From the Guidelines
Bumex, also known as bumetanide, is a potent loop diuretic medication primarily used to treat fluid retention (edema) associated with heart failure, liver disease, and kidney disease, with a typical starting dose of 0.5 to 1 mg once daily, which can be increased gradually to a maximum of 10 mg daily if needed, as recommended by the most recent guidelines 1.
Key Points
- Bumex works by inhibiting sodium and chloride reabsorption in the kidneys' loop of Henle, causing increased urine output and reducing excess fluid in the body.
- It acts more quickly and is about 40 times more potent than furosemide (Lasix), with effects beginning within 30-60 minutes after oral administration and lasting 4-6 hours.
- Patients taking Bumex should monitor for side effects including electrolyte imbalances (particularly potassium depletion), dehydration, dizziness, and hearing problems.
- Regular blood tests to check kidney function and electrolyte levels are important during treatment, as recommended by the European Society of Cardiology guidelines 1.
- Patients should maintain adequate fluid intake while taking this medication unless otherwise directed by their healthcare provider, and should be aware that Bumex may increase blood sugar levels in diabetic patients.
Dosage and Administration
- The initial dose of Bumex is 0.5 to 1 mg once daily, which can be increased gradually to a maximum of 10 mg daily if needed, as shown in the guidelines 1.
- The dose of Bumex may need to be adjusted based on the patient's response to the medication and their kidney function, as recommended by the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines 2.
Monitoring and Precautions
- Patients taking Bumex should be monitored regularly for signs of electrolyte imbalances, dehydration, and other side effects, as recommended by the European Society of Cardiology guidelines 1.
- Regular blood tests to check kidney function and electrolyte levels are important during treatment, as recommended by the European Society of Cardiology guidelines 1.
- Patients should be aware of the potential for Bumex to increase blood sugar levels in diabetic patients, as recommended by the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines 2.
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 3
From the Research
Uses of Bumex (Bumetanide)
- Bumetanide is a potent 'loop' diuretic used for the treatment of oedema associated with: + Congestive heart failure 4, 5, 6, 7 + Hepatic and renal diseases 4, 5, 6, 7 + Acute pulmonary congestion 4, 5 + Premenstrual syndrome 4 + Forced diuresis during and after surgery 4
- It is also effective in treating edema due to cardiac disease, hepatic disease, and renal disease, even in patients with modest to severe renal insufficiency 5
- Bumetanide may be given orally, intravenously, or intramuscularly, producing a rapid and marked diuresis, and increased urinary excretion of sodium, chloride, and other electrolytes 4
Pharmacological Properties
- Bumetanide is approximately 40-fold more potent than frusemide (furosemide) 4, 6
- Its principal site of action is on the ascending limb of the loop of Henle, with a secondary action on the proximal tubule 4, 5
- The drug causes decreases in both free water clearance and solute free water reabsorption, increased fractional delivery of sodium chloride to the distal tubule, and a natriuresis approaching 20% of the filtered load of sodium 5
Clinical Efficacy and Safety
- Bumetanide has been shown to be an effective diuretic in various edematous conditions, with a similar adverse-reaction profile to furosemide, although the incidence of hypochloremia and hypokalemia is greater with bumetanide 6
- The incidence of hyperglycemia and ototoxicity is greater with furosemide 6
- Bumetanide may be useful in patients with increased risk of ototoxicity or in those who have developed resistance to other loop diuretics 5, 6