Maximum Recommended Dose of Bumetanide (Bumex)

The maximum recommended daily dose of bumetanide (Bumex) is 10 mg per day. 1

Dosing Guidelines

The recommended initial dose is 0.5-1.0 mg once or twice daily, which can be titrated based on clinical response 1
Bumetanide has a short duration of action (4-6 hours per dose), making it suitable for multiple daily dosing when clinically indicated 1
For heart failure patients, bumetanide can be administered up to three times daily when needed, while still maintaining the total daily dose below 10 mg 1, 2
In acute heart failure, the recommended initial dose is a bolus of 0.5-1 mg intravenously 2
For patients with volume overload, the dose may be increased according to renal function and history of chronic oral diuretic use 2

Bumetanide is approximately 40 times more potent than furosemide on a milligram-to-milligram basis 3, 4
Peak plasma levels are achieved approximately 30 minutes after oral administration 4
The apparent half-life is 1.2-1.5 hours, with a duration of action of 3-6 hours 3, 4
The drug's principal site of action is on the ascending limb of the loop of Henle, with a secondary action on the proximal tubule 3

Bumetanide can be administered orally, intravenously, or intramuscularly 3
Due to its short duration of action, multiple daily dosing may be necessary to maintain diuresis throughout the day 1
For patients with severe fluid overload requiring sustained diuresis, three-times-daily dosing may be particularly useful 1
When using three-times-daily dosing, start with lower doses (e.g., 0.5-1 mg per dose) and titrate based on clinical response 1

In patients with renal insufficiency, bumetanide doses up to 15 mg/day have been required, particularly in those with chronic renal failure or nephrotic syndrome 3
For patients with end-stage renal disease, bumetanide should be administered at a reduced dose (25-35 mg/kg) three times a week after dialysis 2
In elderly patients (over 59 years), dose reduction may be necessary, similar to other potent diuretics 2

More frequent dosing requires careful monitoring for electrolyte disturbances, particularly hypokalemia and hyponatremia 1, 2
Regular monitoring for volume depletion and prerenal azotemia is necessary, especially with higher doses or more frequent administration 1
Combination with thiazide diuretics may enhance the clinical response to bumetanide in cases of diuretic resistance 2
Potassium supplements or potassium-sparing diuretics may be beneficial additions to bumetanide therapy in patients at risk of hypokalemia 3

Hypokalemia, hyponatremia, and hypochloremia 2, 4
Metabolic alkalosis and hyperuricemia 4
Muscle cramps, especially in patients with renal failure receiving high doses 4, 5
Audiological impairment occurs to a lesser extent than with furosemide 3

If three-times-daily dosing of bumetanide is being considered due to short duration of effect, torsemide may be an alternative as it has a longer duration of action and may be suitable for once-daily dosing 1
Bumetanide may be particularly useful in patients with increased risk of ototoxicity compared to furosemide 6