Maximum Daily Dose of Bumetanide (Bumex)
The maximum recommended daily dose of bumetanide (Bumex) is 10 mg per day. 1
Dosing Guidelines
Standard Dosing
- Initial dose: 0.5 to 1.0 mg once or twice daily
- Usual daily dose range: 1-5 mg
- Maximum daily dose: 10 mg 1, 2
Administration Routes
- Oral: Rapid onset (within 30 minutes), duration 3-6 hours 2
- Intravenous: For severe heart failure or acute situations
- Intramuscular: Alternative when oral or IV routes not feasible
Potency and Conversion
- Bumetanide is approximately 40 times more potent than furosemide (except for potassium excretion where potency is lower) 2
- Conversion ratio from furosemide to bumetanide is approximately 40:1 1
| Furosemide Dose (mg) | Bumetanide Dose (mg) |
|---|---|
| 40 mg | 1 mg |
| 80 mg | 2 mg |
| 160 mg | 4 mg |
Special Considerations
Continuous Infusion
- For continuous IV infusion: Initial 20 mg IV load, then 5-20 mg per hour 1
- Important safety concern: Infusion rates >1 mg/hour are associated with a 4-fold higher risk of severe myalgia compared to rates ≤1 mg/hour 3
- The incidence of severe myalgia with bumetanide infusion is approximately 5.8%, which is 29-fold higher than listed in package labeling 3
Renal Impairment
- Higher doses (up to 15 mg/day) may be required in patients with chronic renal failure or nephrotic syndrome 2
- Monitor for muscle cramps, which are not uncommon in renal patients 2, 4
Monitoring
- Close monitoring of electrolytes (especially potassium, sodium, chloride) is essential 1
- Regular assessment of renal function to prevent acute kidney injury 1
- Watch for adverse effects:
Combination Therapy
- For resistant edema, consider adding a thiazide diuretic for synergistic effect 1
- Potassium supplements or spironolactone may be beneficial to prevent hypokalaemia 2
Bumetanide has a short half-life of approximately 1.5 hours 6, which explains its relatively short duration of action (4-6 hours) and the potential need for multiple daily doses to maintain diuretic effect in patients with significant fluid overload.