bumetanide

Drug Name
Generic Name : bumetanide
Brand Name: Bumex, Burinex (CAN)
Classification:  Loop (high-ceiling) diuretic
Pregnancy Category C
Dosage & Route
Oral
  • edema
    • Adult: 1 mg once daily. Give 2nd dose 6-8 hr later if necessary.
    • Elderly: 0.5 mg daily.
  • Refractory edema
    • Adult: Initially, 5 mg daily increased by 5 mg every 12-24 hr as required. High doses may be divided in 2-3 doses. Max: 10 mg/day.
  • hypertension
    • Adult: 0.5-1 mg daily. Max: 5 mg/day.
Intravenous
  • pulmonary edema
  • Adult: 1-2 mg IV repeated 20 min later if necessary, or 2-5 mg in 500 ml of a suitable infusion fluid given over 30-60 min.
Parenteral
  • Emergency cases of edema
  • Adult: 0.5-1 mg via slow IV/IM inj, subsequently adjust dose according to response.
Therapeutic actions
  • Bumetanide induces diuresis by inhibiting reabsorption of water and electrolytes (sodium and chloride) in the ascending loop of Henle and proximal renal tubule.
    • Absorption: Almost completely and rapidly absorbed from the GIT.
    • Distribution: 95% bound to plasma proteins.
    • Excretion: Elimination half-life: about 1-2 hr. About 80% excreted in the urine; 50% as unchanged drug.
Indications
  • Edema associated with CHF, cirrhosis, renal disease
  • IV: Acute pulmonary edema
  • Unlabeled use: Treatment of adult nocturia (not effective in men with BPH)
Adverse effects
  • Muscle cramps, dizziness, hypotension, headache, nausea, impaired hearing, pruritus, ECG changes, musculoskeletal pain, rash, chest discomfort, renal failure, premature ejaculation, thrombocytopenia, hypokalaemia, hypomagnesaemia, hyponatraemia, hyperuricaemia, hyperglycaemia, hypocalcaemia.
  • Potentially Fatal: Encephalopathy (in patients with preexisting liver disease).
Contraindications
  • Hypersensitivity, progressive renal failure and anuria, hepatic coma, severe electrolyte depletion.
Nursing considerations
Assessment
  • History: Allergy to bumetanide, electrolyte depletion, anuria, severe renal failure, hepatic coma, SLE, gout, diabetes mellitus, lactation
  • Physical: Skin color, lesions; edema; orientation, reflexes, hearing; pulses, baseline ECG, BP, orthostatic BP, perfusion; R, pattern, adventitious sounds; liver evaluation, bowel sounds; urinary output patterns; CBC, serum electrolytes (including calcium), blood glucose, LFTs, renal function tests, uric acid, urinalysis
Interventions
  • Give with food or milk to prevent GI upset.
  • Mark calendars or use reminders if intermittent therapy is best for treating edema.
  • Give single dose early in day so increased urination will not disturb sleep.
  • Avoid IV use if oral use is possible.
  • BLACK BOX WARNING: Arrange to monitor serum electrolytes, hydration, liver function during long-term therapy, water and electrolyte depletion can occur.
  • Provide diet rich in potassium or supplemental potassium.
Teaching points
  • Record alternate day or intermittent therapy on a calendar or dated envelopes.
  • Take the drug early in day so increased urination will not disturb sleep; take with food or meals to prevent GI upset.
  • Weigh yourself on a regular basis, at the same time and in the same clothing; record the weight on your calendar.
  • You may experience these side effects: Increased volume and frequency of urination; dizziness, feeling faint on arising, drowsiness (avoid rapid position changes; hazardous activities, such as driving; and alcohol consumption); sensitivity to sunlight (use sunglasses, sunscreen, wear protective clothing); increased thirst (suck sugarless lozenges; use frequent mouth care); loss of body potassium (a potassium-rich diet, or supplement will be needed).
  • Report weight change of more than 3 pounds in 1 day; swelling in ankles or fingers; unusual bleeding or bruising; nausea, dizziness, trembling, numbness, fatigue; muscle weakness or cramps.

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