bumetanide
Brand: Bumex
Prototype: furosemide
Drug Class: loop diuretic
Drug Family: diuretic
Subclass: sulfonamide loop diuretic
Organ Systems: cardiovascularrenal
Mechanism of Action
Inhibits NKCC2 in thick ascending limb; ~40x more potent than furosemide on mg basis.
NKCC2 cotransporter
Indications
- edema
- heart failure
- renal failure diuresis
Contraindications
- anuria
- sulfonamide allergy
- hepatic coma
Adverse Effects
Common
- hypokalemia
- hyponatremia
- hypotension
Serious
- ototoxicity
- severe electrolyte disturbances
Pharmacokinetics (ADME)
| Absorption | 80-90% oral bioavailability (more reliable than furosemide) |
| Distribution | high |
| Metabolism | hepatic |
| Excretion | renal 45%, fecal |
| Half-life | 1-1.5 hours |
| Onset | 0.5-1 hour |
| Peak | 0.5-2 hours |
| Duration | 4-6 hours |
| Protein Binding | 95% |
| Vd | 0.17 L/kg |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| aminoglycosides | additive ototoxicity and nephrotoxicity | major |
| digoxin | hypokalemia increases digoxin toxicity | major |
Nursing Considerations
- 1 mg bumetanide ≈ 40 mg furosemide
- More predictable oral bioavailability — useful in severe HF when furosemide absorption unreliable
- Monitor electrolytes and renal function
Clinical Pearls
- 40x more potent than furosemide by weight
- More consistent oral bioavailability than furosemide in HF
Safety Profile
Pregnancy use-with-caution
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.