Bumetanide

Bumetanide is used to reduce extra fluid in the body (edema) caused by conditions such as heart failure, liver disease, and kidney disease. This can lessen symptoms such as shortness of breath and swelling in your arms, legs, and abdomen. Bumetanide is a "water pill" (diuretic) that causes you to make more urine. This helps your body get rid of extra water and salt.

Indications

Edema associated with congestive heart failure, hepatic and renal disease, including the nephrotic syndrome.

Dosage

Edema : Adult : 1mg (oral) once daily, Give 2nd dose 6-8 hr later if necessary. Elderly : 0.5mg daily. Refractory edema : Adults: Initially, 5mg (oral) daily increased by 5mg every 12-24hr as required. High doses may be divided in 2-3 doses. Max : 10mg/day, Hypertension: Adult : 0.5-1mg (Oral) daily. Max : 5mg/day. Emergency cases of edema : Adult : 0.5-1mg via slow IV/IM inj, subsequently adjust dose according to response. Pulmonary Edema : Adult : 102mg IV repeated 20min later if necessary

Contra-Indications

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

Special Precautions

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.

Side Effects

Muscle cramps, dizziness, hypotension, headache, nausea, impaired hearing, pruritus, ECG hanges, musculoskeletal pain, rash, chest discomfort, renal failure, premature, ejaculation, thrombocytopenia, hypokalaemia, hypomagnesaemia, hyponatraemia, hyperuricaemia, hyperglycaemia, hypocalcaemia. Encephalopathy (in patients with preexisting liver disease).

Drug Interactions

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