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Indications

Bumetanide is a strong water tablet (loop diuretic) used to remove extra fluid from the body (oedema) caused by heart failure, liver disease (cirrhosis) and kidney disease, including nephrotic syndrome. It is also given by injection in hospital when fluid needs to be removed quickly, such as in fluid on the lungs.

How It Works

Bumetanide acts on a part of the kidney called the loop of Henle and stops it from taking back salt (sodium and chloride). The extra salt is passed out in the urine and carries water with it, so the body loses fluid and swelling goes down. Its effect starts within about 30 minutes to 1 hour after a tablet and lasts around 4 to 6 hours.

Dosage and Administration

The usual adult dose is 1 mg by mouth once a day, preferably in the morning, which the doctor may increase or give twice a day depending on the response. Elderly patients may need less. Take the second dose, if prescribed, no later than mid-afternoon to avoid waking at night to pass urine. Injections are given by a doctor or nurse.

Interactions

• Aminoglycoside antibiotics such as Gentamicin increase the risk of hearing damage and kidney injury.
• Lithium levels can rise to toxic levels.
• Digoxin: low potassium caused by bumetanide increases the risk of heart rhythm problems.
• NSAIDs such as Ibuprofen reduce its effect and may harm the kidneys.
• Other blood pressure medicines add to the drop in blood pressure; corticosteroids such as Prednisolone increase potassium loss.

Contraindications

• Allergy to bumetanide or sulphonamides (cross-reaction is possible).
• No urine production (anuria), severe dehydration or very low sodium or potassium.
• Hepatic coma or pre-coma.

Side Effects

Common effects include passing more urine, thirst, dizziness on standing, tiredness, muscle cramps, headache and low blood levels of potassium, sodium and magnesium. Blood sugar and uric acid may rise, which can trigger gout.

Get urgent medical help for severe dizziness or fainting, very little urine, extreme thirst with confusion, muscle weakness or an irregular heartbeat, ringing in the ears or hearing loss, a severe skin rash, or signs of a severe allergic reaction.

Pregnancy and Lactation

Not usually used in pregnancy because it can reduce blood flow to the baby; use only if the doctor considers it essential. It may reduce milk production and may pass into breast milk; breastfeeding should be discussed with the doctor.

Precautions and Warnings

• Blood tests for salts and kidney function are done regularly.
• Weigh yourself daily if advised; report fast weight loss or gain.
• Use with care in diabetes, gout, enlarged prostate, liver disease and in the elderly.
• Stand up slowly to avoid dizziness.

Overdose

Overdose can cause heavy urination, dehydration, low blood pressure, dangerously low salts and collapse. Seek emergency medical help.

Therapeutic Class

Loop diuretic.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.