What is the typical dosing for Bumex (bumetanide)?

Bumetanide Dosing

For oral administration, start bumetanide at 0.5-1 mg once or twice daily, with a usual daily dose range of 1-5 mg and a maximum of 10 mg per day. 1, 2

Standard Oral Dosing

• Initial dose: 0.5-1 mg once or twice daily 1, 2
• Usual daily dose: 1-5 mg 1
• Maximum daily dose: 10 mg 1, 2, 3
• Bumetanide can be administered up to three times daily when clinically indicated, particularly for severe fluid overload or refractory edema requiring sustained diuresis 2, 4
• The duration of action is 4-6 hours per dose, making multiple daily dosing appropriate for maintaining diuresis throughout the day 4, 5, 6

Intravenous/Intramuscular Dosing

For acute heart failure or when oral administration is not practical, give 0.5-1 mg IV as a bolus over 1-2 minutes. 1, 2, 3

• If response is insufficient, a second or third dose may be given at 2-3 hour intervals 3
• Maximum daily dose remains 10 mg regardless of route 3
• IV bumetanide produces diuresis within 30 minutes 5, 6
• Transition to oral therapy as soon as gastrointestinal absorption is adequate 3

Potency and Equivalence

Bumetanide is approximately 40 times more potent than furosemide on a milligram basis. 2, 5, 7

• Equivalent dosing: 1 mg bumetanide = 40 mg furosemide = 10 mg torsemide 2
• This potency difference applies to most effects except urinary potassium excretion, where bumetanide's relative potency is lower 5

Dose Titration Strategy

When initiating three-times-daily dosing:

• Start with lower individual doses (0.5-1 mg per dose) 4
• Titrate based on urine output and symptoms of congestion 4
• Ensure total daily dose does not exceed 10 mg 2, 4
• Monitor closely for electrolyte disturbances, particularly hypokalemia and hyponatremia 2, 4

Special Populations

Renal disease: Higher doses up to 10-15 mg/day may be required in chronic renal failure or nephrotic syndrome 5, 6

End-stage renal disease: Administer 25-35 mg/kg three times weekly after dialysis 4

Elderly patients: Consider dose reduction similar to other potent diuretics 4

Monitoring Requirements

• Electrolytes (particularly potassium, sodium, chloride): Check frequently during initiation and dose adjustments 1, 2
• Renal function: Monitor for prerenal azotemia and volume depletion 4, 6
• Urine output: Assess frequently in the initial phase to guide dosing 2
• Weight and symptoms: Daily monitoring to evaluate response 1

Combination Therapy for Diuretic Resistance

If maximum dose (10 mg/day) is ineffective, add a thiazide diuretic to enhance diuretic effect synergistically. 1, 2, 4

• Evaluate for medication non-compliance or excessive sodium intake before escalating therapy 2, 4
• Aldosterone antagonists (spironolactone 25-50 mg) can be used in combination 2, 5
• Combination therapy requires more careful monitoring for adverse effects 1

Critical Caveats

• Excessive doses may cause renal impairment and ototoxicity 1
• Bumetanide has lower ototoxicity risk compared to furosemide, making it preferable in patients at increased risk for hearing complications 7
• Muscle cramps and myalgias are not uncommon, especially in renal failure patients receiving higher doses 5, 6
• Hypokalemia and hypochloremia occur more frequently with bumetanide than furosemide 7, 8
• Solutions prepared for IV administration should be used within 24 hours 3