Bumetanide is indicated for the treatment of edema associated with- Congestive heart failure, Hepatic ascites and, Renal disease including the nephrotic syndrome

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.

Oral: 1 mg in the morning , repeated after 6-8 hours if necessary, In severe cases , 5 mg daily increased by 5 mg every 12-24 hours according to response. Elderly , 500 micrograms daily may be sufficient.

Parenteral:

• By IV Injection: 1-2 mg, repeated after 20 minutes if necessary. Elderly, 500 micrograms (1 ml of Bumetanide) daily may be sufficient.
• By IV Infusion: 2-5 mg over 30-60 minutes.Elderly, 500 micrograms (1 ml of Bumetanide) daily may be sufficient.
• By IM Injection: 1 mg initially then adjusted according to response , Elderly 500 micrograms (1 ml of Bumetanide) daily may be sufficient.

Concomitant use of Bumetanide may potentiate the effects of antihypertensive drugs. It shows a tendency to increase the excretion of potassium which can lead to an increase in the sensitivity of the myocardium to the toxic effects of digitalis. As with other diuretics, Bumetanide may cause an increase in blood uric acid.

Loop diuretics should be avoided in severe hypokalaemia, severe hyponatraemia, anuria, comatose and precomatose states associated with liver cirrhosis and in renal failure.

The side effects of Bumetanide include: headache, dizziness, fatigue, postural hypotension and gastrointestinal symptoms. Various skin reactions, photosensitivity reactions and metabolic disturbances, including reduced glucose tolerance are less frequent. Electrolyte disturbances can occur especially during long term treatment.

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.

Serum potassium should be measured periodically and potassium supplements or potassium sparing diuretics added if necessary.

Paediatric use: Safety and effectiveness in paediatric patients below the age of 18 have not been established.

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

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