Is Bumetanide Available as an IV Formulation?
Yes, bumetanide is available as an intravenous (IV) formulation and is FDA-approved for the treatment of edema associated with congestive heart failure, hepatic and renal disease, including nephrotic syndrome. 1
FDA-Approved Formulation
- Bumetanide is supplied as a sterile solution in 4 mL and 10 mL vials at a concentration of 0.25 mg per mL, specifically formulated for intravenous or intramuscular injection. 1
- The FDA label explicitly states that if impaired gastrointestinal absorption is suspected or oral administration is not practical, bumetanide should be given by the intramuscular or intravenous route. 1
Clinical Use in Acute Heart Failure
- Multiple international guidelines reference IV bumetanide as an alternative to IV furosemide for managing acute decompensated heart failure with volume overload. 2
- The European Society of Cardiology recommends an initial IV bolus dose of 0.5-1 mg of bumetanide (equivalent to furosemide 20-40 mg) at admission for patients with acute heart failure and evidence of congestion. 2
- Bumetanide exhibits greater oral bioavailability than furosemide and has been shown to have favorable pharmacokinetic properties, though the IV route remains preferred in acute settings due to unpredictable intestinal absorption from bowel edema. 2
Onset and Duration of Action
- When administered intravenously, bumetanide has an onset of action between 10-15 minutes, reaches peak effect at approximately 50 minutes, and has a total duration of action of about 240 minutes (4 hours). 3
- This rapid onset makes IV bumetanide particularly useful in acute pulmonary edema and other urgent clinical scenarios requiring prompt diuresis. 4, 3
Potency Considerations
- Bumetanide is approximately 40-fold more potent than furosemide on a milligram-per-milligram basis, meaning 1 mg of bumetanide is roughly equivalent to 40 mg of furosemide. 4, 5
- However, recent data from acute decompensated heart failure patients suggests that a higher dose of furosemide may be required than previously established equivalency ratios to achieve similar urine output responses. 6
Important Safety Considerations
- The FDA warns that bumetanide has demonstrated ototoxicity in animal studies at 5-6 times the potency of furosemide, making the risk of hearing impairment a particular concern with high-dose IV therapy, especially in patients with renal impairment. 1
- Excessive doses or too frequent administration can lead to profound electrolyte depletion, particularly hypokalemia, which requires close monitoring especially in patients receiving digitalis. 1
- Patients allergic to sulfonamides may show hypersensitivity to bumetanide and should be monitored accordingly. 1