Adult Dosing

Edema

• Start 0.5-1 mg IV/IM over 2 mins; repeat q2-3 hrs PRN
• MAX: 10 mg/day

Pediatric Dosing

• Safety and effectiveness in pediatric patients < 18 yrs of age have not been established

• Edema associated with congestive heart failure, hepatic disease and renal disease, including the nephrotic syndrome

• Hypersensitivity
• Hepatic coma
• Anuria or severe electrolyte depletion

• Bumetanide is a potent diuretic which if given in excessive amounts, can lead to profound diuresis with water and electrolyte depletion. Individualize dose and carefully supervise

Renal Dose Adjustment

• Progressive renal disease: Development of oliguria or marked increase in BUN/creatinine; discontinue therapy

Hepatic Dose Adjustment

• Cirrhosis/ascites: Caution advised
• Hepatic coma: Contraindicated

• Administered IV if oral route is not feasible/possible
• Excessive doses or too frequent administration can lead to intense diuresis, electrolyte depletion and dehydration, reduction in blood volume with circulatory collapse and possible vascular thrombosis and embolism, especially in elderly patients. Adjust dose according to patient's need
• Bumenatide has been shown to produce ototoxicity. Observe patients for signs/symptoms of ototoxicity, especially if concurrent ototoxic drugs
• In patients with hepatic cirrhosis and ascites, sudden alterations of electrolyte balance may precipitate hepatic encephalopathy and coma
• Monitor for electrolyte imbalance and orthostatic hypotension
• Monitor BUN, serum creatinine, potassium, LFTs, blood sugar (if known/suspected diabetic)

Cautions: Use cautiously in

• Severe hepatic impairment (may precipitate hepatic coma)
• Sensitivity to sulfonamides
• Diabetes mellitus
• Electrolyte depletion
• Arrhythmias
• Acute MI
• SLE
• Hx. of gout
• Hx. of pancreatitis
• Gestational hypertension
• Geriatric population

Pregnancy Category:C

Breastfeeding: Safety unknown, alternate drugs are preferred due to risk of suppression of lactation. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 7 October 2010).

• CNS: Dizziness, headache, nausea, encephalopathy, vertigo
• EENT: Hearing impairment, hearing loss, ear discomfort, tinnitus
• GI: Abdominal pain, diarrhea, dry mouth, nausea, vomiting
• CV: Hypotension, ECG changes
• GU: Excessive urination, increased BUN
• DERM: Photosensitivity, pruritis, rash
• ENDO: Hyperglycemia, hyperuricemia
• HEMA: Thrombocytopenia
• METABOLIC: Dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis
• MUSC: Arthralgia, muscle cramps, myalgia
• MISC: Weakness, hives, fatigue, dehydration, sweating, hyperventilation

• A potent loop diuretic with a rapid onset and short duration of action
• Inhibits reabsorption of Na and K in the ascending loop of Henle
• Partially metabolized by liver; CYP450: 1A2 substrate
• Renally excreted: 81% (45% unchanged); bile: 2%
• Half-life: 1-1.5 hrs

US Availability

bumetadine (generic)

• INJ: 0.25 mg/mL (2, 4, 10 mL vials)

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Availability

bumetadine (generic)

• INJ: 0.5 mg/mL (4 mL amp)

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

Cardiovascular

Diuretics

Loop Diuretics