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Bumetanide: Pediatric drug information

Bumetanide: Pediatric drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Bumetanide: Drug information" and "Bumetanide: Patient drug information"

For abbreviations, symbols, and age group definitions show table
ALERT: US Boxed Warning
Fluid/electrolyte loss:

Bumetanide is a potent diuretic which, if given in excessive amounts, can lead to a profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required and dose and dosage schedule have to be adjusted to the individual patient's needs.

Brand Names: US
  • Bumex
Brand Names: Canada
  • Burinex
Therapeutic Category
  • Antihypertensive Agent;
  • Diuretic, Loop
Dosing: Neonatal

Dosage guidance:

Clinical considerations: Relative to other loop diuretics (eg, furosemide), bumetanide is much more potent; monitor closely during use. Dose equivalency for adult patients with normal renal function (approximate): Bumetanide 1 mg = furosemide 40 mg (Ref).

Edema

Edema (diuresis): Limited data available: Note: Doses in the higher end of the range may be required for patients with heart failure (Ref):

Preterm neonates: Oral, IM, IV: 0.01 to 0.06 mg/kg/dose every 12 to 48 hours; every 12 to 24 hour dosing interval has been used for oliguria in the setting of acute renal failure (Ref); IV and oral doses up to 0.1 mg/kg/dose are recommended (Ref).

Term neonates: Oral, IM, IV: Usual dose: 0.01 to 0.05 mg/kg/dose every 12 to 24 hours; reported dosage range: 0.005 to 0.1 mg/kg/dose (Ref). Note: A dose of 0.1 mg/kg/dose has been shown effective in neonates on extracorporeal membrane oxygenation (Ref).

Dosing: Pediatric

Dosage guidance:

Dosing: Dose equivalency for adult patients with normal renal function (approximate): Bumetanide 1 mg = furosemide 40 mg = torsemide 10 to 20 mg. Note: Ethacrynic acid has a relative potency of 0.7 (Ref).

Edema

Edema (diuresis):

Intermittent dosing:

Infants and Children: Limited data available: Oral, IM, IV: 0.01 to 0.1 mg/kg/dose every 6 to 24 hours; maximum adult daily dose: 10 mg/day; a prospective, open-label dose-range study in infants (mean age: 2 months; range: 0 to 6 months) reported a maximal diuretic response at doses 0.035 to 0.04 mg/kg/dose every 6 to 8 hours, and no additional clinical benefit (ie, urine output) at doses >0.05 mg/kg/dose (Ref).

Adolescents: Very limited data: Oral, IM, IV: Initial: 0.5 to 1 mg/dose every 6 to 24 hours; maximum adult daily dose: 10 mg/day. Note: Dosing in adolescents based on experience in adult patients.

Continuous IV infusion: Limited data available: Infants, Children, and Adolescents ≤16 years: 1 to 10 mcg/kg/hour; titrate to effect (Ref). Note: A wide range of doses (1 to 200 mcg/kg/hour) have been reported; a complete safety analysis is lacking for the higher doses (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustment provided in the manufacturer's labeling; based on experience in adult patients, high doses are effective in end-stage kidney disease (Ref), but use is contraindicated in anuria; use with caution in kidney insufficiency due to increased risk of adverse effects.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; based on experience in adult patients, use is contraindicated in hepatic coma. Use with caution in cirrhosis and ascites due to increased risk of precipitating hepatic coma; initiate with conservative doses and monitoring.

Dosing: Adult

(For additional information see "Bumetanide: Drug information")

Dosage guidance:

Dosing: Loop diuretic approximate oral dose equivalency for patients with normal kidney function: Bumetanide 1 mg = furosemide 40 mg = torsemide 10 to 20 mg (Ref).

Edema or volume overload

Edema or volume overload:

Naive to loop diuretics:

Oral, IV: Initial: 0.5 to 1 mg once, then titrate as needed to an effective dose (see Titration to Effect below) (Ref).

Note: Oral bioavailability is very good (~80% to 100%); the same IV or oral dose is expected to produce a similar effect (Ref).

Refractory edema or acute decompensation in patients taking oral loop diuretics:

IV: Bolus/intermittent dosing: Initial: Administer 1 to 2.5 times the total daily oral maintenance dose once (eg, a patient taking oral bumetanide 1 mg twice daily at home [2 mg/day] can be given 2 to 5 mg IV as an initial bolus), then titrate as needed to an effective dose; maximum effective single dose: 3 to 10 mg depending on kidney function (see "Titration to Effect" below) (Ref).

Titration to effect: If the initial dose does not result in diuresis, double the individual dose (rather than administer the same dose more frequently) until diuresis occurs. Titration of an IV dose can occur at ≥2-hour intervals as needed in hospitalized patients. Once an effective dose is identified, it is typically administered 1 to 3 times daily. The maximum effective dose varies by population; higher than usual doses may be required for patients with nephrotic syndrome or kidney failure; maximum effective single dose: 3 to 10 mg; maximum recommended total daily dose: 10 mg/day (Ref).

Continuous infusion: Note: Reserve for patients who have responded to bolus therapy but need ongoing and sustained diuresis; administer an effective bolus dose then immediately start continuous infusion.

IV: Initial: 0.5 mg/hour; if diuretic response is not adequate, repeat IV bolus dose and increase continuous infusion to 1 mg/hour; continue to bolus and titrate infusion as needed up to 2 mg/hour (Ref).

Note: Higher continuous infusion rates are not recommended due to potential for side effects; consider alternative strategies for fluid removal (Ref).

Transitioning from IV to oral: Give the same IV dose orally (eg, total daily IV dose of 3 mg/day should be converted to an oral dose of 3 mg/day in 1 to 3 divided doses), then monitor urine output and adjust oral dose as needed (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function: IV, Oral:

eGFR ≥30 mL/minute/1.73 m2: No dosage adjustment necessary (Ref).

eGFR <30 mL/minute/1.73 m2:

Higher doses may be required to achieve desired diuretic response due to decreased secretion into the tubular fluid. However, single IV or oral doses >8 to 10 mg are unlikely to result in additional diuretic effect (Ref).

Continuous infusion: IV: Initial: 1 mg/hour; if diuretic response is not adequate, repeat IV bolus dose and increase continuous infusion to 2 mg/hour (Ref).

Hemodialysis, intermittent (thrice weekly): Unlikely to be significantly dialyzable (highly protein bound) (Ref):

IV, Oral:

Patients with anuria: Use is contraindicated (Ref).

Patients with residual kidney function: Dose as per eGFR <30 mL/minute/1.73 m2 (Ref).

Peritoneal dialysis: Unlikely to be significantly dialyzable (highly protein bound) (Ref):

IV, Oral:

Patients with anuria: Use is contraindicated (Ref).

Patients with residual kidney function: Dose as per eGFR <30 mL/minute/1.73 m2 (Ref).

CRRT: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour) unless otherwise noted.

IV, Oral: In general, use not recommended; fluid management can be more effectively managed using CRRT ultrafiltration (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Close monitoring of response and adverse reactions (eg, ototoxicity) due to drug accumulation is important.

IV, Oral:

Patients with anuria: There is no expected clinical benefit; use is not recommended (Ref).

Patients with residual kidney function: Dose as per eGFR <30 mL/minute/1.73 m2 (Ref).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling. Use is contraindicated in hepatic coma. Use with caution in cirrhosis and ascites due to increased risk of precipitating hepatic coma; initiate with conservative doses and monitoring.

Adverse Reactions (Significant): Considerations
Acute kidney injury

Loop diuretics, including bumetanide, may lead to acute kidney injury due to fluid loss.

Mechanism: Dose-related; related to the pharmacologic action (ie, volume depletion) (Ref).

Risk factors:

• Excessive doses (Ref)

• Concurrent administration of nephrotoxic agents (Ref)

• Older adults (Ref)

• Preexisting volume depletion (Ref)

• Reduced blood flow to the kidney or depletion of effective blood volume (eg, bilateral renal artery stenosis, cirrhosis, nephrotic syndrome, heart failure) (Ref)

Fluid/electrolyte loss

Loop diuretics, including bumetanide, may lead to profound diuresis (especially if given in excessive amounts), resulting in hypovolemia and electrolyte loss. Electrolyte disturbances (eg, hypocalcemia, hypokalemia, hypomagnesemia) may predispose a patient to serious cardiac arrhythmias.

Mechanism: Dose-related; related to the pharmacologic action (Ref).

Risk factors:

• Excessive doses with initiation or dose adjustment (Ref)

• Reduced dietary fluid and/or electrolyte intake (Ref)

• Concurrent illness leading to excessive fluid loss (eg, diarrhea, vomiting) (Ref)

• Concomitant administration of an additional diuretic (Ref)

• Very high or very restricted dietary sodium (Ref)

Hypersensitivity (immediate and delayed)

Immediate hypersensitivity reactions, including urticaria, have been reported (Ref) with bumetanide. Delayed hypersensitivity reactions range from nonspecific skin rash to rare severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome and toxic epidermal necrolysis.

Mechanism: Non–dose-related; immunologic. Immediate hypersensitivity reactions: IgE-mediated, with specific antibodies formed against a drug allergen following initial exposure (Ref). SCARs: Delayed type IV hypersensitivity reactions involving a T-cell mediated drug-specific immune response (Ref).

Onset: Immediate hypersensitivity reactions: Rapid; generally occurs within 1 hour of administration but may occur up to 6 hours after exposure (Ref). Delayed hypersensitivity reactions: Varied; typically occur 1 to 8 weeks after drug exposure but may occur more rapidly (usually within 1 to 4 days) upon reexposure (Ref).

Ototoxicity

Loop diuretics, including bumetanide, have been associated with hearing loss (deafness) and tinnitus, which is generally reversible (lasting from 30 minutes to 24 hours after administration) (Ref). There is less risk of ototoxicity with bumetanide compared to furosemide (Ref).

Mechanism: Dose-related; related to the pharmacologic action (ie, inhibition of a secretory isoform of the Na-K-2Cl co-transporter in the inner ear and impacts on ionic composition of cochlear fluids) (Ref).

Risk factors:

• Concurrent kidney disease (Ref)

• Excessive doses (Ref)

• IV administration (Ref): bolus (higher risk) versus continuous infusion (Ref)

• Concurrent use of other ototoxic agents (eg, aminoglycosides) can lead to ototoxicity at lower doses (Ref)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Endocrine & metabolic: Hyperuricemia (18%), hypochloremia (15%), hypokalemia (15%)

Genitourinary: Azotemia (11%)

1% to 10%:

Endocrine & metabolic: Abnormal lactate dehydrogenase (1%), abnormal serum calcium (2%), hyperglycemia (7%), hyponatremia (9%), variations in bicarbonate (3%)

Hematologic & oncologic: Abnormal serum phosphorus level (5%)

Nervous system: Dizziness (1%)

Neuromuscular & skeletal: Muscle cramps (1%)

Renal: Increased serum creatinine (7%)

Respiratory: Variations in CO2 concentration (4%)

<1%:

Cardiovascular: Chest pain, ECG changes, hypotension

Dermatologic: Diaphoresis, pruritus, skin rash, urticaria (Earl 2003)

Endocrine & metabolic: Abnormal alanine aminotransferase, abnormal aspartate transaminase, alkaline phosphatase abnormal, blood cholesterol abnormal, dehydration, glycosuria

Gastrointestinal: Abdominal pain, diarrhea, dyspepsia, nausea, vomiting, xerostomia

Genitourinary: Erectile dysfunction, nipple tenderness, premature ejaculation, proteinuria

Hematologic & oncologic: Abnormal hematocrit, abnormal hemoglobin level, change in prothrombin time, change in serum protein, change in WBC count, thrombocytopenia

Hepatic: Abnormal bilirubin levels

Nervous system: Asterixis, encephalopathy (in patients with preexisting hepatic disease), fatigue, headache, vertigo

Neuromuscular & skeletal: Arthritic pain, asthenia, musculoskeletal pain

Otic: Auditory impairment, otalgia

Renal: Acute kidney injury (Hansrivijit 2020)

Respiratory: Hyperventilation

Postmarketing: Dermatologic: Stevens-Johnson syndrome, toxic epidermal necrolysis

Contraindications

Hypersensitivity to bumetanide or any component of the formulation; anuria; hepatic coma; patients in states of severe electrolyte depletion until the condition improves or is corrected.

Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to other sulfonamide derivatives; hepatic encephalopathy; galactose intolerance, glucose-galactose malabsorption, or congenital lactase deficiency.

Note: Although the FDA-approved product labeling states this medication is contraindicated in patients with hypersensitivity to sulfonamide-containing drugs, the scientific basis of this cross-sensitivity has been challenged.

Warnings/Precautions

Concerns related to adverse effects:

• Hyperuricemia: Asymptomatic hyperuricemia has been reported with use.

• Sulfonamide (“sulfa”) allergy: The FDA-approved product labeling for many medications containing a sulfonamide chemical group includes a broad contraindication in patients with a prior allergic reaction to sulfonamides. There is a potential for cross-reactivity between members of a specific class (eg, two antibiotic sulfonamides). However, concerns for cross-reactivity have previously extended to all compounds containing the sulfonamide structure (SO2NH2). An expanded understanding of allergic mechanisms indicates cross-reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides may not occur or at the very least this potential is extremely low (Brackett 2004; Johnson 2005; Slatore 2004; Tornero 2004). In particular, mechanisms of cross-reaction due to antibody production (anaphylaxis) are unlikely to occur with nonantibiotic sulfonamides. T-cell-mediated (type IV) reactions (eg, maculopapular rash) are not well understood and it is not possible to completely exclude this potential based on current insights. In cases where prior reactions were severe (Stevens-Johnson syndrome/TEN), some clinicians choose to avoid exposure to these classes.

Disease-related concerns:

• Bariatric surgery: Dehydration: Avoid diuretics in the immediate postoperative period after bariatric surgery; electrolyte disturbances and dehydration may occur. Diuretics may be resumed, if indicated, once oral fluid intake goals are met (Ziegler 2009).

• Hepatic impairment: Use caution in patients with cirrhosis; initiate bumetanide therapy with conservative dosing and close monitoring of electrolytes; avoid sudden changes in fluid and electrolyte balance and acid/base status which may lead to hepatic encephalopathy.

• Kidney impairment: Larger doses may be necessary in patients with impaired kidney function to obtain the same therapeutic response (Brater 1998).

Special populations:

• Neonates: In vitro studies using pooled sera from critically-ill neonates have shown bumetanide to be a potent displacer of bilirubin; avoid use in neonates at risk for kernicterus.

• Surgical patients: If given the morning of surgery, bumetanide may render the patient volume depleted and blood pressure may be labile during general anesthesia.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.

Other warnings and precautions:

• Diuretic resistance: For some patients, despite high doses of loop diuretic, an adequate diuretic response cannot be attained. Diuretic resistance may be overcome by IV rather than oral administration or the use of 2 diuretics together (eg, a loop diuretic in combination with a thiazide diuretic). When such combinations are used, serum electrolytes need to be monitored even more closely (ACC [Hollenberg 2019]).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Injection:

Generic: 0.25 mg/mL (4 mL, 10 mL)

Tablet, Oral:

Bumex: 0.5 mg [contains fd&c blue #1 (brill blue) aluminum lake, quinoline (d&c yellow #10) aluminum lake]

Generic: 0.5 mg, 1 mg, 2 mg

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Bumetanide Injection)

0.25 mg/mL (per mL): $0.60 - $1.04

Tablets (Bumetanide Oral)

0.5 mg (per each): $0.41 - $2.43

1 mg (per each): $0.82 - $2.70

2 mg (per each): $0.41 - $2.98

Tablets (Bumex Oral)

0.5 mg (per each): $2.70

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Burinex: 0.5 mg

Burinex: 1 mg, 5 mg [contains corn starch]

Administration: Pediatric

Oral: May be administered with or without regard to food.

Parenteral: IV:

Intermittent IV: May be administered undiluted by direct IV injection or further diluted and administered over 5 minutes (Ref).

Continuous IV infusion: In pediatric patients, may be administered undiluted or diluted via an infusion pump.

Administration: Adult

IV: Administer IV slowly, over 1 to 2 minutes. Undiluted direct IV injections may be administered at a rate of 0.5 to 1 mg over 1 to 2 minutes.

Oral: May administer with or without food. An intermittent dose schedule, such as an alternate-day schedule or administering for 3 to 4 days with rest periods of 1 to 2 days in between, may be the most tolerable and effective regimen for the continued control of edema.

Usual Infusion Concentrations: Pediatric

IV infusion: 0.04 mg/mL or 0.25 mg/mL (undiluted).

Storage/Stability

IV: Store vials at 15°C to 30°C (59°F to 86°F). Infusion solutions in D5W, NS, or LR should be used within 24 hours after preparation. Light sensitive; discoloration may occur when exposed to light.

Tablet: Store at 15°C to 30°C (59°F to 86°F); protect from light.

Use

Management of edema secondary to congestive heart failure, hepatic and renal disease, including nephrotic syndrome (FDA approved in adults).

Medication Safety Issues
Sound-alike/look-alike issues:

Bumetanide may be confused with Buminate.

Bumex may be confused with Brevibloc, Buprenex.

Older Adult: High-Risk Medication:

Beers Criteria: Diuretics are identified in the Beers Criteria as a potentially inappropriate medication to be used with caution in patients 65 years and older due to the potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium concentration closely when initiating or adjusting the dose in older adults (Beers Criteria [AGS 2023]).

International issues:

Bumex [US] may be confused with Permax brand name for pergolide [multiple international markets].

Metabolism/Transport Effects

Substrate of OAT1/3;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Ajmaline: Sulfonamides may increase adverse/toxic effects of Ajmaline. Specifically, the risk for cholestasis may be increased. Risk C: Monitor

Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Allopurinol: Loop Diuretics may increase adverse/toxic effects of Allopurinol. Loop Diuretics may increase serum concentration of Allopurinol. Specifically, Loop Diuretics may increase the concentration of Oxypurinol, an active metabolite of Allopurinol. Risk C: Monitor

Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification

Amikacin Liposome (Oral Inhalation): Loop Diuretics may increase nephrotoxic effects of Amikacin Liposome (Oral Inhalation). Loop Diuretics may increase ototoxic effects of Amikacin Liposome (Oral Inhalation). Risk C: Monitor

Aminoglycosides: Loop Diuretics may increase adverse/toxic effects of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Risk C: Monitor

Aminolevulinic Acid (Systemic): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Systemic). Risk X: Avoid

Aminolevulinic Acid (Topical): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Topical). Risk C: Monitor

Amphetamines: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Angiotensin II Receptor Blockers: Loop Diuretics may increase hypotensive effects of Angiotensin II Receptor Blockers. Loop Diuretics may increase nephrotoxic effects of Angiotensin II Receptor Blockers. Risk C: Monitor

Angiotensin-Converting Enzyme Inhibitors: Loop Diuretics may increase hypotensive effects of Angiotensin-Converting Enzyme Inhibitors. Loop Diuretics may increase nephrotoxic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Antidiabetic Agents: Hyperglycemia-Associated Agents may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Antihypertensive Agents: Loop Diuretics may increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor

Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Arsenic Trioxide: Loop Diuretics may increase QTc-prolonging effects of Arsenic Trioxide. Loop Diuretics may increase hypotensive effects of Arsenic Trioxide. Management: When possible, avoid concurrent use of arsenic trioxide with drugs that can cause electrolyte abnormalities, such as the loop diuretics. Risk D: Consider Therapy Modification

Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Beta2-Agonists: May increase hypokalemic effects of Loop Diuretics. Risk C: Monitor

Bilastine: Loop Diuretics may increase QTc-prolonging effects of Bilastine. Risk C: Monitor

Bile Acid Sequestrants: May decrease absorption of Loop Diuretics. Risk C: Monitor

Brigatinib: May decrease antihypertensive effects of Antihypertensive Agents. Brigatinib may increase bradycardic effects of Antihypertensive Agents. Risk C: Monitor

Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid

Canagliflozin: May increase hypotensive effects of Loop Diuretics. Risk C: Monitor

Cardiac Glycosides: Loop Diuretics may increase adverse/toxic effects of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of loop diuretics. Risk C: Monitor

Cefazedone: May increase nephrotoxic effects of Loop Diuretics. Risk C: Monitor

Cefotiam: Loop Diuretics may increase nephrotoxic effects of Cefotiam. Risk C: Monitor

Cefpirome: Loop Diuretics may increase nephrotoxic effects of Cefpirome. Risk C: Monitor

Ceftizoxime: Loop Diuretics may increase nephrotoxic effects of Ceftizoxime. Risk C: Monitor

Cephaloridine: Loop Diuretics may increase nephrotoxic effects of Cephaloridine. Loop Diuretics may increase serum concentration of Cephaloridine. Risk X: Avoid

Cephalothin: Loop Diuretics may increase nephrotoxic effects of Cephalothin. Risk C: Monitor

Cephradine: May increase nephrotoxic effects of Loop Diuretics. Risk C: Monitor

CISplatin: Loop Diuretics may increase ototoxic effects of CISplatin. Loop Diuretics may increase nephrotoxic effects of CISplatin. Risk C: Monitor

Corticosteroids (Systemic): May increase hypokalemic effects of Loop Diuretics. Risk C: Monitor

CycloSPORINE (Systemic): May increase adverse/toxic effects of Loop Diuretics. Specifically, the risk for hyperuricemia and gout may be increased. Risk C: Monitor

Desmopressin: May increase hyponatremic effects of Loop Diuretics. Risk X: Avoid

Dexmethylphenidate: May decrease therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Diacerein: May increase therapeutic effects of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Risk C: Monitor

Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Dichlorphenamide: Loop Diuretics may increase hypokalemic effects of Dichlorphenamide. Risk C: Monitor

Dofetilide: Loop Diuretics may increase QTc-prolonging effects of Dofetilide. Management: Monitor serum potassium and magnesium more closely when dofetilide is combined with loop diuretics. Electrolyte replacements will likely be required to maintain potassium and magnesium serum concentrations. Risk D: Consider Therapy Modification

DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor

Empagliflozin: May increase hypotensive effects of Loop Diuretics. Risk C: Monitor

EPINEPHrine (Systemic): Diuretics may increase arrhythmogenic effects of EPINEPHrine (Systemic). Diuretics may decrease vasopressor effects of EPINEPHrine (Systemic). Risk C: Monitor

Fexinidazole: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Management: Avoid use of fexinidazole with OAT1/3 substrates when possible. If combined, monitor for increased OAT1/3 substrate toxicities. Risk D: Consider Therapy Modification

Flunarizine: May increase therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Foscarnet: Loop Diuretics may increase serum concentration of Foscarnet. Management: When diuretics are indicated during foscarnet treatment, thiazides are recommended over loop diuretics. If patients receive loop diuretics during foscarnet treatment, monitor closely for evidence of foscarnet toxicity. Risk D: Consider Therapy Modification

Herbal Products with Blood Pressure Increasing Effects: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor

Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Immune Globulin: Loop Diuretics may increase thrombogenic effects of Immune Globulin. Risk C: Monitor

Indoramin: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Iodinated Contrast Agents: Loop Diuretics may increase nephrotoxic effects of Iodinated Contrast Agents. Risk C: Monitor

Ipragliflozin: May increase adverse/toxic effects of Loop Diuretics. Specifically, the risk for intravascular volume depletion may be increased. Risk C: Monitor

Isocarboxazid: May increase hypotensive effects of Diuretics. Risk X: Avoid

Ivabradine: Loop Diuretics may increase arrhythmogenic effects of Ivabradine. Risk C: Monitor

Leflunomide: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor

Levosulpiride: Loop Diuretics may increase adverse/toxic effects of Levosulpiride. Risk X: Avoid

Licorice: May increase hypokalemic effects of Loop Diuretics. Risk C: Monitor

Lithium: Loop Diuretics may decrease serum concentration of Lithium. Loop Diuretics may increase serum concentration of Lithium. Risk C: Monitor

Loop Diuretics: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Mecamylamine: Sulfonamides may increase adverse/toxic effects of Mecamylamine. Risk X: Avoid

Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor

Methotrexate: May decrease therapeutic effects of Loop Diuretics. Loop Diuretics may increase serum concentration of Methotrexate. Methotrexate may increase serum concentration of Loop Diuretics. Risk C: Monitor

Methoxsalen (Systemic): Photosensitizing Agents may increase photosensitizing effects of Methoxsalen (Systemic). Risk C: Monitor

Methylphenidate: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Netilmicin (Ophthalmic): Loop Diuretics may increase nephrotoxic effects of Netilmicin (Ophthalmic). Risk X: Avoid

Neuromuscular-Blocking Agents: Loop Diuretics may decrease neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Loop Diuretics may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor

Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nitisinone: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Loop Diuretics. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: May decrease diuretic effects of Loop Diuretics. Loop Diuretics may increase nephrotoxic effects of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended. Risk D: Consider Therapy Modification

Obinutuzumab: May increase hypotensive effects of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider Therapy Modification

Opioid Agonists: May increase adverse/toxic effects of Diuretics. Opioid Agonists may decrease therapeutic effects of Diuretics. Risk C: Monitor

Palopegteriparatide: Loop Diuretics may decrease therapeutic effects of Palopegteriparatide. Loop Diuretics may increase therapeutic effects of Palopegteriparatide. Risk C: Monitor

Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Perazine: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor

Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Piperacillin: May increase hypokalemic effects of Diuretics. Risk C: Monitor

Polyethylene Glycol-Electrolyte Solution: Diuretics may increase nephrotoxic effects of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor

Porfimer: Photosensitizing Agents may increase photosensitizing effects of Porfimer. Risk X: Avoid

Prazosin: Antihypertensive Agents may increase hypotensive effects of Prazosin. Risk C: Monitor

Pretomanid: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Probenecid: May decrease diuretic effects of Loop Diuretics. Probenecid may increase serum concentration of Loop Diuretics. Risk C: Monitor

Promazine: Loop Diuretics may increase QTc-prolonging effects of Promazine. Risk X: Avoid

Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Reboxetine: May increase hypokalemic effects of Loop Diuretics. Risk C: Monitor

Salicylates: May decrease therapeutic effects of Loop Diuretics. Loop Diuretics may increase serum concentration of Salicylates. Risk C: Monitor

Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Sodium Phosphates: Diuretics may increase nephrotoxic effects of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor

Taurursodiol: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk X: Avoid

Terazosin: Antihypertensive Agents may increase hypotensive effects of Terazosin. Risk C: Monitor

Teriflunomide: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Tobramycin (Oral Inhalation): Loop Diuretics may increase ototoxic effects of Tobramycin (Oral Inhalation). Loop Diuretics may increase nephrotoxic effects of Tobramycin (Oral Inhalation). Risk C: Monitor

Topiramate: Loop Diuretics may increase hypokalemic effects of Topiramate. Risk C: Monitor

Urapidil: Antihypertensive Agents may increase hypotensive effects of Urapidil. Risk C: Monitor

Vaborbactam: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Vadadustat: May increase serum concentration of OAT1/3 Substrates (Clinically Relevant). Risk C: Monitor

Vancomycin: Loop Diuretics may increase nephrotoxic effects of Vancomycin. Risk C: Monitor

Verteporfin: Photosensitizing Agents may increase photosensitizing effects of Verteporfin. Risk C: Monitor

Xipamide: May increase adverse/toxic effects of Loop Diuretics. Specifically, the risk of hypovolemia, electrolyte disturbances, and prerenal azotemia may be increased. Risk C: Monitor

Zoledronic Acid: Loop Diuretics may increase hypocalcemic effects of Zoledronic Acid. Risk C: Monitor

Dietary Considerations

May cause potassium loss; potassium supplement or dietary changes may be required.

Pregnancy Considerations

Adverse events have been observed in some animal reproduction studies.

Monitoring Parameters

Serum electrolytes (baseline and frequently during therapy); blood pressure; urine output and renal function parameters (baseline and frequently during therapy); fluid balance (body weight; neonatal and young pediatric patients may require more frequent monitoring than older patients); hearing (with high doses or extended duration).

Mechanism of Action

Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and proximal renal tubule, interfering with the chloride-binding cotransport system, thus causing increased excretion of water, sodium, chloride, magnesium, phosphate, and calcium; it does not appear to act on the distal tubule

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Oral: 0.5 to 1 hour; IV: 2 to 3 minutes.

Peak effect: Oral: 1 to 2 hours; IV: 15 to 30 minutes.

Duration: Oral: 4 to 6 hours; IV: 2 to 3 hours.

Distribution: Vd: Neonates and Infants: 0.15 to 0.39 L/kg (Lopez-Samblas 1997; manufacturer's labeling); Adults: 9 to 25 L.

Protein binding: 94% to 96%; Neonates: 97%.

Metabolism: Partially hepatic.

Bioavailability: 59% to 89% (median: 80%); 80% to 100% (Brater 2011).

Half-life elimination:

Premature and full term neonates: 6 hours (range up to 15 hours).

Infants <2 months: 2.5 hours.

Infants 2 to 6 months: 1.5 hours.

Adults: 1 to 1.5 hours.

Excretion: Urine (81% of total dose; 45% of which is unchanged drug); feces (2% of total dose).

Clearance:

Preterm and full term neonates: 0.2 to 1.1 mL/minute/kg (Lopez-Samblas 1997; manufacturer's labeling).

Infants <2 months: 2.17 mL/minute/kg.

Infants 2 to 6 months: 3.8 mL/minute/kg.

Adults: 2.9 ± 0.2 mL/minute/kg.

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: The half-life is relatively preserved (~1.6 hours) in patients with CrCl <30 mL/minute/1.73 m2 (Voelker 1987).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Burinex;
  • (AR) Argentina: Butinat | Segurex;
  • (AT) Austria: Burinex;
  • (AU) Australia: Burinex;
  • (BD) Bangladesh: Bumecard | Conart | Urinide;
  • (BE) Belgium: Burinex;
  • (BR) Brazil: Burinax | Fluxil;
  • (CH) Switzerland: Burinex;
  • (CL) Chile: Subit;
  • (CN) China: Chang su | Li liao;
  • (CO) Colombia: Poliurene;
  • (CZ) Czech Republic: Burinex;
  • (DE) Germany: Burinex;
  • (DO) Dominican Republic: Burinex | Miccil;
  • (EC) Ecuador: Miccil;
  • (EE) Estonia: Burinex;
  • (EG) Egypt: Burinex | Edemex;
  • (ES) Spain: Fordiuran;
  • (FI) Finland: Burinex;
  • (FR) France: Burinex;
  • (GB) United Kingdom: Betinex | Bumetanide almus | Bumetanide arrow | Bumetanide cox | Bumetanide kent | Burinex;
  • (GR) Greece: Burinex;
  • (HK) Hong Kong: Burinex;
  • (ID) Indonesia: Burinex;
  • (IE) Ireland: Burinex;
  • (IT) Italy: Fontego;
  • (JO) Jordan: Burinex;
  • (JP) Japan: Lunetoron;
  • (KR) Korea, Republic of: Burinex;
  • (LB) Lebanon: Burinex;
  • (LU) Luxembourg: Burinex;
  • (LV) Latvia: Burinex;
  • (MX) Mexico: Budimin | Bumedyl | Bumetanida | Drenural | Durin | Miccil;
  • (MY) Malaysia: Bumet | Burinex;
  • (NL) Netherlands: Bumetanide Actavis | Bumetanide CF | Bumetanide ratiopharm | Bumetanide sandoz | Burinex;
  • (NO) Norway: Bumetanide centrafarm | Burinex;
  • (NZ) New Zealand: Burinex;
  • (PE) Peru: Miccil;
  • (PH) Philippines: Burinex;
  • (PL) Poland: Burinex;
  • (PR) Puerto Rico: Bumex;
  • (PY) Paraguay: Burinex;
  • (RU) Russian Federation: Buphenox;
  • (SA) Saudi Arabia: Burinex;
  • (SE) Sweden: Burinex;
  • (SG) Singapore: Burinex;
  • (SI) Slovenia: Burinex;
  • (SR) Suriname: Bumetanide Actavis;
  • (TH) Thailand: Burinex;
  • (TR) Turkey: Bumid;
  • (TW) Taiwan: Budema | Buedor | Bumeta | Burinex | Busix | Butanide | Urenide;
  • (UA) Ukraine: Buphenox;
  • (VE) Venezuela, Bolivarian Republic of: Biulan | Bumelex;
  • (ZA) South Africa: Burinex
  1. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372 [PubMed 37139824]
  2. Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319. [PubMed 11487763]
  3. American Society of Health-System Pharmacists (ASHP). Pediatric continuous infusion standards. Available at https://www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/Pediatric-Infusion-Standards.ashx. Updated August 2022. Accessed August 15, 2023.
  4. Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed. American College of Physicians; 2007.
  5. Bellón T. Mechanisms of severe cutaneous adverse reactions: recent advances. Drug Saf. 2019;42(8):973-992. doi:10.1007/s40264-019-00825-2 [PubMed 31020549]
  6. Blumenthal KG, Peter JG, Trubiano JA, Phillips EJ. Antibiotic allergy. Lancet. 2019;393(10167):183-198. doi:10.1016/S0140-6736(18)32218-9 [PubMed 30558872]
  7. Bourke E. Letter: Frusemide, bumetanide, and ototoxicity. Lancet. 1976;1(7965):917-918. doi:10.1016/s0140-6736(76)92147-4 [PubMed 58190]
  8. Brackett CC, Singh H, Block JH. Likelihood and mechanisms of cross-allergenicity between sulfonamide antibiotics and other drugs containing a sulfonamide functional group. Pharmacotherapy. 2004;24(7):856-870. [PubMed 15303450]
  9. Brater DC, Chennavasin P, Day B, et al. Bumetanide and furosemide. Clin Pharmacol Ther. 1983;34(2):207-213. doi: 10.1038/clpt.1983.154. [PubMed 6872415]
  10. Brater DC. Diuretic therapy. N Engl J Med. 1998;339(6):387-395. [PubMed 9691107]
  11. Brater DC. Update in diuretic therapy: clinical pharmacology. Semin Nephrol. 2011;31(6):483-494. doi: 10.1016/j.semnephrol.2011.09.003. [PubMed 22099505]
  12. Brater DC, Ellison DH. Causes and treatment of refractory edema in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 1, 2021.
  13. Brater DC, Ellison DH. Loop diuretics: Dosing and major side effects. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 12, 2022.
  14. Brockow K, Przybilla B, Aberer W, et al. Guideline for the diagnosis of drug hypersensitivity reactions: S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG) in collaboration with the Association of German Allergologists (AeDA), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group (DKG), the Swiss Society for Allergy and Immunology (SGAI), the Austrian Society for Allergology and Immunology (ÖGAI), the German Academy of Allergology and Environmental Medicine (DAAU), the German Center for Documentation of Severe Skin Reactions and the German Federal Institute for Drugs and Medical Products (BfArM). Allergo J Int. 2015;24(3):94-105. doi:10.1007/s40629-015-0052-6 [PubMed 26120552]
  15. Bulkley CF, Johnson PN, Henry E, Harrison D, Lewis TV, Miller JL. Bumetanide continuous-infusion dosing in critically ill pediatric patients. Am J Health Syst Pharm. 2012;69(17):1458, 1460-1. [PubMed 22899737]
  16. Bumetanide injection, USP [prescribing information]. Mahwah, NJ: Glenmark Pharmaceuticals Inc USA; September 2022.
  17. Bumex (bumetanide) [prescribing information]. Parsippany, NJ: Validus Pharmaceuticals LLC; January 2024.
  18. Burinex (bumetanide) [product monograph]. Montreal, Quebec, Canada: Knight Therapeutics Inc; July 2022.
  19. Centers for Disease Control (CDC). Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm [PubMed 6810084]
  20. Cody RJ, Kubo SH, Pickworth KK. Diuretic treatment for the sodium retention of congestive heart failure. Arch Intern Med. 1994;154(17):1905-1914. [PubMed 8074594]
  21. Colucci WS. Treatment of acute decompensated heart failure: Specific therapies. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed June 16, 2022.
  22. Cook JA, Smith DE, Cornish LA, et al, “Kinetics, Dynamics, and Bioavailability of Bumetanide in Healthy Subjects and Patients With Congestive Heart Failure,” Clin Pharmacol Ther, 1988, 44(5):487-500. [PubMed 3180632]
  23. Delpire E, Lu J, England R, Dull C, Thorne T. Deafness and imbalance associated with inactivation of the secretory Na-K-2Cl co-transporter. Nat Genet. 1999;22(2):192-195. doi:10.1038/9713 [PubMed 10369265]
  24. Devarajan P. Renal failure. In: Kliegman RM, St. Geme J, eds. Nelson Textbook of Pediatrics. 21st ed. Saunders Elsevier; 2020:chap. 550.
  25. Ding D, Liu H, Qi W, et al. Ototoxic effects and mechanisms of loop diuretics. J Otol. 2016;11(4):145-156. doi:10.1016/j.joto.2016.10.001 [PubMed 29937824]
  26. Earl G, Davenport J, Narula J. Furosemide challenge in patients with heart failure and adverse reactions to sulfa-containing diuretics. Ann Intern Med. 2003;138(4):358-359. doi:10.7326/0003-4819-138-4-200302180-00025 [PubMed 12585844]
  27. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
  28. Felker GM, Lee KL, Bull DA, et al; NHLBI Heart Failure Clinical Research Network. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364(9):797-805. doi: 10.1056/NEJMoa1005419. [PubMed 21366472]
  29. Felker GM, Mentz RJ. Diuretics and ultrafiltration in acute decompensated heart failure. J Am Coll Cardiol. 2012;59(24):2145-2153. doi: 10.1016/j.jacc.2011.10.910. [PubMed 22676934]
  30. Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916. doi: 10.1210/jc.2015-4061. [PubMed 26934393]
  31. Gal P, Reed M. Medications. In: Kliegman RM, Behrman RE, Jenson HB, et al, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007: 2955-2999.
  32. Greenberg A. Diuretic complications. Am J Med Sci. 2000;319(1):10-24. [PubMed 10653441]
  33. Halstenson CE, Matzke GR. Bumetanide: a new loop diuretic (Bumex, Roche Laboratories). Drug Intell Clin Pharm. 1983;17(11):786-797. doi:10.1177/106002808301701101 [PubMed 6357686]
  34. Hansrivijit P, Techorueangwiwat C, Khanal R, Dimech CT, Thongprayoon C, Cheungpasitporn W. Treatment outcomes of bumetanide continuous infusion: A systematic review and meta-analysis. Nephrology (Carlton). 2020;25(10):744-748. doi:10.1111/nep.13739 [PubMed 32725702]
  35. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063 [PubMed 35363499]
  36. Hollenberg SM, Warner Stevenson L, Ahmad T, et al. 2019 ACC expert consensus decision pathway on risk assessment, management, and clinical trajectory of patients hospitalized with heart failure: a report of the American College of Cardiology solution set oversight committee. J Am Coll Cardiol. 2019;74(15):1966-2011. doi:10.1016/j.jacc.2019.08.001 [PubMed 31526538]
  37. Ikeda K, Oshima T, Hidaka H, Takasaka T. Molecular and clinical implications of loop diuretic ototoxicity. Hear Res. 1997;107(1-2):1-8. doi:10.1016/s0378-5955(97)00009-9 [PubMed 9165341]
  38. "Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics (AAP) Committee on Drugs. Pediatrics. 1997;99(2):268-278. [PubMed 9024461]
  39. Jackson EK. Drugs affecting renal excretory function. In: Brunton LL, Hilal-Dandan R, Knollmann BC, eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 13th ed. McGraw Hill; 2018: chap. 25.
  40. James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. [PubMed 24352797]
  41. Johnson KK, Green DL, Rife JP, Limon L. Sulfonamide cross-reactivity: fact or fiction? [published correction appears in Ann Pharmacother. 2005;39(7-8):1373]. Ann Pharmacother. 2005;39(2):290-301. [PubMed 15644481]
  42. Lopez-Samblas AM, Adams JA, Goldberg RN, et al. The pharmacokinetics of bumetanide in the newborn infant. Biol Neonate. 1997;72(5):265-272. [PubMed 9395836]
  43. Malha L, Mann SJ. Loop diuretics in the treatment of hypertension. Curr Hypertens Rep. 2016;18(4):27. doi:10.1007/s11906-016-0636-7 [PubMed 26951244]
  44. McCallister KM, Chhim RF, Briceno-Medina M, Shelton CM, Figueroa M, Rayburn M. Bumetanide continuous infusions in critically ill pediatric patients. Pediatr Crit Care Med. 2015;16(2):e19-22. [PubMed 25560424]
  45. Miller JL, Thomas AN, Johnson PN. Use of continuous-infusion loop diuretics in critically ill children. Pharmacotherapy. 2014;34(8):858-867. [PubMed 24897942]
  46. Murray KL, Wright D, Laxton B, Miller KM, Meyers J, Englebright J. Implementation of standardized pediatric i.v. medication concentrations. Am J Health Syst Pharm. 2014;71(17):1500-1508. [PubMed 25147175]
  47. NICE Clinical Guideline. Diagnosis and management of drug allergy in adults, children and young people. Drug Allergy. 2014;183.
  48. Nishimura RA, Otto CM, Bonow RO, et al, 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):2440-92. doi: 10.1161/CIR.0000000000000029. [PubMed 24589852]
  49. Oh SW, Han SY. Loop diuretics in clinical practice. Electrolyte Blood Press. 2015;13(1):17-21. doi:10.5049/EBP.2015.13.1.17 [PubMed 26240596]
  50. Oliveros M, Pham JT, John E, et al. The use of bumetanide for oliguric acute renal failure in preterm infants. Pediatr Crit Care Med. 2011;12(2):210-214. [PubMed 20625335]
  51. Palmer BF. Metabolic complications associated with use of diuretics. Semin Nephrol. 2011;31(6):542-552. doi:10.1016/j.semnephrol.2011.09.009 [PubMed 22099511]
  52. Refer to manufacturer's labeling.
  53. Rosanno JW. Heart failure. In: Kliegman RM, St. Geme J, eds. Nelson Textbook of Pediatrics. 21st ed. Saunders Elsevier; 2020:chap. 469.
  54. Rudy DW, Voelker JR, Greene PK, et al, "Loop Diuretics for Chronic Renal Insufficiency: A Continuous Infusion Is More Efficacious Than Bolus Therapy," Ann Intern Med. 1991;115(5):360-366. [PubMed 1863026]
  55. Rybak LP. Pathophysiology of furosemide ototoxicity. J Otolaryngol. 1982;11(2):127-133. [PubMed 7042998]
  56. Sica DA, Carter B, Cushman W, Hamm L. Thiazide and loop diuretics. J Clin Hypertens (Greenwich). 2011;13(9):639-643. doi:10.1111/j.1751-7176.2011.00512.x [PubMed 21896142]
  57. Slatore CG, Tilles SA. Sulfonamide hypersensitivity. Immunol Allergy Clin North Am. 2004;24(3):477-490. [PubMed 15242722]
  58. Sterns RH. General principles of the treatment of edema in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed January 12, 2022.
  59. Sullivan JE, Witte MK, Yamashita TS, et al. Dose-ranging evaluation of bumetanide pharmacodynamics in critically ill infants. Clin Pharmacol Ther. 1996;60(4):424-434. [PubMed 8873690]
  60. Tornero P, De Barrio M, Baeza ML, Herrero T. Cross-reactivity among p-amino group compounds in sulfonamide fixed drug eruption: diagnostic value of patch testing. Contact Dermatitis. 2004;51(2):57-62. [PubMed 15373844]
  61. Vargo DL, Kramer WG, Black PK, Smith WB, Serpas T, Brater DC. Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide and furosemide in patients with congestive heart failure. Clin Pharmacol Ther. 1995;57(6):601-609. doi: 10.1016/0009-9236(95)90222-8. [PubMed 7781259]
  62. Voelker JR, Cartwright-Brown D, Anderson S, et al. Comparison of loop diuretics in patients with chronic renal insufficiency. Kidney Int. 1987;32(4):572-578. doi:10.1038/ki.1987.246 [PubMed 3430953]
  63. Ward OC and Lam LK. Bumetanide in heart failure in infancy. Arch Dis Child. 1977;52(11):877-882. [PubMed 413494]
  64. Warrington R, Silviu-Dan F, Wong T. Drug allergy. Allergy Asthma Clin Immunol. 2018;14(Suppl 2):60. doi:10.1186/s13223-018-0289-y [PubMed 30275849]
  65. Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens (Greenwich). 2014;16(1):14-26. doi: 10.1111/jch.12237. [PubMed 24341872]
  66. Wells TG. The pharmacology and therapeutics of diuretics in the pediatric patient. Pediatr Clin North Am. 1990;37(2):463-504. [PubMed 2184406]
  67. Wells TG, Fasules JW, Taylor BJ, Kearns GL. Pharmacokinetics and pharmacodynamics of bumetanide in neonates treated with extracorporeal membrane oxygenation. J Pediatr. 1992;121(6):974-980. doi:10.1016/s0022-3476(05)80355-5 [PubMed 1447670]
  68. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published online ahead of print on November 13, 2017.]. Hypertension. 2017. doi: 10.1161/HYP.0000000000000065. [PubMed 29133356]
  69. Wu X, Zhang W, Ren H, Chen X, Xie J, Chen N. Diuretics associated acute kidney injury: clinical and pathological analysis. Ren Fail. 2014;36(7):1051-1055. doi:10.3109/0886022X.2014.917560 [PubMed 24940940]
  70. Ziegler O, Sirveaux MA, Brunaud L, Reibel N, Quilliot D. Medical follow up after bariatric surgery: nutritional and drug issues. General recommendations for the prevention and treatment of nutritional deficiencies. Diabetes Metab. 2009;35(6, pt 2):544-557. doi: 10.1016/S1262-3636(09)73464-0. [PubMed 20152742]
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