From the Guidelines
Furosemide (Lasix) and Bumetanide (Bumex) are both effective loop diuretics, but Bumex is approximately 40 times more potent than Lasix, and the choice between them should be based on individual patient response and clinical situation, as suggested by the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1.
Comparison of Furosemide and Bumetanide
- Both medications are loop diuretics used to treat fluid retention and edema in heart failure patients.
- Bumetanide has a higher potency compared to Furosemide, with 1mg of Bumetanide roughly equivalent to 40mg of Furosemide.
- The duration of action for Bumetanide is 4-6 hours, which is shorter than Furosemide's 6-8 hours, as outlined in the guideline 1.
- Both medications have similar side effect profiles, including electrolyte imbalances, dehydration, and hearing problems at high doses.
Clinical Considerations
- The initial daily dose of Bumetanide is 0.5-1.0 mg once or twice, with a maximum total daily dose of 10 mg, whereas Furosemide's initial daily dose is 20-40 mg once or twice, with a maximum total daily dose of 600 mg, as stated in the guideline 1.
- Patients may respond more favorably to one medication over the other due to differences in oral bioavailability.
- Diuretic resistance can be overcome by escalating the loop diuretic dose, administering diuretics intravenously, or combining different diuretic classes, as suggested by the guideline 1.
- Monitoring of electrolytes, kidney function, and blood pressure is necessary for both medications.
From the FDA Drug Label
Pharmacological and clinical studies have shown that 1 mg bumetanide has a diuretic potency equivalent to approximately 40 mg furosemide.
- Comparison of Diuretic Potency: Bumetanide (Bumex) is approximately 40 times more potent than Furosemide (Lasix) on a milligram-per-milligram basis, as 1 mg of bumetanide is equivalent to about 40 mg of furosemide.
- Key Difference: The primary difference lies in their potency, with bumetanide being significantly more potent than furosemide, which may influence the dosage and frequency of administration 2.
From the Research
Comparison of Furosemide and Bumetanide
- Furosemide and bumetanide are both loop diuretics that inhibit sodium transport in the thick ascending limb of the loop of Henle 3.
- Bumetanide is approximately 40 times as potent as furosemide on a milligram-for-milligram basis 3.
- Both drugs have similar pharmacokinetic parameters, with peak serum concentrations attained at approximately 30 minutes after oral administration for bumetanide 3.
- Furosemide and bumetanide have been compared in several studies, with results showing that they are equally effective in controlling edema and hypertension in patients with various conditions, including congestive heart failure, hepatic cirrhosis, and renal insufficiency 4, 5, 6.
Efficacy and Safety
- Both furosemide and bumetanide have been shown to be effective in reducing edema, body weight, and abdominal girth in patients with edema due to renal disease 6.
- The incidence of hypochloremia and hypokalemia is greater with bumetanide, while the incidence of hyperglycemia and ototoxicity is greater with furosemide 3.
- Bumetanide may be preferred in patients with increased risk of ototoxicity 3.
- Furosemide and bumetanide have similar adverse-reaction profiles, with minor side-effects such as hypokalaemia and hyperuricaemia being common with both agents 4.
Pharmacokinetics in Neonates and Infants
- The half-life of both furosemide and bumetanide is considerably longer in neonates than in adults, with the clearance of these drugs reduced at birth 7.
- The volume of distribution of furosemide undergoes little variation during neonate maturation, while the dose of furosemide and bumetanide must be adjusted based on the patient's age and weight 7.
- Continuous infusion of furosemide has been shown to result in more controlled diuresis with fewer hemodynamic and electrolytic variations compared to intermittent infusion 7.