What is the conversion dose from oral (PO) Bumex (bumetanide) to intravenous (IV) Bumex (bumetanide)?

From the Guidelines

The conversion dose from oral (PO) Bumex (bumetanide) to intravenous (IV) Bumex (bumetanide) is 1:1, meaning the same dose can be used for both routes of administration. This is based on the pharmacokinetic properties of bumetanide, which has excellent oral bioavailability, allowing for a straightforward conversion between oral and IV routes 1. When converting between routes, clinicians should monitor the patient's response, including:

• Urine output
• Electrolytes
• Hemodynamic parameters as individual responses may vary. Bumetanide is a potent loop diuretic, and regardless of administration route, patients should be monitored for potential side effects such as electrolyte imbalances, particularly hypokalemia. It's also important to note that while the dose remains the same, the onset of action differs between routes - IV administration produces effects within minutes, while oral administration takes about 30-60 minutes to begin working. The American College of Cardiology Foundation/American Heart Association guidelines provide recommendations for the use of diuretics, including bumetanide, in the treatment of heart failure, but do not specifically address the conversion between oral and IV routes 1. However, the guideline does provide information on the initial daily dose, maximum total daily dose, and duration of action for bumetanide, which can be useful in guiding dosing decisions. For example, the guideline recommends an initial daily dose of 0.5 to 1.0 mg once or twice, with a maximum total daily dose of 10 mg, and a duration of action of 4 to 6 hours 1.

From the Research

Conversion Dose from Oral (PO) Bumex to Intravenous (IV) Bumex

The conversion dose from oral (PO) Bumex (bumetanide) to intravenous (IV) Bumex can be determined based on the drug's pharmacokinetic properties.

• Bumetanide is rapidly and almost completely absorbed after oral administration, with peak plasma levels achieved approximately 30 minutes after oral administration 2.
• The pharmacokinetic parameters of bumetanide are similar to those of furosemide, with an apparent half-life of 1.2-1.5 hours and a volume of distribution of about 25 liters 2.
• Studies have shown that oral or intravenous bumetanide 0.5 to 2 mg/day produces results comparable to those with frusemide 20 to 80 mg/day 3.
• The potency of bumetanide is approximately 40 times that of furosemide on a milligram-for-milligram basis 3, 4.
• In general, the IV dose of bumetanide is the same as the oral dose, as the drug is almost completely absorbed after oral administration 2.

Clinical Considerations

• The conversion dose may vary depending on the individual patient's condition and response to the drug.
• Higher doses of bumetanide may be required in patients with chronic renal failure or nephrotic syndrome 3, 5.
• The drug's adverse-reaction profile is similar to that of furosemide, although the incidence of hypochloremia and hypokalemia is greater with bumetanide 4.
• Clinically important side effects are infrequent, with audiological impairment occurring to a lesser extent than with frusemide 3.

Key Points

• The conversion dose from oral to IV bumetanide is generally 1:1, due to the drug's high oral bioavailability.
• The dose of bumetanide should be individualized based on the patient's condition and response to the drug.
• Patients with chronic renal failure or nephrotic syndrome may require higher doses of bumetanide 3, 5.