bumetanide

Absorption: Well absorbed after oral or IM administration. IV administration results in complete bioavailability.

Distribution: Widely distributed.

Protein Binding: 72–96%.

Metabolism/Excretion: Partially metabolized by liver; 50% eliminated unchanged by kidneys and 20% excreted in feces.

Half-Life: 60–90 min (6 hr in neonates).

Time/Action Profile ⬆ ⬇

(diuretic effect)

ROUTE	ONSET	PEAK	DURATION
PO	30–60 min	1–2 hr	4–6 hr
IM	30–60 min	1–2 hr	4–6 hr
IV	2–3 min	15–45 min	2–3 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Cross-sensitivity with thiazides and sulfonamides may occur;
Hepatic coma or anuria;
Lactation: Lactation.

Use Cautiously in:

Severe liver disease (may precipitate hepatic coma; concurrent use with potassium-sparing diuretics may be necessary);
Electrolyte depletion;
Diabetes mellitus;
Increasing azotemia;
Pedi: Potent displacer of bilirubin and should be used cautiously in critically ill or jaundiced neonates because of risk of kernicterus. Injection contains benzyl alcohol, which may cause gasping syndrome in neonates. Safety and effectiveness not established in children;
Geri: Appears on Beers list. May worsen or cause hyponatremia in older adults. Use with caution in older adults and monitor sodium concentrations closely when initiating therapy or the dose.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension

Derm: photosensitivity, pruritus, rash, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS

EENT: hearing loss, tinnitus

Endo: hyperglycemia, hyperuricemia

F and E: dehydration, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis, hypocalcemia

GI: diarrhea, dry mouth, nausea, vomiting

GU: ↑BUN

MS: arthralgia, muscle cramps, myalgia

Neuro: dizziness, encephalopathy, headache

Interactions ⬆ ⬇

Drug-drug:

↑risk of hypotension with antihypertensives, nitrates, or acute ingestion of alcohol.
↑risk of hypokalemia with other diuretics, amphotericin B, stimulant laxatives, and corticosteroids.
Hypokalemia may ↑ risk of digoxin toxicity.
↓lithium excretion, may cause lithium toxicity.
↑risk of ototoxicity with aminoglycosides.
NSAIDs↓ effects of bumetanide.

Route/Dosage ⬆ ⬇

PO (Adults ): 0.5–2 mg/day given in 1–2 doses; titrate to desired response (maximum daily dose = 10 mg/day).
PO (Infants and Children): 0.015–0.1 mg/kg/dose every 6–24 hrs (maximum: 10 mg/day).
PO (Neonates ): 0.01–0.05 mg/kg/dose every 12–24 hr in term neonates or every 24–48 hr in preterm neonates.
IM IV (Adults ): 0.5–1 mg/dose, may repeat every 2–3 hr as needed (up to 10 mg/day).
IM IV (Infants and Children): 0.015–0.1 mg/kg/dose every 6–24 hr (maximum: 10 mg/day).
IM IV (Neonates ): 0.01–0.05 mg/kg/dose every 12–24 hr in term neonates or every 24–48 hr in preterm neonates.

Availability ⬆ ⬇

(Generic available)

Tablets: 0.5 mg; 1 mg; 2 mg; 5 mg
Solution for injection: 0.25 mg/mL

Assessment ⬆ ⬇

Assess fluid status during therapy. Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes. Notify health care professional if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs.
Monitor BP and pulse before and during administration. Monitor frequency of prescription refills to determine compliance.
Assess patients receiving digoxin for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion; ↑ risk of digoxin toxicity due to potassium-depleting effect of diuretic. Potassium supplements or potassium-sparing diuretics may be used concurrently to prevent hypokalemia.
Assess patient for tinnitus and hearing loss. Audiometry is recommended for patients receiving prolonged high-dose IV therapy. Hearing loss is most common after rapid or high-dose IV administration in patients with decreased renal function or those taking other ototoxic drugs.
Assess for allergy to sulfonamides.
Assess patient for skin rash frequently during therapy. Discontinue bumetanide at first sign of rash; may be life-threatening. Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. Treat symptomatically; may recur once treatment is stopped.
Geri: Diuretic use is associated with increased risk for falls in older adults. Assess falls risk and implement fall prevention strategies.

Lab Test Considerations:

Monitor electrolytes, renal and hepatic function, serum glucose, and uric acid levels before and periodically during therapy. May cause ↓ serum sodium, potassium, calcium, and magnesium concentrations. May also cause ↑ BUN, serum glucose, creatinine, and uric acid levels.

Implementation ⬆ ⬇

If administering twice daily, give last dose no later than 5 pm to minimize disruption of sleep cycle.
- IV is preferred over IM for parenteral administration.
PO: May be taken with food to minimize gastric irritation.

IV Administration:

Diluent: Administer undiluted.Concentration: 0.25 mg/mL.
Rate: Administer slowly over 1–2 min.
Diluent: May dilute in D5W or 0.9% NaCl. May also administer as undiluted drug. Protect from light.Concentration: Not to exceed 0.25 mg/mL.
Rate: Infuse over 5 min. May be administered over 12 hr for patients with renal impairment.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take bumetanide as directed. Take missed doses as soon as possible; do not double doses.
- Caution patient to change positions slowly to minimize orthostatic hypotension. Caution patient that drinking alcohol, exercising during hot weather, or standing for long periods may enhance orthostatic hypotension.
- Instruct patient to consult health care professional regarding a diet high in potassium. See Food Sources for Specific Nutrients.
- Advise patient to contact health care professional of gain more than 3 lbs in one day.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any OTC medications concurrently with this therapy.
- Instruct patient to notify health care professional of medication regimen before treatment or surgery.
- Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
- Advise patient to contact health care professional immediately if rash, muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities occurs.
- Advise patients with diabetes to monitor blood glucose closely; may cause increased levels.
- Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding. Diuretics have the potential to decrease milk volume and suppress lactation.
- Emphasize the importance of routine follow-up examinations.
- Caution older patients or their caregivers about increased risk for falls. Suggest strategies for fall prevention.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇