What is the use of Bumetanide (diuretic)?

From the Guidelines

Bumetanide is a loop diuretic primarily used to treat edema associated with heart failure, with a typical starting dose of 0.5-1 mg once or twice daily, and a maximum total daily dose of 10 mg, as recommended by the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1.

Key Points

• Bumetanide works by inhibiting the sodium-potassium-chloride cotransporter in the thick ascending limb of the loop of Henle in the kidneys, preventing sodium and chloride reabsorption and increasing urine output.
• The medication has a duration of action of 4-6 hours, and its use is commonly initiated with low doses, which are increased until urine output increases and weight decreases, generally by 0.5 to 1.0 kg daily 1.
• Diuretic resistance can be overcome by escalating the loop diuretic dose, intravenous administration of diuretics, or combination of different diuretic classes, as stated in the 2022 AHA/ACC/HFSA guideline 1.

Clinical Considerations

• Bumetanide is approximately 40 times more potent than furosemide, with 1 mg of bumetanide roughly equivalent to 40 mg of furosemide.
• Common side effects include electrolyte imbalances (particularly potassium depletion), dehydration, and increased blood glucose.
• Regular monitoring of electrolytes, kidney function, and blood pressure is essential during treatment, as recommended by the 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults 1.
• Patients should be advised to take the medication in the morning to avoid nighttime urination and to maintain adequate fluid intake unless otherwise directed.
• Bumetanide should be used cautiously in patients with sulfa allergies, gout, diabetes, or hearing impairment, as it may exacerbate these conditions.

From the FDA Drug Label

INDICATIONS AND USAGE Bumetanide injection is indicated for the treatment of edema associated with congestive heart failure, hepatic and renal disease, including the nephrotic syndrome. The use of Bumetanide, a diuretic, is for the treatment of:

• Edema associated with:
  • Congestive heart failure
  • Hepatic disease
  • Renal disease, including the nephrotic syndrome 2

From the Research

Uses of Bumetanide

• Bumetanide is a potent 'loop' diuretic used for the treatment of oedema associated with congestive heart failure, hepatic and renal diseases, acute pulmonary congestion, and premenstrual syndrome 3.
• It is also used in forced diuresis during and after surgery 3.
• Bumetanide has been shown to be effective in treating edema due to cardiac disease, hepatic disease, and renal disease, even in patients with modest to severe renal insufficiency 4.
• It may be useful in the treatment of edema refractory to other loop diuretics 4.

Administration and Pharmacokinetics

• Bumetanide may be given orally, intravenously, or intramuscularly, producing a rapid and marked diuresis within 30 minutes, which persists for 3 to 6 hours 3.
• The principal site of action is on the ascending limb of the loop of Henle, with a secondary action on the proximal tubule 3, 4.
• Bumetanide is approximately 40-fold more potent than frusemide (furosemide) 3, 5.

Efficacy and Safety

• Studies have shown that bumetanide is an effective diuretic, with results comparable to those of frusemide in patients with oedema due to congestive heart failure, pulmonary oedema, or hepatic disease 3, 6.
• Bumetanide has been associated with hypokalemia, hypochloremia, metabolic alkalosis, hyperuricemia, and prerenal azotemia, but the incidence of ototoxicity is lower compared to furosemide 4, 7, 5.
• Combination with thiazide diuretics enhances the clinical response to bumetanide, and potassium supplements and spironolactone may be beneficial additions to bumetanide in patients at risk of hypokalaemia 3.