Generic Name : bumetanide
Brand Name: Bumex, Burinex (CAN)
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bumetanide Nursing Considerations & Management
Classification: Loop (high-ceiling) diuretic
Pregnancy Category C
Dosage & Route
- 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.
- Adult: 0.5-1 mg daily. Max: 5 mg/day.
- 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.
- Emergency cases of edema
- Adult: 0.5-1 mg via slow IV/IM inj, subsequently adjust dose according to response.
- 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.
- Edema associated with CHF, cirrhosis, renal disease
- IV: Acute pulmonary edema
- Unlabeled use: Treatment of adult nocturia (not effective in men with BPH)
- 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).
- Hypersensitivity, progressive renal failure and anuria, hepatic coma, severe electrolyte depletion.
- 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
- 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.
- 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.