Bumetanide

BUMEX

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Pronunciation: byoo-MET-a-nide

Bumetanide ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Bumetanide ballicule

Bumetanide BUMEX mascot mnemonic cartoon — Visual mnemonic: Bumetanide mascot
**“Bum Bummer”**
Bananas dispersing → ↓ serum potassium

What it isNKCC2-inhibiting loop diuretic; edema and volume overload in heart failure or kidney disease.

Why this oneOral bioavailability near 80%, far more reliable than furosemide, and it is about 40 times more potent milligram for milligram.

What limits itSame electrolyte losses as the class. The potency ratio is the usual source of dosing error when converting from furosemide.

Bumetanide molecular structure (skeletal formula) — Molecular structure: Bumetanide

FDA-approved for

edema (1983)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Potent diuretic; excessive amounts can cause profound diuresis with water and electrolyte depletion — careful supervision and individualized dosing required

FDA dosing	Population	Start	Target	Max
Edema	Adults	0.5–2 mg QD	0.5–2 mg QD (single dose)	10 mg/day

Renal Contraindicated in anuria; discontinue if marked rise in BUN/creatinine or oliguria in progressive renal disease

Hepatic Keep dosage to a minimum in hepatic failure

If initial dose inadequate, a 2nd or 3rd dose may be given at 4–5 hour intervals up to max 10 mg/day

Instructions

Individualize dose with careful monitoring of response and electrolytes
Intermittent schedule (alternate days, or 3–4 days on with 1–2 day rest) recommended for continued edema control
Bumetanide:furosemide substitution ratio approximately 1:40
May be given IV/IM when oral not practical; switch to oral as soon as possible

Available strengths

tab 0.5, 1, 2 mg
inj 0.25 mg/mL
nasal spray 500 mcg/spray

Contraindications

Anuria
Hepatic coma or severe electrolyte depletion (until corrected)

Cautions

Profound diuresis with fluid/electrolyte depletion
Ototoxicity (impaired hearing)
Serious skin reactions (SJS, TEN)
Electrolyte abnormalities: hypokalemia, hyponatremia, hypochloremia, azotemia, hyperuricemia

Adverse reactions

Muscle cramps
Dizziness
Hypotension
Headache
Nausea
Encephalopathy (in pre-existing liver disease)

Pregnancy No adequate human studies; use only if potential benefit justifies fetal risk

Lactation Undefined

Cost

Bumetanide (BUMEX)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $	CostPlus
0.5 mg	tab	30 qd	$3.86/mo	offered
1 mg	tab	30 qd	$3.24/mo	offered
2 mg	tab	30 qd	$5.46/mo	offered
0.25 mg/mL	inj	per unit		not offered

Generic entry1994

⚠ BOXED WARNING

Profound diuresis with water and electrolyte depletion

Principal riskVolume depletion with hypokalemia

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityVolume depletion, electrolyte loss, kidney injury and ototoxicity at high exposure.

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Memory aids: interaction avatars

CYP3A4 substrate (minor)

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