====== Bumetanide (Bumex®) ======
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|^ Bumetanide || Brand Names | Bumex® || Drug Class | Loop Diuretic || Primary Indications | Heart Failure; Edema; CKD volume overload || Blood Pressure Effect | ↓ preload, ↓ BP || Mortality Benefit | No (symptom relief) || Elimination | Hepatic & renal || Black Box Warning | Ototoxicity (high dose/rapid IV) || FDA Approval | 1983 |
===== Overview =====Bumetanide is a potent loop diuretic that blocks NKCC2 in the thick ascending limb. It is more potent on a mg-per-mg basis than furosemide and is useful when loop potency is needed.
—-===== Mechanism of Action =====Primary Molecular Target * Na-K-2Cl cotransporter (NKCC2) in thick ascending limbSegment Effects * ↓ NaCl reabsorption in TAL * ↑ Ca2+ and Mg2+ excretion * Disrupts medullary concentrating gradientNet Physiologic Outcomes * Powerful diuresis * Rapid relief of congestion * Useful in resistant edema—-===== Indications ===== * Heart failure with congestion * Edema from renal/hepatic disease * Severe volume overload—-
===== Black Box Warning =====Risk of profound diuresis, electrolyte depletion, and ototoxicity with high doses or rapid IV.
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===== Contraindications =====Absolute: * AnuriaRelative / Caution: * Hypovolemia * Severe electrolyte depletion * Gout
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===== Dosing =====Heart failure/edema: * PO: 0.5–2 mg daily or BID * IV: 0.5–1 mg, repeat as neededRenal adjustment: * Higher doses may be required in CKD
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===== Pharmacokinetics =====Absorption: * Oral/IVBioavailability: * ~80–90%Metabolism: * HepaticHalf-life: * ~1–1.5 hoursElimination: * Hepatic & renal
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===== Adverse Effects =====Common: * Hypokalemia * Hypomagnesemia * Hypotension * PolyuriaSerious: * Ototoxicity * AKI from overdiuresis * Hyponatremia
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===== Drug Interactions =====Increased risk: * Digoxin toxicity (via hypokalemia) * NSAIDs (↓ effect) * Lithium (↑ levels)Avoid combination: * Aminoglycosides (ototoxicity risk)
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===== Monitoring =====Labs: * Electrolytes (K+, Mg2+, Na+) * CreatinineVitals: * Blood pressure * WeightClinical: * Volume status * Hearing changes (high dose)
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===== Clinical Pearls ===== * Very potent on a mg basis * Useful in diuretic resistance * Short half-life requires BID dosing in many
—-===== Comparison Within Class =====Compared to other loop diuretics: * More potent than furosemide * Shorter half-life than torsemide * High bioavailability—-===== Related ===== * Loop Diuretics * Heart Failure * Diuretics