Bumetanide (Injection)

Bumetanide is an injection that treats edema, particularly in cases where the condition developed as a result of congestive heart failure or hepatic and renal disease, including the nephrotic syndrome.

Overview

In cases where edema, or excess fluid, is present in the body, bumetanide is prescribed as a diuretic. This treatment is commonly prescribed, where the edema is a consequence of heart failure, liver disease, or kidney disease. Once the drug has a chance to affect the patient, some symptoms, such as a shortness of breath or swelling of the limbs and abdomen, can be either reduced or eliminated. The primary function of bumetanide is to cause the body to create more urine, thereby reducing the levels of water and salt present in the body.

Bumetanide is often used in cases where high doses of furosemide, another diuretic, have proven ineffective. Often, furosemide is prescribed first, because it's a milder acting drug. As bumetanide is said to be 40 times more potent than furosemide, it's often used as a drug of last resort, though there is no practical reason it can't be used as a first or preferred treatment of choice.

Conditions treated

  • Edema

Type of medicine

  • Diuretic

Side Effects

While a list of the most common side effects associated with bumetanide follows, it's by no means a complete list. Unmentioned symptoms may result and any adverse effects experienced by the patient should be reported to his or her doctor as soon as possible. A high degree of severity or frequency should be treated as a serious adverse reaction to bumetanide, requiring a consultation between the patient and doctor. Negative reactions may be the result of an allergic reaction or another source of incompatibility with the drug. The prescribing doctor may be able to adjust dosage, administer a different drug, or offer other suggestions for reducing or eliminating harmful side effects.

The side effects most commonly observed in patients taking bumetanide include:

  • Dizziness or lightheadedness
  • Skin rash or itching
  • Headaches
  • Muscle cramps or muscle pain
  • General weakness
  • Feeling excessively tired
  • Confusion
  • Fainting
  • Drowsiness
  • Dry mouth or excessive thirst
  • Stomach or abdominal pain
  • Nausea
  • Vomiting
  • Increased or irregular heart rate
  • Inability to urinate
  • Difficulty concentrating, including memory problems
  • Loss of appetite
  • Seizures
  • Trembling or shakiness
  • Hallucinations
  • Shallow breathing or trouble breathing
  • Easily bruised
  • Unexplained bleeding from the nose, mouth, vagina, or rectum
  • Pinpoint spots on the skin, purple or red in color
  • Flu-like symptoms, such as a fever, sore throat, and headache, which may be accompanied by blistering or peeling of the skin
  • Difficulty hearing

Dosage

The patient should be monitored regularly, as bumetanide is administered. Dosage levels may need to be changed in accordance with how well the drug interacts with the patient's condition. Typically, the patient should receive a single dose of 0.5 mg to 2 mg on a daily schedule.

As an injection, doses are typically administered by a trained caregiver in a hospital setting. In cases where arrangements are made for the patient to take the medication at home, they will be given detailed instructions on proper administration of the injection. The 0.5 mg to 2 mg may vary, based on the physician's judgment.

In some cases, the single dosage may not be sufficient to initiate a response. This will be readily apparent, because bumetanide is a fast acting diuretic with a limited duration. If the expected response isn't observable, one or two additional doses may be given, administered four to five hours apart, but treatment should not exceed 10 mg per day.

For prolonged treatment of edema, an intermittent treatment schedule is recommended. For instance, bumetanide can be given on alternating days. Similarly, the drug may be administered for three or four consecutive days, followed by a rest period of one to two days. In treating patients with hepatic failure, doses should be limited to a minimum in both quantity and frequency.

Major Drug Interactions

In many cases, drugs the patient may already be taking can adversely affect a new medication, or it can cause negative reactions in the patient. For that reason, it's important for the patient to share his or her drug history with the prescribing doctor. While this includes prescription medications, the patient should also share information on non-prescription drugs he or she may be taking. This includes herbal remedies and vitamins, as well as medications for headaches, heartburn, or insomnia.

Other factors that can inhibit the effectiveness of a new medication may include alcohol and narcotic drug use. The patient should share his or her recreational drug and alcohol use with the doctor to ensure a conflict won't limit the medicine's effectiveness or cause adverse reactions in the patient.

Below is a list of drugs most commonly known to interact negatively with bumetanide. If the patient is taking any of the following medications, he or she should notify their doctor prior to starting the new treatment:

  • Aminoglycoside antibiotics
  • Indomethacin
  • Lithium
  • Probenecid
  • Digoxin
  • Antihypertensives
  • Anticoagulants

The patient should discuss any need to change, start, or stop medications with his or her doctor. Altering medications may affect the way bumetanide acts, making the treatment ineffective or causing harmful reactions for the patient. Any drug therapy can be adjusted safely under the doctor's guidance, reducing risks to the patient's health and ensuring bumetanide is still effective in its current dosage and treatment schedule.

Warnings

Prior to beginning bumetanide drug therapy, the patient should also share details about his or her medical history. Current or past medical conditions may adversely impact the way bumetanide interacts within the body, so it's important that the physician is aware of any factor that could affect bumetanide as a useful diuretic. Additionally, the patient and doctor should discuss any allergies to other drugs, as well as to certain foods, dyes, preservatives, or chemicals.

Specifically, medical conditions known to affect how bumetanide interacts with the body are listed below. The patient should make sure his or her doctor is made aware of any of these diagnoses or conditions:

  • Kidney problems
  • Liver problems
  • Difficulty urinating
  • Gout
  • Diabetes
  • Low potassium levels
  • Dehydration

Bumetanide dosages should be carefully monitored to ensure it doesn't cause dehydration or a loss of electrolytes in the patient. Water loss is common, as is a reduction of blood volume, so the patient should be watched for possible circulatory collapse. Vascular thrombosis and embolism have been observed in elderly patients, when administered bumetanide.

Hypokalemia is another concern in administering this potent diuretic and monitoring patients should include checking for hepatic cirrhosis and ascites, or aldosterone excess, especially where renal function is normal. Additionally, congestive heart failure, diarrhea, and nephropathy may result.

Where hepatic cirrhosis and ascites is observed in the patient, a change in electrolytes can instigate hepatic encephalopathy and coma. For this reason, patients who have developed these conditions should be treated in a hospital setting, where he or she can be continuously monitored. This allows for smaller doses of bumetanide to be administered along with careful monitoring of the patient's electrolyte balance. A sudden change in the electrolyte balance can then be treated by administering supplemental potassium and/or spironolactone, which may prevent hypokalemia and metabolic alkalosis.

Ototoxicity is another concern in administering bumetanide, though blood levels necessary to cause ototoxicity will rarely be achieved. In animal testing, the potential of this occurring was found to be low, but still possible. As such, physicians should be aware that this occurring, especially with high or frequent doses, is a probability.

There have also been rare instances of patients developing thrombocytopenia in response to receiving bumetanide drug therapy. Patients should be monitored for this condition, as well. Additionally, a patient with an allergy to sulfonamides in general will likely show a hypersensitivity to bumetanide treatments.

Storage

Bumetanide should not be removed from its original container and it should be kept tightly closed. Additionally, it should be stored out of the reach of children. It can be stored at room temperature, but steps should be taken to keep it away from sources of excess heat and moisture.

As is true of any medication, bumetanide should be maintained in a safe place and, if the bottle comes with a safety cap, the patient should ensure it is tightly screwed into place. Often, children can open bottles and may swallow medications that can have a poisonous reaction. For that reason, keeping bumetanide safely away from both children and pets is essential.

When the treatment is no longer needed or the drug has expired, the patient should discard of the drug immediately. A caregiver can provide proper instructions for disposing of unused portions of prescription and non-prescription medications.

Summary

Since bumetanide is a potent diuretic, patients taking the drug at home should avoid taking a dose within four hours of their bedtime. Otherwise, the individual may have to get up frequently to urinate throughout the night. Additionally, dosages are based on the severity and the type of the patient's medical condition, so quantity and frequency should not be adjusted without the doctor's consent. In treating older adults, a lower dose is often prescribed to reduce side effects and adverse reactions. For this reason, a larger dose should be first discussed with the prescribing physician, so it can be done safely.

Taking bumetanide on a regular schedule will help patients gain the maximum benefits from the treatment. For that reason, patients are encouraged to take their doses at the same time every day. This will help them get into the habit of taking the drug and reduce the chances of a missed dose. If the patient does miss a dose, he or she should be instructed to take the missed dose as soon as possible. However, the patient should be cautioned against taking an extra dose to make up for a missed dose and should not take the missed dose, if it's near time for the next one.

Patients should also be instructed to take bumetanide, even on occasions where they don't feel ill. Very often, people with high blood pressure won't feel sick, but still need the treatment. Also, it's important for the patient to continue seeing his or her doctor on a regular basis. By canceling scheduled appointments, the doctor may miss important indicators that bumetanide is having a harmful effect on the patient or may not be causing the desired reaction. Careful monitoring is necessary to ensure further complications don't endanger the patient's health or necessitate a longer treatment schedule for the patient. By working together, the doctor and patient can gain the maximum advantages from bumetanide without unnecessarily increasing the risks to the patient's overall health or well being.

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Last Reviewed:
December 23, 2017
Last Updated:
April 02, 2018