Dosing and uses of Bumex, Burinex (bumetanide)
Adult dosage forms and strengths
injectable solution
- 0.25mg/mL
tablet
- 0.5mg
- 1mg
- 2mg
Edema
PO: 0.5-2 mg once; may be repeated in 4-5 hours for up to 2 doses; not to exceed 10 mg/day
IM: 0.5-1 mg once; may be repeated in 2-3 hours for up to 2 doses; not to exceed 10 mg/day
IV: 1 mg initially, then 0.5-2 mg/hr
Hypertension (Off-label)
I mg IV loading dose, then 0.5-2 mg/day PO divided q12hr
Dosing Considerations
1 mg bumetanide is roughly equivalent to 40 mg furosemide
Edema due to congestive heart failure, hepatic disease, or nephrotic syndrome
- Use with fluid retention refractory to thiazides or with impaired renal function
- May be tried if patient is allergic to furosemide
Overdose management
- Normal saline may be used for volume replacement
- Dopamine or norepinephrine may be used to treat hypotension
- Treat hyperkalemia with IV glucose (D25W) with rapid-acting insulin and concurrent IV sodium bicarbonate; use oral or rectal solutions of sodium polystyrene in sorbitol if needed
- If dysrhythmia due to decreased potassium or magnesium is suspected, replace aggressively
- Discontinue treatment if no symptoms are apparent after 6 hours
Pediatric dosage forms and strengths
injectable solution
- 0.25mg/mL
tablet
- 0.5mg
- 1mg
- 2mg
Edema (Off-label)
<6 months: 0.01-0.05 mg/kg once daily or every other day; optimum diuretic effect is reported at 0.04 mg/kg; lower dosages have been shown to have greater efficacy
≥6 months: 0.015-0.1 mg/kg once daily or every other day; not to exceed 10 mg/day
Geriatric dosage forms and strengths
In general, dosage selection for elderly should be cautious, usually starting at low end of dosing range, in view of higher incidence of decreased hepatic, renal, or cardiac function and greater frequency of concomitant disease or other drug therapy
Bumex, Burinex (bumetanide) adverse (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 (ie, Stevens-Johnson syndrome, toxic epidermal necrolysis)
Vertigo
Vomiting
Warnings
Black box warnings
Agent is potent diuretic that, if given in excessive amounts, may lead to profound diuresis with water and electrolyte depletion
Careful medical supervision is required; dosing must be adjusted to patient's needs
Contraindications
Documented hypersensitivity to bumetanide or sulfonamides
Severe uncorrected electrolyte depletion, anuria, hepatic coma
Cautions
Risk of electrolyte imbalance, alterations in glucose metabolism, blood dyscrasias, development of oliguria or increased blood urea nitrogen (BUN) or creatinine, hepatic disease, hyperuricemia, hypokalemia, hypomagnesemia, hypovolemia, neonates at risk for kernicterus
Risk of ototoxicity with rapid IV administration
Fluid status and renal function should be monitored to prevent oliguria, increased creatinine and BUN, and azotemia
Asymptomatic hyperuricemia is reported
Use with caution in patients with cirrhosis
Coadministration with antihypertensive agent may increase risk of hypotension
Pregnancy and lactation
Pregnancy category: C
Lactation: Unknown whether drug is excreted in breast milk; use with caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Bumex, Burinex (bumetanide)
Mechanism of action
Inhibits reabsorption of sodium and chloride in ascending loop of Henle, thereby causing excretion of water and sodium, chloride, calcium, magnesium, potassium, and hydrogen ions
Absorption
Bioavailability: 59-89%
Onset: IV, 2-3 min; PO/IM, 30-60 min
Duration: 4-6 hr
Peak plasma time: IV, 5 min; IM, 30 min; PO, 1-2 hr
Distribution
Protein bound: 94-96%
Vd: Adults, 9-25 L; neonates and infants, 0.26-0.39 L/kg
Metabolism
Partially metabolized in liver
Metabolites: Bumetanide conjugates, desbutyl bumetanide, primary alcohols, aliphatic acid metabolite (inactive)
Elimination
Half-life: Adults, 1-1.5 hr; infants >1 month, 2.4 hr; neonates, 6 hr
Excretion: Urine (81%), feces (2%)
Administration
IV Incompatibilities
Additive: Dobutamine
Y-site: Fenoldopam, midazolam
IV Compatibilities
Solution: D5W
Additive: Floxacillin, furosemide
Syringe: Doxapram
Y-site: Check with manufacturer
IV/IM Administration
May be administered by IM injection, by IV injection over 1-2 minutes, or by IV infusion
If glass ampoules are used, filter to remove particles
Storage
Store at room temperature
Protect from light; drug discolors when exposed to light
