Bumetanide (Bumex) Dosing Guidelines
The recommended initial dose of bumetanide is 0.5 to 1.0 mg once or twice daily orally, with a maximum total daily dose of 10 mg. 1, 2
Dosing by Route of Administration
Oral Administration
- Initial dose: 0.5-1 mg once or twice daily 1
- Can be administered up to three times daily when clinically indicated 1
- Maximum total daily dose: 10 mg 1, 2
- Duration of action: 4-6 hours per dose 1, 3
Parenteral Administration (IV/IM)
- Initial dose: 0.5-1 mg intravenously or intramuscularly 2
- IV administration should be given over 1-2 minutes 2
- If response is insufficient, a second or third dose may be given at intervals of 2-3 hours 2
- Maximum daily dose: 10 mg 2
Dosing in Specific Clinical Scenarios
Acute Heart Failure
- Initial dose: 0.5-1 mg IV as a bolus 4
- Equivalent to furosemide 20-40 mg IV or torsemide 10-20 mg IV 3
- Patients should be assessed frequently in the initial phase to monitor urine output 4
- For patients on chronic diuretic therapy, the initial IV dose should be at least equivalent to their oral dose 3
Volume Overload
- Dose may be increased according to renal function and history of chronic oral diuretic use 4
- Continuous infusion may be considered after the initial starting dose in patients with evidence of volume overload 4
- Mean dose in continuous infusion studies: approximately 1 mg/hour 5
Equivalence to Other Loop Diuretics
- Bumetanide is approximately 40 times more potent than furosemide on a milligram-to-milligram basis 3, 6
- Equivalent dosing ratio: 40 mg furosemide = 1 mg bumetanide = 10 mg torsemide 3
Monitoring and Precautions
Electrolyte Monitoring
- Regular monitoring for electrolyte disturbances, particularly hypokalemia and hyponatremia 1
- Consider potassium supplements or spironolactone where risk of hypokalemia can be identified 6
Potential Adverse Effects
- Hypokalaemia, hyponatraemia, hyperuricaemia 4
- Hypovolaemia and dehydration; urine output should be assessed frequently 4
- Neurohormonal activation 4
- May increase hypotension following initiation of ACEI/ARB therapy 4
Combination Therapy
- Thiazides in combination with bumetanide may be useful in cases of diuretic resistance 4, 1
- Aldosterone antagonists (spironolactone, eplerenone 25–50 mg p.o.) can be used in association with bumetanide 4
- Combinations in low doses are often more effective with fewer side-effects than higher doses of a single drug 4
Special Considerations
- For patients with refractory edema, more frequent dosing (up to three times daily) may be necessary to maintain diuretic effect 1
- If maximum dose is ineffective, consider evaluating for medication non-compliance or excessive sodium intake 1
- Consider torsemide as an alternative for patients requiring longer duration of action 1