Bumetanide
Indications
Bumetanide is indicated for the treatment
of edema associated with- Congestive heart failure, Hepatic ascites and,
Renal disease including the nephrotic syndrome
Pharmacology
Bumetanide is a loop diuretic of the
sulfamyl category to treat heart failure. It is often used in patients
in whom high doses of furosemide are ineffective. There is however no
reason not to use bumetanide as a first choice drug. The main difference
between the two substances is in bioavailability. It is said to be a
more predictable diuretic, meaning that the predictable absorption is
reflected in a more predictable effect. Bumetanide is 40 times more
potent than furosemide (for patients with normal renal function).
Bumetanide interferes with renal cAMP and/or inhibits the sodium-potassium ATPase pump. Bumetanide appears to block the active reabsorption of chloride and possibly sodium in the ascending loop of Henle, altering electrolyte transfer in the proximal tubule. This results in excretion of sodium, chloride, and water and, hence, diuresis.
Bumetanide interferes with renal cAMP and/or inhibits the sodium-potassium ATPase pump. Bumetanide appears to block the active reabsorption of chloride and possibly sodium in the ascending loop of Henle, altering electrolyte transfer in the proximal tubule. This results in excretion of sodium, chloride, and water and, hence, diuresis.
Dosage & Administration
Oral: 1 mg in the morning ,
repeated after 6-8 hours if necessary, In severe cases , 5 mg daily
increased by 5 mg every 12-24 hours according to response. Elderly , 500
micrograms daily may be sufficient.
Parenteral:
Parenteral:
- By IV Injection: 1-2 mg, repeated after 20 minutes if necessary. Elderly, 500 micrograms (1 ml of Bumetanide) daily may be sufficient.
- By IV Infusion: 2-5 mg over 30-60 minutes.Elderly, 500 micrograms (1 ml of Bumetanide) daily may be sufficient.
- By IM Injection: 1 mg initially then adjusted according to response , Elderly 500 micrograms (1 ml of Bumetanide) daily may be sufficient.
Interaction
Concomitant use of Bumetanide may
potentiate the effects of antihypertensive drugs. It shows a tendency to
increase the excretion of potassium which can lead to an increase in
the sensitivity of the myocardium to the toxic effects of digitalis. As
with other diuretics, Bumetanide may cause an increase in blood uric
acid.
Contraindications
Loop diuretics should be avoided in severe
hypokalaemia, severe hyponatraemia, anuria, comatose and precomatose
states associated with liver cirrhosis and in renal failure.
Side Effects
The side effects of Bumetanide include:
headache, dizziness, fatigue, postural hypotension and gastrointestinal
symptoms. Various skin reactions, photosensitivity reactions and
metabolic disturbances, including reduced glucose tolerance are less
frequent. Electrolyte disturbances can occur especially during long term
treatment.
Pregnancy & Lactation
Pregnancy Category C. There are no adequate
and well controlled studies in pregnant woman. It is not known wheather
this drug is excreted in human milk.
Precautions & Warnings
Serum potassium should be measured periodically and potassium supplements or potassium sparing diuretics added if necessary.
Use in Special Populations
Paediatric use: Safety and effectiveness in paediatric patients below the age of 18 have not been established.
Overdose Effects
Symptoms would be those caused by excessive diuresis. Empty stomach by gastric lavage or emesis.
Therapeutic Class
Loop diuretics
Storage Conditions
Store in a cool & dry place. Protect from light.
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