Adult: For the treatment of cases associated with heart failure, cirrhosis of the liver, and renal disease including nephrotic syndrome to patients in whom gastrointestinal absorption may be impaired or oral administration is not practical: Initially, 0.5-1 mg via IM or slow IV inj over 1-2 minutes. If response is inadequate, may repeat doses every 2-3 hours until desired diuretic response is achieved. Max: 10 mg daily. Doses must be individualised based on patient's response. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Oral Oedema
Adult: For the treatment of cases associated with heart failure, cirrhosis of the liver, and renal disease including nephrotic syndrome: 1 mg once daily, in the morning or early evening, may give a 2nd dose after 6-8 hours, if necessary. In refractory cases, higher doses may be needed until desired diuretic response is achieved. Doses must be individualised and adjusted according to patient's response. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines). Elderly: 0.5 mg daily. Dosage should be adjusted based on patient's response.
What are the brands available for Bumetanide in Hong Kong?
Burinex
Hepatic Impairment
Initiate at the lower end of the dosing range.
Administration
Bumetanide May be taken with or without food. May be taken w/ meals to reduce GI discomfort.
Reconstitution
IV inj: May be diluted in NaCl 0.9%, dextrose 5% in water, and lactated Ringer's solution.
Contraindications
Anuria, hepatic coma, severe electrolyte depletion.
Special Precautions
Patient with sulfonamide allergy, hypotension, prostatic hypertrophy or micturition impairment, potential urinary tract obstruction, elevated BUN or creatinine. Patient undergoing surgery. Postoperative period after bariatric surgery. Correct hypovolaemia, hypotension, and severe electrolyte disturbance before treatment initiation. Severe renal (e.g. renal failure) and hepatic (e.g. cirrhosis, ascites) impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Immediate and delayed hypersensitivity reactions (e.g. urticaria, skin rash, Stevens-Johnson syndrome and toxic epidermal necrolysis), acute kidney injury, hepatic encephalopathy (in patients with pre-existing hepatic disease), hypovolaemia, electrolyte imbalance (e.g. hypocalcaemia, hypokalaemia, hypomagnesaemia), dehydration, asymptomatic hyperuricaemia, ototoxicity (e.g. deafness, tinnitus). Blood and lymphatic system disorders: Pancytopenia, thrombocytopenia, leucopenia (including neutropenia), anaemia. Cardiac disorders: Chest pain and discomfort. Gastrointestinal disorders: Abdominal pain and discomfort, dyspepsia, nausea, vomiting, diarrhoea, xerostomia. General disorders and administration site conditions: Peripheral oedema, fatigue, asthenia, malaise. Investigations: Increased BUN and serum creatinine. Metabolism and nutrition disorders: Thirst, hyperglycaemia, hyponatraemia, hypochloraemia. Musculoskeletal and connective tissue disorders: Muscle spasms, myalgia, muscle cramps. Nervous system disorders: Dizziness, vertigo, lethargy, somnolence, headache. Renal and urinary disorders: Micturition disorder, azotaemia. Reproductive system and breast disorders: Gynaecomastia, breast pain. Respiratory, thoracic and mediastinal disorders: Dyspnoea, cough. Skin and subcutaneous tissue disorders: Pruritus. Vascular disorders: Hypotension. Potentially Fatal: Profound diuresis with water and electrolyte depletion (especially at high doses or for prolonged periods).
Monitor blood pressure, serum electrolytes (e.g. K, Na), renal function, fluid intake and output, blood glucose sugar (particularly in patients with known or suspected diabetes) periodically.
Overdosage
Symptoms: Profound water loss, polyuria, dehydration; electrolyte depletion manifested by dry mouth, thirst, weakness, lethargy, drowsiness, mental confusion, anorexia, vomiting, restlessness, muscle pain and cramps, seizures; hypovolaemia and circulatory collapse with a possibility of vascular thrombosis and embolism. Management: Supportive and symptomatic treatment. General measures to restore blood volume, maintain blood pressure and correct electrolyte imbalance. Initiate fluid and electrolyte replacement. Careful monitoring of urinary output and serum electrolyte levels. May induce emesis or perform gastric lavage.
Drug Interactions
Increased risk of digitalis toxicity. Decreased diuretic and natriuretic effect with indometacin and probenecid. May increase risk of ototoxicity with aminoglycosides and other ototoxic drugs (e.g. cisplatin). May potentiate the effect of other antihypertensive drugs. Antagonised diuretic effect and increased risk of nephrotoxicity with NSAIDs. May increase risk of lithium toxicity. Increased risk of nephrotoxicity with other nephrotoxic drugs.
Lab Interference
May result in a false-negative aldosterone/renin ratio (ARR).
Action
Description: Mechanism of Action: Bumetanide is a potent sulfonamide type loop diuretic. It acts on the ascending loop of Henle and proximal renal tubule by inhibiting Na and chloride reabsorption and interferes with the chloride-binding cotransport system, resulting in increased excretion of water, chloride, phosphate, Na, Mg, and Ca. Onset: 30-60 minutes (oral); approx 40 minutes (IM); 2-3 minutes (IV). Duration: 4-6 hours (oral); 2-3 hours (IV). Pharmacokinetics: Absorption: Rapidly and almost completely absorbed from the gastrointestinal tract; completely absorbed (IM). Bioavailability: 80-95%. Time to peak plasma concentration: 1-2 hours (oral, IM); 15-30 minutes (IV). Distribution: Volume of distribution: 9-25 L. Plasma protein binding: 94-96%. Metabolism: Partially metabolised in the liver via oxidation of the N-butyl side chain to form alcohol metabolites. Excretion: Via urine (81%; 45% as unchanged drug); faeces (10-20%). Elimination half-life: 1-1.5 hours.
Chemical Structure
Bumetanide Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 2471, Bumetanide. https://pubchem.ncbi.nlm.nih.gov/compound/Bumetanide. Accessed May 31, 2024.
Storage
Tab/intact vials: Store between 15-30°C. Protect from light. Diluted solution: Use within 24 hours after preparation.
C03CA02 - bumetanide ; Belongs to the class of high-ceiling sulfonamide diuretics.
References
AFT Pharmaceuticals Ltd. Burinex 1 mg Tablets data sheet 22 May 2020. Medsafe. http://www.medsafe.govt.nz. Accessed 13/03/2024.Anon. Bumetanide. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 13/03/2024.Anon. Bumetanide. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 13/03/2024.Buckingham R (ed). Bumetanide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 13/03/2024.Bumetanide 1 mg Tablets (Teva UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 13/03/2024.Bumetanide Injection, Solution (Athenex Pharmaceutical Division, LLC.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 13/03/2024.Bumetanide Tablet (Upsher-Smith Laboratories, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 13/03/2024.Burinex Injection 0.5 mg/mL (4 mL) (DKSH Malaysia Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 13/03/2024.Burinex Tablet 1 mg (DKSH Malaysia Sdn. Bhd.). NPRA. https://www.npra.gov.my. Accessed 13/03/2024.Joint Formulary Committee. Bumetanide. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 13/03/2024.
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