What is the dose for a Bumex (bumetanide) drip?

From the Guidelines

Bumetanide (Bumex) continuous infusion is typically dosed at 0.5-2 mg/hour for adults with severe fluid overload or refractory edema, as recommended by the most recent guidelines 1.

Key Considerations

• Start with 0.5-1 mg/hour and titrate based on urine output and clinical response, not exceeding 10 mg total daily dose.
• Before initiating, check baseline electrolytes, renal function, and hydration status.
• During the infusion, monitor electrolytes (especially potassium, sodium, and magnesium) every 4-6 hours, track fluid status, and assess urine output hourly.
• Bumetanide works by inhibiting sodium and chloride reabsorption in the loop of Henle, resulting in increased diuresis.
• This potent loop diuretic is approximately 40 times more potent than furosemide on a milligram basis.
• Continuous infusion provides more consistent diuresis than intermittent bolus dosing and may be beneficial in patients with significant edema, heart failure exacerbations, or those with poor response to bolus therapy.
• Adjust dosing for patients with renal impairment, and consider combination therapy with thiazide diuretics for diuretic resistance, as suggested by previous studies 1.

Monitoring and Adjustments

• Regularly monitor the patient's response to the infusion and adjust the dose as needed to achieve the desired clinical response.
• Be aware of potential side effects, such as hypokalemia, hypotension, and renal impairment, and take steps to mitigate these risks.
• Consider the use of other diuretics, such as thiazides, in combination with bumetanide for patients with resistant edema or those who require additional diuretic support.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Dosage should be individualized with careful monitoring of patient response. Parenteral Administration Bumetanide injection may be administered parenterally (IV or IM) to patients in whom gastrointestinal absorption may be impaired or in whom oral administration is not practical. The usual initial dose is 0. 5 to 1 mg intravenously or intramuscularly. Intravenous administration should be given over a period of 1 to 2 minutes.

The bumetanide drip dose is not explicitly stated in the label, but the usual initial dose is 0.5 to 1 mg given intravenously over 1 to 2 minutes 2.

• The label does not provide a specific drip dose or rate for continuous infusion.
• Intravenous administration should be carefully monitored and individualized.
• The daily dosage should not exceed 10 mg.

From the Research

Bumex Drip Dose

• The dose of bumetanide for a drip can vary depending on the patient's condition and the desired outcome.
• According to 3, the mean dose of bumetanide was 5.7 ± 2.2 μg/kg/hr (1-10 μg/kg/hr) with a median duration of 3.3 days (0.3-18.5) in critically ill pediatric patients.
• In adults, the mean dose of bumetanide was 1.08 ± 0.43 mg/hour with a mean treatment duration of 45.09 ± 10.12 hours, as reported in 4.
• A potency ratio of 41:1 was found for intermittent bumetanide compared to furosemide in patients with heart failure, as stated in 5.
• The efficacy of bumetanide can be measured by its ability to achieve negative fluid balance, with 76% of patients achieving this outcome by 48 hours, as shown in 3.
• The safety of bumetanide can be evaluated by monitoring for adverse drug reactions, such as serum potassium concentration less than 3 mEq/L, serum chloride concentration less than 90 mEq/L, and serum carbon dioxide concentration greater than 35 mEq/L, as mentioned in 3.

Comparison with Furosemide

• Bumetanide is more potent than furosemide, with a dose equivalence ratio of 40:1, as supported by 5.
• The pharmacokinetics of bumetanide and furosemide differ, with bumetanide having a shorter half-life and larger volume of distribution, as described in 6.
• Both bumetanide and furosemide can be used to treat edema due to cardiac disease, hepatic disease, and renal disease, as stated in 7.

Special Considerations

• In neonates, the half-life of bumetanide is longer than in adults, and the clearance is reduced, as reported in 6.
• In patients with renal failure, high doses of bumetanide may cause myalgias and muscle tenderness, as mentioned in 7.
• The use of bumetanide in combination with other diuretics, such as furosemide, may increase the risk of adverse drug reactions, as stated in 6.