Names and pronunciation
(byoo-met′a-nide) Bumex, Burinex
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Drug reference
(byoo-met′a-nide) Bumex, Burinex
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Func. class.: Loop diuretic, antihy- pertensive
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Chem. class.: Sulfonamide derivative
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ACTION: Acts on ascending loop of Henle by inhibiting reabsorption of chlo- ride, sodium
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USES: Edema in heart failure, renal disease, hepatic disease
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CONTRAINDICATIONS: Hyper- sensitivity to sulfonamides, anuria, hepatic coma
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Black Box Warning: Fluid and electrolyte depletion Precautions: Pregnancy, breastfeeding, neonates, ascites, severe renal disease, hepatic cirrhosis, blood dyscrasias, oto- toxicity, hyperuricemia, hypokalemia, hyperglycemia, oliguria, hypomagnese- mia, hypovolemia Black Box Warning: Dehydration Black Box Warning: Dehydration: weight, I&O daily to determine fluid loss; if urinary output decreases or azotemia occurs, product should be discontinued; safest dosage schedule is alternate days • B/P lying, standing; postural hypoten- sion may occur Black Box Warning: Fluid and elec- trolyte depletion: potassium, sodium, calcium; include BUN, blood glucose, CBC, serum creatinine, blood pH, ABGs, uric acid, calcium, magnesium; severe electrolyte depletion should be corrected before starting treatment • Blood glucose if patient is diabetic; blood uric acid levels in those with gout • Improvement in edema of feet, legs, sacral area daily if medication is being used for HF • Signs of metabolic alkalosis: drowsi- ness, restlessness • Hypokalemia: postural hypoten- sion, malaise, fatigue, tachycardia, leg cramps, weakness • Rashes, temperature elevation daily • Confusion, especially in geriatric pa- tients; take safety precautions if needed • Digoxin toxicity in patients taking di- goxin products: anorexia, nausea, vomiting, confusion, paresthesia, muscle cramps; lithium toxicity in those taking lithium • Beers: use cautiously in older adults; may cause or exacerbate syndrome of inap- propriate antidiuretic hormone secretion
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SIDE EFFECTS CNS: Headache, fatigue, weakness, diz- ziness, encephalopathy CV: Hypotension, ECG changes, dehydration EENT: Loss of hearing ELECT: Hypokalemia, hypochloremic alkalosis, hypomagnesemia, hyperuri- cemia, hypocalcemia, hyponatremia ENDO: Hyperglycemia GI: Dry mouth, upset stomach, vomiting, diarrhea, nausea GU: Polyuria, glycosuria INTEG: Rash, pruritus MS: Myalgia, arthralgia
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INTERACTIONS Increase: ototoxicity—aminoglycosides, avoid concurrent use Increase: hypokalemia—corticosteroids, diuretics, laxatives (stimulants); monitor closely Increase: diuresis—other diuretics, mon- itor for dehydration and electrolyte imbalances Increase: toxicity—lithium, digoxin, monitor levels of each Increase: hypotension, antihypertensives, nitrates Decrease: diuretic effect—NSAIDs, mon- itor carefully Decrease: antidiabetic effects—antidia- betics, monitor glucose Drug/Herb Increase: effect—hawthorn, horse chest- nut, avoid using together Decrease: effect of bumetanide—gin- seng, ephedra Drug/Lab Increase: glucose Decrease: chloride, potassium, sodium, calcium, phosphorus
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TREATMENT OF OVERDOSE: Lavage if taken orally; monitor electro- lytes; administer dextrose in saline; mon- itor hydration, CV, renal status HIGH ALERT
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DOSAGE AND ROUTES • Adult and adolescent: PO 0.5-2 mg/ day; IV/IM 0.5-1 mg; may give second or third dose at 2-3 hr intervals, not to ex- ceed 10 mg/day • Child and infant (unlabeled): PO/IM/ IV 0.015-0.1 mg/kg dose q6-24hr, max 10 mg/day PO/IM/IV • Neonates (unlabeled): 0.01-0.05 kg/dose q12-24hr
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Available forms: Tablets 0.5, 1, 2, 5 mg; injection 0.25 mg/mL PO route • Use in AM to prevent nocturia • Without regard to food IV, direct route • Direct IV undiluted slowly over 1-2 min through Y-tube, 3-way stopcock, or B hep-lock Intermittent IV INFUSION route • Dilute in LR, D5W, 0.9% NaCl (rarely given by this method), give over 12 hr with renal disease; give at 4 mg/min or less, use infusion pump, protect from light Y-site compatibilities: Acyclovir, alfentanil, allopurinol, amifostine, amikacin, amino- caproic acid, aminophylline, amiodarone, amoxicillin, amphotericin B lipid complex (Abelcet), amphotericin B liposome (AmBisome), anidulafungin, ascorbic acid injection, atenolol, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleo- mycin, buprenorphine, butorphanol, cal- cium chloride/gluconate, CARBOplatin, caspofungin, cefamandole, ceFAZolin, cefepime, cefmetazole, cefonicid, cefotax- ime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, ceftobiprole, cefTRIAXone, cefuroxime, cephapirin, chloramphenicol, cimetidine, cisatracurium, CISplatin, cladribine, clarithromycin, clindamycin, codeine, cyanocobalamin, cyclophospha- mide, cycloSPORINE, cytarabine, DACTINo- mycin, DAPTOmycin, dexamethasone, dex- medetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxa- curium, DOXOrubicin, doxycycline, enala- prilat, ePHEDrine, EPINEPHrine, epirubi- cin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, famoti- dine, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, folic acid, furose- mide, gatifloxacin, gemcitabine, gentami- cin, glycopyrrolate, granisetron, heparin, hydrocortisone sodium succinate, HYDRO- morphone, hydrOXYzine, IDArubicin, ifos- famide, imipenem-cilastatin, indomethacin, insulin (regular), irinotecan, isoprotere- nol, ketorolac, labetalol, levofloxacin, lido- caine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, mel- phalan, meperidine, metaraminol, metho- trexate, methoxamine, methyldopate, meth- ylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, micafungin, miconazole, milrinone, mito- XANtrone, morphine, moxalactam, multiple vitamins injection, mycophenolate, nafcil- lin, nalbuphine, naloxone, netilmicin, nitroglycerin, nitroprusside, norepineph- rine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, palonosetron, pami- dronate, pancuronium, pantoprazole, PEMEtrexed, penicillin G potassium/ sodium, pentazocine, PENTobarbital, PHE- Nobarbital, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, poly- myxin B, potassium chloride, procain- amide, promethazine, propofol, proprano- lol, protamine, pyridoxine, quiNIDine, ranitidine, remifentanil, rifampin, ritodrine, riTUXimab, rocuronium, sodium acetate, sodium bicarbonate, succinylcholine, SUFentanil, tacrolimus, teniposide, theoph- ylline, thiamine, thiotepa, ticarcillin, ticar- cillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, tolazoline, TPN, traMA- Dol, trastuzumab, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole
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Evaluate: • Therapeutic response: decreased edema, B/P
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CLINICAL CONSIDERATIONS Assess • For tinnitus, hearing loss, ear pain; obtain audiometric testing for long-term IV treatment
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Patient and caregiver information: • To increase fluid intake to 2-3 L/day unless contraindicated; to take potas- sium supplement; to rise slowly from ly- ing or sitting position • To recognize adverse reactions: mus- cle cramps, weakness, nausea, dizziness, edema, weight gain • To take with food, milk for GI symp- toms; to avoid alcohol • To take early in day to prevent noctu- ria; if another dose is needed, take after noon, not to double or miss dose • To take B/P, pulse, weight weekly • That orthostatic hypotension may oc- cur, to avoid rising rapidly • To continue other medical regimens • That continuing exams and blood work will be needed • To notify other health care professionals of condition being treated, medications taken • Pregnancy/breastfeeding: To report if pregnancy is planned or suspected or if breastfeeding
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PHARMACOKINETICS Excreted by kidneys (50% unchanged), feces (20%); crosses placenta; excreted in breast milk; protein binding >72%; half-life 1-11⁄2 hr PO: Onset 1⁄2-1 hr, peak 1-2 hr, duration 3-6 hr IM: Onset 40 min, peak 1-2 hr, duration 4-6 hr IV: Onset 5 min, peak 15-30 min, dura- tion 3-6 hr
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• Adult and adolescent: PO 0.5-2 mg/ day; IV/IM 0.5-1 mg; may give second or third dose at 2-3 hr intervals, not to ex- ceed 10 mg/day
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