Oral Dosage of Bumetanide (Bumex)
The standard oral dose of bumetanide (Bumex) is 0.5 to 1.0 mg once or twice daily, with a maximum total daily dose of 10 mg. 1
Dosing Guidelines
- Initial oral dosing typically starts at 0.5 to 1.0 mg once or twice daily 1
- Due to bumetanide's short duration of action (4-6 hours per dose), multiple daily dosing may be necessary to maintain diuresis throughout the day 1
- The total daily dose should not exceed 10 mg, regardless of dosing frequency 1
- Bumetanide is approximately 40 times more potent than furosemide on a milligram-for-milligram basis 2, 3
Pharmacokinetic Properties
- Bumetanide is rapidly absorbed after oral administration, with peak plasma levels achieved approximately 30 minutes after dosing 3
- The drug has a short half-life of 1.2-1.5 hours 3
- Duration of action is typically 3-6 hours per dose 2
- The principal site of action is the ascending limb of the loop of Henle, with a secondary action on the proximal tubule 2
Clinical Applications
- For heart failure patients, bumetanide can be administered up to three times daily when clinically indicated 1
- In patients with severe fluid overload requiring sustained diuresis, three-times-daily dosing may be particularly useful 1
- For patients with refractory edema who need more frequent dosing to maintain diuretic effect, multiple daily doses may be necessary 1
- Higher doses (up to 15 mg/day) may be required in patients with chronic renal failure or nephrotic syndrome 2
Monitoring and Precautions
- More frequent dosing requires careful monitoring for electrolyte disturbances, particularly hypokalemia and hyponatremia 1
- Careful monitoring for volume depletion and prerenal azotemia is necessary with multiple daily dosing 1
- When initiating a three-times-daily regimen, start with lower doses (e.g., 0.5-1 mg per dose) 1
- Titrate based on clinical response, monitoring urine output and symptoms of congestion 1