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Drugs List
Therapeutic Indications
Dosage
Administration
Contraindications
Precautions and Warnings
Pregnancy and Lactation
Side Effects
Monograph

Precautions and Warnings

Correct hypovolaemia and hypotension before initiation of treatment.

NSAIDs may antagonise the action of diuretics. Patients should be advised not to take NSAIDs unless advised by a clinician.

Rapid mobilisation of oedema may cause circulatory collapse, particularly in elderly patients. This should be born in mind when bumetanide is given in high doses.

Electrolyte disturbances may occur, particularly in patients with a low salt diet.
Use with caution in patients suspected of electrolyte imbalances

Regularly monitor serum electrolytes, particularly sodium, potassium, chloride and bicarbonate.
Supplemental electrolytes may be required.

Diabetes mellitus - monitor blood and urinary glucose in patients with diabetes mellitus and those suspected of latent diabetes.

Chronic renal failure patients should remain under constant hospital supervision.
Discontinue if blood urea increases or oliguria/anuria occur during treatment for oedema due to renal insufficiency.

Use in caution in patients taking nephrotoxic or ototoxic drugs.

In prostatic hypertrophy urinary retention may occur. This can be avoided by the use of low doses and less potent diuretics initially. An adequate urinary output should be established before initiating treatment.

May exacerbate gout.

May cause dizziness or fatigue, patients should not drive or operate machinery if they experience these effects.

Hepatic impairment - ( see Dosage - hepatic impairment).

Renal impairment - ( see Dosage - renal impairment).

Pregnancy - (see Pregnancy section).

Elderly (see Dosage Elderly ).

Children 1 month - 12 years (see Dosage Children ).

Can cause a positive anti doping test in athletes.

Some formulations contain lactose and should be avoided in patients with galactosaemia, glucose-galactose malabsorption syndrome and lactose intolerance.

Some formulations contain sorbitol and should be avoided in patients with hereditary fructose intolerance.

Use with caution in patients with a family history of long QT syndrome and patients with a history of torsade de pointes.

Consider monitoring ECG in patients at risk of QT prolongation.

Correct electrolyte disorders before treatment.

Pregnancy and Lactation

Pregnancy

Diuretics are no longer part of the standard therapy for hypertension and oedema during pregnancy. They should only be used for particular indications. Bumetanide has been recommended for the treatment of nephrotic syndrome in pregnancy.

Diuretics can reduce the plasma volume and lead to a reduced perfusion of the placenta.

There is inadequate data on the use of this drug in pregnancy so it is not generally recommended.

A study on 44 newborns exposed to bumetanide during the first trimester showed 2 major cardiovascular defects when 0.4 were expected. Caution should therefore especially be applied in this trimester.

Tests with bumetanide on rats, rabbits, mice and hamsters have shown a low teratogenic risk. Rabbits given doses of 3.4 times the maximum human therapeutic dose (MTHD) showed slightly embryocidal effects (Briggs, 2008).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Contraindicated during breastfeeding. Safety has not been established.

Bumetanide and other diuretics are thought to suppress lactation and it is not known whether the drug is excreted in breast milk, so the manufacturer advises avoidance if possible. Low doses in mothers whose lactation is well established are unlikely to suppress lactation.

Schaefer (2007) concludes that single doses of bumetanide do not require limitation of breastfeeding, but therapy should be changed.

If use considered essential, then discontinue breastfeeding while on therapy or observe infant for adverse effects.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Licensed in neonates - No.

Presentation

Tablets containing 1mg bumetanide
Tablets containing 5mg bumetanide
Oral solution containing 200 micrograms / ml bumetanide

Drugs List

bumetanide 1mg tablets

bumetanide 1mg/5ml oral solution sugar-free

bumetanide 5mg tablets

Therapeutic Indications

Uses

Treatment of oedema, such as that associated with:
Cardiac failure
Hepatic cirrhosis
Renal disease (including nephrotic syndrome)

Dosage

A twice daily dose regime should be considered especially where high doses are given.

Adults

1mg to be taken in the morning (or early evening). A second dose can be given 6 to 8 hours later if necessary. Increase dose until adequate diuresis is obtained.

In severe cases, (e.g. oedema of cardiac or renal origin), higher doses may be necessary, and 5mg daily may be given. This can be increased, if necessary, by 5mg every 12 to 24 hours until an adequate response is obtained or side effects appear.

Elderly

Adjust dosage according to response. A daily dose of 500 micrograms may be sufficient in some elderly patients.

Children

Children aged 12 to 18 years
(See Dosage; Adult)
Children aged 1 month to 12 years (unlicensed)
15 to 50 micrograms/kg given one to four times daily. Maximum dose is 2mg per dose or 5mg per day.

Patients with Renal Impairment

Use with caution.

Higher doses may be needed to induce diuresis in renal insufficiency.
Treatment should be stopped if increased blood urea, oliguria or anuria develop.

Patients with Hepatic Impairment

Use with caution. No additional dosage information available. Hepatic impairment may increase risk of encephalopathy, hypokalaemia and hypomagnesaemia.

Additional Dosage Information

In most patients, a 1mg dose of bumetanide exerts a similar effect to 40mg furosemide.

This 1:40 relationship is not valid for higher doses of bumetanide.

After oral administration, diuresis begins within about 30 minutes to an hour, with a peak effect between 1 and 2 hours. The diuretic effect lasts about 4 hours but may be prolonged to 6 hours after high doses.

Administration

For oral administration.

Contraindications

Raised blood urea
Oliguria or anuria
Hepatic coma
Breast feeding ( See Lactation section )
Neonates
Hypovolaemia
Hypotension
Severe hypokalaemia
Severe hyponatraemia
Precomatose states associated with liver cirrhosis
Renal impairment due to hepatotoxic drugs
Renal impairment due to nephrotoxic drugs
Long QT syndrome
Torsade de pointes