BMA Concise Guide to Medicine & Drugs

Bumetanide

Brand name Burinex

Used in the following combined preparations None

QUICK REFERENCE

Drug group Loop diuretic

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Bumetanide is a powerful, short-acting loop diuretic used to treat oedema (accumulation of fluid in tissue spaces) resulting from heart failure, nephrotic syndrome, and cirrhosis of the liver. Bumetanide is particularly useful in treating people with impaired kidney function who do not respond well to thiazide diuretics. It is often injected in an emergency to relieve pulmonary oedema (fluid in the lungs).

Bumetanide increases potassium loss in the urine, which can result in a wide variety of symptoms. For this reason, potassium supplements or a potassium-sparing diuretic may be given with the drug.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, liquid, injection.

Frequency and timing of doses Usually once daily in the morning. In some cases, twice daily.

Dosage range 1–5mg daily. Dose may be increased if kidney function is impaired.

Onset of effect Within 30 minutes by mouth; more quickly by injection.

Duration of action 2–4 hours.

Diet advice Use of this drug may reduce potassium in the body. Eat plenty of fresh fruit and vegetables, such as bananas and tomatoes.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose No cause for concern, but take as soon as you remember. However, if it is late in the day do not take the missed dose, or you may need to get up during the night to pass urine. Take the next scheduled dose as usual.

Stopping the drug Do not stop the drug without consulting your doctor; symptoms may recur.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Adverse effects are caused mainly by the rapid fluid loss produced by bumetanide, which can lead to dizziness and fainting. These usually diminish as the body adjusts to the drug. Bumetanide may precipitate gout in susceptible people and can affect the control of diabetes. The drug may also cause lethargy, fatigue, and muscle cramps, which should be notified to your doctor if they are severe. In all cases, you should contact your doctor if you experience a rash, photosensitivity, nausea, or vomiting.

INTERACTIONS

Anti-arrhythmic drugs Low potassium levels may increase these drugs’ toxicity.

Antibacterials Very high doses of bumetanide can increase the ear damage that is caused by some antibiotics.

Digoxin Excessive potassium loss may increase the adverse effects of digoxin.

Non-steroidal anti-inflammatory drugs (NSAIDs) These drugs may reduce the diuretic effect of bumetanide.

Lithium Bumetanide may increase the blood levels of lithium, leading to an increased risk of lithium toxicity.

Amisulpride, sertindole, and pimozide Low potassium levels increase the risk of abnormal heart rhythms with these antipsychotic drugs.

Thiazides Extremely large amounts of urine may be produced when these drugs are taken with bumetanide.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have a long-term liver or kidney problem.

· You have prostate problems.

· You have gout.

· You are taking other medicines.

Pregnancy Not usually prescribed. May cause a reduction in blood supply to the developing baby. Discuss with your doctor.

Breast-feeding This drug may reduce your milk supply. Discuss with your doctor.

Infants and children Not usually prescribed. Reduced dose necessary.

Over 60 Dosage is often reduced.

Driving and hazardous work Avoid such activities until you have learned how bumetanide affects you because the drug may cause dizziness and faintness.

Alcohol Keep consumption low. The drug increases the likelihood of dehydration and hangovers after drinking alcohol.

PROLONGED USE

Serious problems are unlikely, but the levels of certain salts in the body may occasionally become abnormal during prolonged use.

Monitoring Regular blood tests may be performed to check on kidney function and levels of body salts.