probenecid: Pre-treatment with probenecid reduces both the natriuresis and hyperreninemia produced by bumetanide.
Indomethacin: Indomethacin blunts the increases in urine volume and sodium excretion seen during bumetanide treatment and inhibits the bumetanide-induced increase in plasma renin activity.
Antihypertensives: Bumetanide may potentiate the effect of various antihypertensive drugs, necessitating a reduction in the dosage of these drugs.

Renal Dose :

Dose in Renal Impairment GFR (mL/min)

20-50	Dose as in normal renal function
10-20	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 function
HDF/High flux	Unknown dialysability. Dose as in normal renal function
CAV/VVHD	Not dialysed. Dose as in normal renal function

Hepatic Dose :

Start at the lower end of the dosage range and increase gradually to get the desired clinical response. Use diuretics carefully in patients with hepatic disease because minor alterations of fluid and electrolytes may lead to hepatic coma.