What is the use of Bumex (Bumetanide)?

From the Guidelines

Bumex (Bumetanide) is a loop diuretic primarily used to treat fluid retention (edema) associated with heart failure, with an initial dose of 0.5–1.0 mg and a usual daily dose of 1–5 mg, as recommended by the 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 1.

Key Points

• Bumex is a potent loop diuretic that works by preventing the kidneys from reabsorbing salt and water, causing increased urine production to reduce excess fluid in the body.
• The typical starting dose is 0.5 to 1 mg once daily, which can be increased gradually to a maximum of 5 mg daily if needed, according to the 2016 ESC guidelines 1.
• Bumex acts quickly, usually within 30-60 minutes after oral administration, with effects lasting 4-6 hours.
• Patients should take Bumex in the morning to avoid nighttime urination disrupting sleep.

Important Considerations

• Common side effects include increased urination, electrolyte imbalances (particularly potassium depletion), dizziness, and dehydration.
• Regular monitoring of kidney function and electrolyte levels is essential during treatment, as excessive doses may cause renal impairment and ototoxicity 1.
• Patients should maintain adequate fluid intake while taking Bumex and report symptoms like severe dizziness, muscle cramps, or irregular heartbeat, which could indicate electrolyte imbalances requiring medical attention.

Dosage and Administration

• The dose of Bumex may need to be adjusted according to volume status/weight, and a maximum dose of 5 mg daily is recommended 1.
• Bumex can be administered orally or intravenously, and the dose should be adjusted accordingly to avoid excessive doses that may cause adverse effects.

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 Bumex (Bumetanide) 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 Bumex (Bumetanide)

• Bumetanide is a potent 'loop' diuretic used for the treatment of oedema associated with:
  • Congestive heart failure 3, 4, 5, 6, 7
  • Hepatic and renal diseases 3, 4, 5, 6, 7
  • Acute pulmonary congestion 3, 7
  • Premenstrual syndrome 3
  • Forced diuresis during and after surgery 3
• Bumetanide may be given orally, intravenously, or intramuscularly, producing a rapid and marked diuresis 3, 4, 5
• The principal site of action is on the ascending limb of the loop of Henle, with a secondary action on the proximal tubule 3, 5, 6

Therapeutic Efficacy

• Bumetanide has been shown to be an effective diuretic in the treatment of edema due to cardiac disease, hepatic disease, and renal disease 3, 4, 5, 6, 7
• It has also been used to treat edema refractory to other loop diuretics 5
• Bumetanide is approximately 40 times as potent as furosemide on a milligram-for-milligram basis 3, 6

Administration and Dosage

• The usual dose of bumetanide is 0.5 to 2 mg/day, which produces results comparable to those with furosemide 20 to 80 mg/day 3
• Higher doses of bumetanide may be required in patients with chronic renal failure or nephrotic syndrome, up to 15 mg/day 3
• Intravenous bumetanide has an onset of action between 10 and 15 minutes, with a peak at 50 minutes and a total duration of action of about 240 minutes 4