Maximum Recommended Dose of Bumetanide (Bumex)
The maximum total daily dose of bumetanide is 10 mg. 1
Dosing Guidelines for Bumetanide
Bumetanide is a potent loop diuretic used primarily for the treatment of fluid retention (edema) associated with heart failure, hepatic disease, and renal disease. The dosing recommendations are as follows:
Oral Administration
- Initial dose: 0.5 to 1.0 mg once or twice daily 2
- Usual daily dose: 0.5 mg to 2 mg 1
- Maximum daily dose: 10 mg 2, 1
Intravenous Administration
- Initial dose: 1.0 mg 2
- Maximum single dose: 4 to 8 mg 2
- Continuous infusion: 0.5 to 2 mg per hour (following a 1 mg IV loading dose) 2
Administration Considerations
Due to bumetanide's rapid onset and short duration of action (4-6 hours), if the diuretic response to an initial dose is inadequate, a second or third dose may be given at 4-5 hour intervals, up to the maximum daily dose 1
An intermittent dosing schedule (given on alternate days or for 3-4 days with 1-2 day rest periods) is recommended as the safest and most effective method for continued control of edema 1
In patients with hepatic failure, dosage should be kept to a minimum 1
Clinical Pearls
Bumetanide is approximately 40 times more potent than furosemide, with a typical dose conversion ratio of 1:40 (1 mg bumetanide ≈ 40 mg furosemide) 1, 3
Despite its higher potency, bumetanide may have a relatively lower potency for urinary potassium excretion compared to furosemide 3
In patients with chronic renal failure, higher doses (up to 10 mg daily) may be required for adequate diuresis 3, 4
Bumetanide has a shorter duration of action (4-6 hours) compared to other loop diuretics like torsemide (12-16 hours) 2
Potential Adverse Effects
Common adverse effects include electrolyte imbalances (particularly hypokalemia), muscle cramps, dizziness, and headache 5
Audiological impairment may occur less frequently with bumetanide than with furosemide 3
Careful monitoring of electrolytes, renal function, and fluid status is essential during bumetanide therapy, especially at higher doses
By understanding the maximum dose and proper administration of bumetanide, clinicians can effectively manage fluid overload while minimizing the risk of adverse effects.