Hypertension, Heart failure, Oedema, Nephrotic syndrome Hypersensitivity, progressive renal failure and anuria, hepatic coma, severe electrolyte depletion.

Loop diuretics

Bumetanide is a loop diuretic of the sulfamyl category to treat heart failure. It is often used in patients in whom high doses of furosemide are ineffective. There is however no reason not to use bumetanide as a first choice drug. The main difference between the two substances is in bioavailability. It is said to be a more predictable diuretic, meaning that the predictable absorption is reflected in a more predictable effect. Bumetanide is 40 times more potent than furosemide (for patients with normal renal function).Bumetanide interferes with renal cAMP and/or inhibits the sodium-potassium ATPase pump. Bumetanide appears to block the active reabsorption of chloride and possibly sodium in the ascending loop of Henle, altering electrolyte transfer in the proximal tubule. This results in excretion of sodium, chloride, and water and, hence, diuresis.

Administration: May be taken with or without food. May be taken w/ meals to reduce GI discomfort. Adult Dose: Oral Oedema Adult: 1 mg once daily. Give 2nd dose 6-8 hr later if necessary. Elderly: 0.5 mg daily. Refractory oedema Adult: Initially, 5 mg daily increased by 5 mg every 12-24 hr as required. High doses may be divided in 2-3 doses. Max: 10 mg/day. Hypertension Adult: 0.5-1 mg daily. Max: 5 mg/day. Parenteral Emergency cases of oedema Adult: 0.5-1 mg via slow IV/IM inj, subsequently adjust dose according to response. Intravenous Pulmonary oedema Adult: 1-2 mg IV repeated 20 min later if necessary, or 2-5 mg in 500 ml of a suitable infusion fluid given over 30-60 min.

Reduced diuretic and natriuretic actions by probenecid. Indometacin blunts action of bumetanide; concurrent usage with antihypertensives may increase risk of orthostatic hypotension. Potentially Fatal: Avoid concurrent usage with ototoxic drugs such as aminoglycoides and nephrotoxic drugs. Reduced lithium excretion via kidneys.

Hypersensitivity, progressive renal failure and anuria, hepatic coma, severe electrolyte depletion.

>10% Hyperuricemia (18%),Hypochloremia (15%),Hypokalemia (15%),Azotemia (11%) 1-10% Hyponatremia (9%),Hyperglycemia (7%),Increased serum creatinine (7%),Variations in phosphorus (5%),Variations in CO2 content (4%),Variations in bicarbonate (3%),Variations in calcium (2%),Dizziness (1%),Muscle cramps (1%),Ototoxicity (1%) <1% Asterixis,Dehydration,Hypotension,Orthostatic hypotension,Pruritus,Rash,Renal failure,Serious skin reactions (ie, Stevens-Johnson syndrome, toxic epidermal necrolysis),Vertigo,Vomiting Potentially Fatal: Encephalopathy (in patients with preexisting liver disease).

Pregnancy Category C. There are no adequate and well controlled studies in pregnant woman. It is not known wheather this drug is excreted in human milk.

Precaution: Pregnancy, lactation; regular monitoring of serum electrolytes (especially potassium, calcium, magnesium); in case of hypokalemia, potassium supplements/potassium-sparing diuretics added. Monitor blood-glucose, BUN, creatinine levels as well as blood counts. Sulfonamide allergy. CHF patients on digitalis, K losing nephropathy, hepatic cirrhosis and ascitis, diarrhoeal states. Lactation: Unknown whether drug is excreted in breast milk; use with caution

Symptoms would be those caused by excessive diuresis. Empty stomach by gastric lavage or emesis.

Store in a cool & dry place. Protect from light.

Loop diuretics

Bumetanide induces diuresis by inhibiting reabsorption of water and electrolytes (sodium and chloride) in the ascending loop of Henle and proximal renal tubule.

Pregnancy category: C Lactation: Unknown whether drug is excreted in breast milk; use with caution