• Edema due to heart failure, hepatic disease, or renal impairment.

Unlabeled Uses:

• Reversal of oliguria in preterm neonates.

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.

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.

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.

(Generic available)

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

• 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.

Bumex

• Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule.
• Increases renal excretion of water, sodium chloride, magnesium, potassium, and calcium.
• Effectiveness persists in impaired renal function.

• Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions).

Therapeutic Classification: diuretics

Pharmacologic Classification: loop diuretics

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).

Burinex

(diuretic effect)

• 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 Appendix M.
  • 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.
  • Geri: Caution older patients or their caregivers about increased risk for falls. Suggest strategies for fall prevention.

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