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Bumetanide (Bumex)
(byou- MET-ah-nyd)
Pregnancy Category: C Bumex Burinex (Rx)

Classification: Loop diuretic

See Also: See also Diuretics, Loop .

Action/Kinetics: Inhibits reabsorption of both sodium and chloride in the proximal tubule as well as the ascending loop of Henle. Possible activity in the proximal tubule to promote phosphate excretion. Onset, PO: 30-60 min. Peak effect, PO: 1-2 hr. Duration, PO: 4-6 hr (dose-dependent). Onset, IV: Several minutes. Peak effect, IV: 15-30 min. Duration, IV: 3.5-4 hr. t 1/2: 1-1.5 hr. Metabolized in the liver although 45% excreted unchanged in the urine.

Uses: Edema associated with CHF, nephrotic syndrome, hepatic disease. Adjunct to treat acute pulmonary edema. Especially useful in clients refractory to other diuretics. Investigational: Treatment of adult nocturia. Not effective in males with prostatic hypertrophy.

Contraindications: Anuria. Hepatic coma or severe electrolyte depletion until the condition is improved or corrected. Hypersensitivity to the drug. Lactation.

Special Concerns: Safety and efficacy in children under 18 have not been established. Geriatric clients may be more sensitive to the hypotensive and electrolyte effects and are at greater risk in developing thromboembolic problems and circulatory collapse. SLE may be activated or made worse. Clients allergic to sulfonamides may show cross sensitivity to bumetanide. Sudden changes in electrolyte balance may cause hepatic encephalopathy and coma in clients with hepatic cirrhosis and ascites.

Side Effects: Electrolyte and fluid changes: Excess water loss, dehydration electrolyte depletion including hypokalemia, hypochloremia, hyponatremia; hypovolemia, thromboembolism, circulatory collapse. Otic: Tinnitus, reversible and irreversible hearing impairment, deafness, vertigo (with a sense of fullness in the ears). CV: Reduction in blood volume may cause circulatory collapse and vascular thrombosis and embolism, especially in geriatric clients. Hypotension, ECG changes, chest pain. CNS: Asterixis, encephalopathy with preexisting liver disease, vertigo, headache, dizziness. GI: Upset stomach, dry mouth, N&V, diarrhea, GI pain. GU: Premature ejaculation, difficulty maintaining erection, renal failure. Musculoskeletal: Arthritic pain, weakness, muscle cramps, fatigue. Hematologic: Agranulocytosis, thrombocytopenia. Allergic: Pruritus, urticaria, rashes. Miscellaneous: Sweating, hyperventilation, rash, nipple tenderness, photosensitivity, pain following parenteral use.

Laboratory Test Alterations: Alterations in LDH, AST, ALT, alkaline phosphatase, creatinine clearance, total serum bilirubin, serum proteins, cholesterol. Changes in hemoglobin, PT, hematocrit, WBCs, platelet and differential counts, phosphorus, carbon dioxide content, bicarbonate, and calcium. Urinary glucose and protein, serum creatinine. Also, hyperuricemia, hypochloremia, hypokalemia, azotemia, hyponatremia, hyperglycemia.

Overdose Management: Symptoms: Profound loss of water, electrolyte depletion, dehydration, decreased blood volume, circulatory collapse (possibility of vascular thrombosis and embolism). Symptoms of electrolyte depletion include: anorexia, cramps, weakness, dizziness, vomiting, and mental confusion. Treatment: Replace electrolyte and fluid losses and monitor urinary electrolyte levels as well as serum electrolytes. Emesis or gastric lavage. Oxygen or artificial respiration may be necessary. General supportive measures.

How Supplied: Injection: 0.25 mg /mL; Tablet: 0.5 mg, 1 mg, 2 mg

Adults: 0.5-2 mg once daily; if response is inadequate, a second or third dose may be given at 4-5-hr intervals up to a maximum of 10 mg/day.
Adults: 0.5-1 mg; if response is inadequate, a second or third dose may be given at 2-3-hr intervals up to a maximum of 10 mg/day. Initiate PO dosing as soon as possible.

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