From the Guidelines
Bumetanide and furosemide are both loop diuretics used to treat fluid overload conditions, but they differ in potency and dosing, with bumetanide being approximately 40 times more potent than furosemide. The key differences between bumetanide and furosemide lie in their potency, dosing, and oral bioavailability. Bumetanide is roughly equivalent to 40mg of furosemide, with 1mg of bumetanide being a common dose, whereas furosemide is typically dosed at 20-80mg once or twice daily 1.
Potency and Dosing
- Bumetanide: 0.5-2mg once or twice daily
- Furosemide: 20-80mg once or twice daily Bumetanide has better and more predictable oral bioavailability, around 80-95%, compared to furosemide, which has an oral bioavailability of 50-70% 1. This makes bumetanide potentially more reliable for patients with gut edema or malabsorption issues.
Mechanism of Action
Both medications work by inhibiting the sodium-potassium-chloride cotransporter in the ascending loop of Henle, preventing sodium reabsorption and increasing urine output.
Side Effects
Side effects are similar for both and include electrolyte disturbances (particularly potassium depletion), dehydration, and ototoxicity, though bumetanide may have slightly less risk of hearing problems. Monitoring of electrolytes, kidney function, and fluid status is essential with either medication.
Clinical Use
According to the most recent guidelines, loop diuretics like bumetanide and furosemide are the preferred diuretic agents for use in most patients with heart failure, with the goal of eliminating clinical evidence of fluid retention using the lowest dose possible to maintain euvolemia 1.
Recommendation
The choice between bumetanide and furosemide should be based on the individual patient's needs, with consideration of their potency, dosing, and oral bioavailability, as well as their potential side effects and the patient's specific clinical condition. Given the most recent evidence, bumetanide may be preferred in patients with gut edema or malabsorption issues due to its better oral bioavailability 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Bumetanide is a loop diuretic with a rapid onset and short duration of action. Pharmacological and clinical studies have shown that 1 mg bumetanide has a diuretic potency equivalent to approximately 40 mg furosemide.
The main difference between Bumetanide and Furosemide is their diuretic potency, with 1 mg of bumetanide being equivalent to approximately 40 mg of furosemide 2.
From the Research
Difference between Bumetanide and Furosemide
- Bumetanide is a potent 'loop' diuretic, approximately 40-fold more potent than furosemide 3
- The principal site of action for bumetanide is on the ascending limb of the loop of Henle, with a secondary action on the proximal tubule 3
- Furosemide, on the other hand, is also a 'loop' diuretic, but its potency is lower compared to bumetanide 3, 4
- Bumetanide produces a rapid and marked diuresis, and increased urinary excretion of sodium, chloride, and other electrolytes, which persists for 3 to 6 hours 3
- In patients with oedema due to congestive heart failure, pulmonary oedema, or hepatic disease, oral or intravenous bumetanide 0.5 to 2 mg/day produces results comparable to those with furosemide 20 to 80 mg/day 3
- The dose-response curves for bumetanide and furosemide deviate significantly from parallelism, and bumetanide has a lower potency for urinary potassium excretion compared to furosemide 4
- Combination therapy with metolazone and furosemide can be effective in managing refractory fluid overload in patients with renal failure 5, 6
- Bumetanide can be used as an alternative to furosemide, especially in patients with renal disease, where it may produce a better response 3
- Both bumetanide and furosemide can be used in combination with other diuretics, such as amiloride or potassium chloride, to enhance their clinical response 7