From the Guidelines
Bumetanide is recommended for patients with HFpEF to relieve symptoms of congestion, with a typical starting dose of 0.5-1 mg once daily, titrated up to 5 mg daily in divided doses based on symptom response and fluid status, as stated in the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1. The use of bumetanide in HFpEF is primarily aimed at reducing fluid overload and alleviating symptoms such as shortness of breath, peripheral edema, and pulmonary congestion.
- The mechanism of action of bumetanide involves inhibiting the sodium-potassium-chloride cotransporter in the thick ascending limb of the loop of Henle, which reduces sodium and water reabsorption and increases urine output.
- According to the ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012, diuretics, including bumetanide, are used to control sodium and water retention and relieve breathlessness and edema in patients with HFpEF 1.
- The 2022 AHA/ACC/HFSA guideline for the management of heart failure recommends the use of loop diuretics, such as bumetanide, as the preferred diuretic agents for most patients with HF, including those with HFpEF 1.
- It is essential to monitor patients for electrolyte imbalances, particularly hypokalemia and hyponatremia, with regular blood tests recommended during dose adjustments, as noted in the ESC guidelines 1.
- Bumetanide should be used as part of a comprehensive treatment approach that may include blood pressure control, exercise, sodium restriction, and management of comorbidities, as suggested by the 2022 AHA/ACC/HFSA guideline 1.
From the FDA Drug Label
INDICATIONS AND USAGE Bumetanide tablets are indicated for the treatment of edema associated with congestive heart failure, hepatic and renal disease, including the nephrotic syndrome. The role of bumetanide in managing symptoms in a patient with Heart Failure with preserved Ejection Fraction (HFpEF) is to treat edema associated with congestive heart failure.
- Key points:
- Bumetanide is indicated for edema in congestive heart failure.
- HFpEF is a type of congestive heart failure.
- Bumetanide can be used to manage edema in HFpEF. 2
From the Research
Role of Bumetanide in HFpEF
Bumetanide is a potent 'loop' diuretic that can be used to manage symptoms in patients with Heart Failure with preserved Ejection Fraction (HFpEF) [ 3 ]. The primary use of bumetanide is for the treatment of edema associated with congestive heart failure, hepatic and renal diseases, acute pulmonary congestion, and premenstrual syndrome.
Mechanism of Action
Bumetanide works by inhibiting the reabsorption of sodium and chloride in the ascending limb of the loop of Henle, resulting in increased urine production and a decrease in fluid volume [ 4 ]. This mechanism of action makes bumetanide an effective treatment for edema and fluid overload in patients with HFpEF.
Clinical Evidence
Studies have shown that bumetanide is effective in reducing edema and improving symptoms in patients with congestive heart failure [ 3 ]. A study published in 1976 found that bumetanide caused a significant diuresis and increased excretion of sodium, potassium, and chloride in patients with congestive heart failure [ 5 ]. Another study published in 2020 found that continuous bumetanide infusion may be used in the treatment of acute heart failure or volume overload with close monitoring for new-onset or worsening acute kidney injury [ 6 ].
Key Points
- Bumetanide is a potent 'loop' diuretic that can be used to manage symptoms in patients with HFpEF.
- The primary use of bumetanide is for the treatment of edema associated with congestive heart failure, hepatic and renal diseases, acute pulmonary congestion, and premenstrual syndrome.
- Bumetanide works by inhibiting the reabsorption of sodium and chloride in the ascending limb of the loop of Henle.
- Studies have shown that bumetanide is effective in reducing edema and improving symptoms in patients with congestive heart failure.
- Continuous bumetanide infusion may be used in the treatment of acute heart failure or volume overload with close monitoring for new-onset or worsening acute kidney injury.
Comparison with Other Treatments
While bumetanide may be effective in managing symptoms in patients with HFpEF, other treatments such as SGLT2 inhibitors have also shown promise in reducing hospitalization for heart failure [ 7 ]. However, the role of bumetanide in HFpEF is still an area of ongoing research, and more studies are needed to fully understand its effects and potential benefits.