What is the comparison between bumetanide (Bumex) and furosemide (Lasix)?

From the Guidelines

Bumetanide (Bumex) and furosemide (Lasix) are both loop diuretics used to treat heart failure, with bumetanide being approximately 40 times more potent than furosemide.

Key Differences

• The initial dose of furosemide is typically 20-40 mg i.v., while bumetanide is typically 0.5-1 mg i.v. 1
• The duration of action for bumetanide is 4-6 hours, while furosemide has a duration of action of 6-8 hours 1
• The maximum total daily dose for bumetanide is 10 mg, while furosemide has a maximum total daily dose of 600 mg 1

Clinical Use

• Both bumetanide and furosemide can be used for the treatment of acute and chronic heart failure, with the choice of medication depending on the patient's specific needs and medical history 1
• Bumetanide may be preferred in patients with renal impairment, as it has a more predictable dose-response relationship and is less likely to cause ototoxicity 1
• Furosemide may be preferred in patients with severe heart failure, as it has a longer duration of action and can be administered in higher doses 1

Important Considerations

• Both bumetanide and furosemide can cause electrolyte depletion, particularly hypokalemia, and patients should be monitored closely for signs of electrolyte imbalance 1
• The use of bumetanide and furosemide in combination with other diuretics, such as thiazide diuretics, can increase the risk of electrolyte depletion and should be used with caution 1

From the FDA Drug Label

Pharmacological and clinical studies have shown that 1 mg bumetanide has a diuretic potency equivalent to approximately 40 mg furosemide. The comparison between bumetanide (Bumex) and furosemide (Lasix) is that 1 mg of bumetanide is equivalent to approximately 40 mg of furosemide in terms of diuretic potency 2.

• Key differences:
  • Bumetanide has a rapid onset and short duration of action, while furosemide has a duration of diuretic effect of 6 to 8 hours.
  • Bumetanide is somewhat more chloruretic than natriuretic, while furosemide inhibits primarily the absorption of sodium and chloride.
• Similarities:
  • Both bumetanide and furosemide are loop diuretics.
  • Both drugs increase potassium excretion.

From the Research

Comparison of Bumetanide and Furosemide

• Bumetanide is a potent 'loop' diuretic, approximately 40-fold more potent than furosemide 3
• The two drugs have similar clinical responses, with the exception of renal disease, where patients with edema appear to respond better to bumetanide 3
• Studies have shown that bumetanide and furosemide are effective in reducing edema due to congestive heart failure, with decreases in body weight, abdominal girth, edema, hepatomegaly, blood pressure, and heart rate 4
• Bumetanide may be safer than furosemide with regard to ototoxicity, as suggested by audiometric studies 5
• Both drugs are generally well tolerated, with common side effects including tendencies toward hypokalemia, hypochloremia, alkalosis, and hyperuricemia 4

Efficacy and Safety

• Bumetanide and furosemide have been compared in several studies, with results indicating that both drugs are effective and safe in the long-term treatment of edema due to congestive heart failure and renal edema 4, 6
• One study found that bumetanide significantly improved weight loss in patients with nephrotic syndrome, compared to furosemide 7
• Another study found that torsemide, a different loop diuretic, may be more efficacious and safer than furosemide in patients with heart failure, but the evidence for bumetanide is limited 7

Dosage and Administration

• Bumetanide may be given orally, intravenously, or intramuscularly, with a rapid and marked diuresis occurring within 30 minutes and persisting for 3 to 6 hours 3
• The recommended dose of bumetanide is 0.5 to 2 mg/day, while furosemide is typically given at a dose of 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