What to Know About Bumex (Bumetanide)

Bumex (bumetanide) is considered a strong water pill (diuretic) that works to decrease excess fluid in the body, by increasing the amount of fluid that the kidneys excrete. Bumetanide is in the class of drugs called loop diuretics.

Bumetanide works by making the kidneys pass more fluid. It does this by disrupting the transport of salt and water across specific kidney cells. These cells are located in a structure called the loop of Henle, thus the name, loop diuretics.

If too much fluid is lost, it can result in dangerous adverse effects such as dehydration and electrolyte imbalances. Therefore, it’s important to take bumetanide exactly as prescribed.

Bumetandine is available as an oral tablet to swallow or in a liquid form, it is also available to be given as an intramuscular injection and as an intravenous (IV) medication.

Uses

The primary use of bumetanide is in the treatment of edema associated with congestive heart failure. In fact, the American Heart Association has recommended diuretics (including loop diuretics) as the first line treatment for certain types of heart failure.

Congestive heart failure is a condition in which the heart is unable to pump enough blood to adequately oxygenate the body’s tissues and organs. The heart muscle isn't pumping blood as efficiently as it should. This can happen due to conditions such as high blood pressure or narrowed arteries that cause the heart to weaken over time.

Edema is swelling caused by excess fluid trapped in the body's tissues. Other conditions that cause edema, such as kidney or liver disease, may also warrant the diuretic effects of bumetanide. Diuretics can help to lessen swelling in the legs, arms, and abdomen, as well as shortness of breath and other symptoms caused by edema.

The Food and Drug Administration (FDA) approved the use of bumetanide for edema due to several conditions, including:

• Renal (kidney) dysfunction: Such as nephrotic syndrome
• Liver disease in adults: Such as cirrhosis (scarring of the liver from long term injury)
• Edematous conditions due to cardiac (heart) failure

Bumetanide is also FDA-approved for the treatment of edema when there is an allergy to Lasix (another type of diuretic). The FDA reports, “Successful treatment with Bumex following instances of allergic reactions to furosemide suggests a lack of cross-sensitivity.”

Off-Label Uses 

Several studies have shown that bumetanide may have some properties that help in the treatment of seizures and behavioral problems in those with tuberous sclerosis, a rare disorder that causes tumors in various areas of the body and can affect the brain.

Bumetanide is sometimes prescribed for hypertension, but be sure to talk to your healthcare provider if you are considering taking this medication for high blood pressure. Another off-label use of bumetanide is the treatment of hypercalcemia (high levels of calcium in the blood).

Before Taking

Before taking bumetanide, it’s important to tell your healthcare provider if:

• You have an allergy to bumetanide or sulfonamide. People with a sulfonamide allergy have a high risk of being allergic to bumetanide.
• You have kidney disease.
• You have diabetes.
• You are pregnant or breastfeeding, or if you plan to become pregnant.

You'll also need to provide a list of all medications you are taking, including prescription and non-prescription drugs, herbal and natural supplements and vitamins, as well as any type of topical (on the skin) medications such as lotions, ointments, creams, or patches.

Contraindications and Precautions

A contraindication is a situation in which a specific drug or procedure should not be performed because it could potentially cause harm. When two drugs should not be given together, it’s called a relative contraindication. In other situations, a certain drug should not be used when a person has a medical condition that the drug could make worse.

Contraindications for bumetanide include:

• Children and adolescents under the age of 18: Safety and effectiveness have not been established in pediatric patients.
• Pregnancy: Bumetanide should only be taken during pregnancy if the potential benefits of the drug outweigh the risk to the fetus. There have not been any human studies to prove the safety of Bumex during pregnancy.
• People who are breastfeeding: it is unknown whether Bumex is excreted in human milk, therefore, breastfeeding is not recommended for people taking loop diuretics.
• Hypersensitivity to sulfonamides: People who are allergic to Gantanol (sulfamethoxazole), Azulfidine (sulfasalazine) and Gantrisin (sulfisoxazole) may also be allergic to bumetanide.

Precautions to be aware of when taking bumetanide include:

• Development of oliguria (low urine output) in those with renal disease.
• An increase in blood urea nitrogen (BUN) or creatinine: These are indications that the kidneys may not be working properly.
• Hepatic coma: This is a severe stage of liver disease that adversely impacts the brain.
• Hypersensitivity (allergy) to bumetanide: Symptoms may include hives, swelling of the face, lips, tongue, or throat, trouble breathing. If you have any of these symptoms, seek emergency medical care right away.

There are several safety factors to be aware of when taking loop diuretics. These include monitoring for signs of:

• Depletion of electrolytes and fluid volume levels: The dosage of Bumex should be adjusted accordingly. Too high of doses or too frequent administration could cause severe water loss, dehydration, and electrolyte depletion (such as potassium, magnesium, or calcium depletion). Electrolyte levels should be monitored closely.
• Circulatory collapse: This could occur as a result of low fluid volume. Elderly people are particularly susceptible to circulatory collapse. The dosage of Bumex should be adjusted to ensure adequate fluid volume (not giving so much medication that too much fluid is excreted rather than just the excess fluid). 
• Risk of dehydration from prolonged sweating, severe diarrhea or vomiting: It’s important to report these symptoms to your healthcare provider.
• Risk of renal (kidney) problems: Kidney function tests (such as monitoring BUN and creatinine levels) should be done periodically, particularly for those with renal insufficiency.
• Ventricular arrhythmias: Those with a heart condition involving an irregular heart rate are considered high risk when they have low potassium levels, because potassium helps to regulate the heart rate. Potassium levels should be closely monitored in people with ventricular arrhythmias who take loop diuretics.
• Hypokalemia (low potassium levels): Loop diuretics increase potassium loss. It’s important to have your potassium levels closely monitored when taking them. Eating foods high in potassium or taking potassium supplements may be recommended. Other types of diuretics that spare potassium may be given.

Other Loop Diuretics

There are several other loop diuretics that are FDA approved. These include:

• Demadex (torsemide)
• Edecrin (ethacrynic acid)
• Lasix (furosemide)

Bumetanide is more potent than some of the other loop diuretics (such as furosemide). It would take only 1 milligram (mg) of bumetanide to equal 40 mg of furosemide.

Furosemide is the most widely used diuretic for people with heart failure, but the research has been mixed as far as a comparison between various types of loop diuretics.

A 2020 study found that people who received torsemide were less likely to have heart failure due to ischemia (lack of oxygen supply), but more likely to have diabetes mellitus, hypertension (and chronic kidney disease than those who received furosemide.

Dosage

Bumetanide is available as an oral (by mouth) pill in three dosages, including  0.5 milligrams (mg), 1 mg, and 2 mg. 

The manufacturer recommends a total daily dose of bumetanide tablets of 0.5 milligrams (mg) to 2 mg given in a single dose for most people.

The maximum daily dose is up to 10 mg per day. Because of the drug's short action, it may be given two to three times a day (at four- to five-hour intervals) when the initial dose does not result in an adequate response. But, the total must not exceed 10 mg in 24 hours.

Bumetanide tablets may be given as a chronic, daily medication, or intermittently for 3 to 4 days with 1 to 2 days of rest period in between, which the manufacturer reports as the safest and most effective method of controlling edema on a continuous basis.

The FDA recommends careful monitoring to ensure the right dose for each individual person’s situation. 

Modifications

Bumetanide can be prescribed on its own, or it can be given in combination with amiloride, a potassium-sparing diuretic. It is given with bumetanide to help prevent low potassium levels.

Oral Administration

Bumetanide is available in a liquid form for people who are unable to swallow pills orally (by mouth). Be sure to use an oral syringe (preferably one that comes from the pharmacy) for measuring precise dosages of liquid bumetanide.

Parenteral Administration

Parenteral administration is defined as a medication that is given by an alternate route, other than by mouth, such as by injection or intravenous infusion. For those who are unable to take medications by mouth, bumetanide is also available in an injectable (IM) form.

An intravenous (IV) form of bumetanide is often used on a short-term basis for those who are critically ill. Parenteral administration should be discontinued (and oral drugs should be ordered) as soon as possible.

How to Take and Store

Take bumetanide with or without food. It's best to avoid taking loop diuretics within four hours of going to bed to avoid being awakened with frequent urination.

Bumetanide should be stored at room temperature (between approximately 68 to 77 degrees Fahrenheit). Keep the medication in its original labeled, light-resistant container with a childproof lid.

Side Effects

The most common side effect of bumetanide is frequent urination.

Common

Common side effects of bumetanide include:

• Frequent urination
• Lightheadedness
• Nausea
• Diarrhea

Be sure to contact your healthcare provider if you have any of these common symptoms if they are severe or if they do not subside.

Severe

Severe side effects include:

• Ringing in the ears
• Loss of hearing
• Low platelet count
• Increased uric acid
• Low potassium
• Low chloride
• Severe skin rash
• Difficulty swallowing
• Trouble breathing
• Hives

If you have any of these symptoms, seek immediate emergency medical care.

Warnings

Warnings for people taking loop diuretics include:

• Aging: Because older people have a decrease in renal (kidney) function, caution should be taken when taking bumetanide.
• Having surgery: If you are scheduled for surgery or have an upcoming dental surgical procedure planned, be sure to tell your surgeon or dentist that you are taking bumetanide. Bumetanide, taken before surgery could cause low blood volume, causing fluctuation of blood pressure during the surgical procedure.

Black Box Warnings

Bumetanide is a strong diuretic that has the potential to cause severe water and electrolyte depletion. It is vital to have very close medical supervision anytime a person is taking bumetanide or any other type of loop diuretic so that the dosage and schedule of drug administration can be adjusted according to the specific needs of each individual.

Imbalance of electrolytes (such as low sodium and potassium levels) may precipitate a condition called hepatic encephalopathy or coma in those with cirrhosis of the liver and ascites (an accumulation of fluid in the abdomen).

If you have a liver condition, it’s important to have your electrolyte levels monitored closely; the healthcare provider may likely prescribe a potassium supplement to prevent low potassium levels.

Drug Interactions

Bumetanide may interfere with the effectiveness of other drugs or vice versa. These medications may have interactions or there can be an increased risk of side effects when taken with bumetanide:

• Drugs that can cause ototoxicity (toxicity to the inner ear and auditory nerve): These include aminoglycoside antibiotics such as amikacin, Garamycin (gentamicin), or Bethkis (tobramycin).
• Drugs that are known to have nephrotoxic potential: Defined as the potential of being toxic to the kidneys.
• Lithium: Because diuretics such as bumetanide act to lower the clearance of lithium in the kidneys, there is an increased risk of lithium toxicity.
• Probenecid: Because it increases the volume of urine output produced by bumetanide, probenecid should not be administered at the same time as bumetanide.
• Indomethacin: Interferes with the action of bumetanide
• Antihypertensive medications: Bumetanide may potentiate the action of antihypertensive medications, resulting in a need to lower the dosage of these drugs.
• Corticosteroids (such as prednisone): There is a risk of adverse interactions between corticosteroids and bumetanide.
• Lanoxin (digoxin): Bumetanide increases the risk of digoxin toxicity.