bumetanide: clinical use

Prescribing considerations

• Use caution with hypotension, hepatic impairment, porphyria, diabetes, gout and concurrent nephrotoxic or ototoxic medicines.
• Severe chronic renal failure requiring intensive therapy warrants close hospital supervision.
• Do not directly substitute high-intensity furosemide treatment using a fixed equivalence ratio.
• Review treatment promptly during illness causing vomiting, diarrhoea, fever or reduced fluid intake.

Contraindications and cautions

• Check product-specific contraindications. The selected tablet lists hypersensitivity to bumetanide, sulfonamides or excipients; oliguria or anuria; rising blood urea in progressive renal disease; hepatic coma; severe electrolyte imbalance; and concurrent lithium.
• The selected oral solution contraindicates active-ingredient or excipient hypersensitivity and hepatic coma. Stop treatment if progressive renal disease is accompanied by marked urea elevation, oliguria or anuria.
• Do not restart after bumetanide-associated Stevens–Johnson syndrome or toxic epidermal necrolysis.
• The oral solution is unsuitable in hereditary fructose intolerance because it contains sorbitol. The tablet contains lactose and is unsuitable in specified rare hereditary carbohydrate-intolerance disorders.

Monitoring

• Assess hydration, oedema, blood pressure and symptomatic response.
• Monitor renal function and serum sodium, potassium, chloride and bicarbonate.
• Consider glucose monitoring in diabetes or suspected latent diabetes.
• Monitor uric acid where gout or hyperuricaemia is relevant.
• Investigate hearing symptoms and review nephrotoxic or ototoxic treatment.

Clinical pharmacology

Bumetanide is a rapidly absorbed, highly protein-bound, short-acting loop diuretic. It inhibits NKCC2-mediated electrolyte reabsorption in the thick ascending limb, producing natriuresis and diuresis. Elimination involves renal excretion of unchanged medicine and biliary routes; clearance may be reduced in renal or hepatic impairment.

Formulation and product differences

• The selected tablet contains lactose. Its score line facilitates swallowing and is not intended to produce equal portions.
• The selected oral solution is a clear, green, peppermint-flavoured liquid containing sorbitol and methyl and propyl parahydroxybenzoates; the parabens may cause delayed allergic reactions.
• The selected oral solution is licensed from age 12 years, whereas the selected tablet is licensed for adults for its stated oedema indications.

Oral solution

Route: Oral

Strengths: 0.2 mg/mL

Tablet

Route: Oral

Strengths: 5 mg