Bumetanide
A potent loop diuretic, about 40 times stronger than furosemide by weight, used for edema in heart failure and in liver or kidney disease.
Drug card
- Class
- Loop diuretic
- How it works
- Blocking NKCC2 in the loop of Henle, so much more salt and water is lost
- Used for
- Edema in heart failure
- Edema from liver or kidney disease or nephrotic syndrome
- Known for
- Severe fluid and salt loss with low blood pressure
- Low potassium
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does bumetanide work?
Blocks sodium and chloride reabsorption in the thick ascending limb of Henle's loop, and may act on the proximal tubule too, as the extra phosphate in urine suggests. It removes somewhat more chloride than sodium, its potassium loss grows with the dose, and oral and intravenous doses give almost the same diuresis.
Like other loop diuretics: They block the Na-K-2Cl cotransporter (NKCC2) in the thick ascending limb of Henle's loop, reaching it from inside the tubule. Sodium, chloride and water are lost in large amounts, along with potassium, magnesium and calcium. The diuresis is strong and quick, and it still works when kidney function is poor.
Uses
What is bumetanide used for?
- Edema in heart failure
- Edema from liver or kidney disease or nephrotic syndrome
Side effects
Side effects of bumetanide
- Severe fluid and salt loss with low blood pressureKnown forSerious
- Low potassiumKnown forSerious
- Low sodium and chloride
- Muscle cramps
- Dizziness
- Headache
- Nausea
- Encephalopathy in people with liver diseaseSerious
- Raised uric acid
- Raised blood sugar
- Impaired hearingSerious
- Severe skin reactions (Stevens-Johnson syndrome, TEN)Serious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Contraindicated in anuria, hepatic coma and severe electrolyte depletion.
- Rising urea or creatinine, or falling urine output, in progressive kidney disease means stopping it.
- Not combined with aminoglycosides or lithium; probenecid and indomethacin blunt its effect.
- Sulfonamide allergy may cross-react, yet people allergic to furosemide have tolerated it.
Good to know: Weight for weight about 40 times as potent as furosemide, and oral doses work almost as well as intravenous ones.
Remember it
A way to remember it
OH DANG
- O
- Ototoxicity
- H
- Hypokalemia
- D
- Dehydration
- A
- Allergy to sulfonamides
- N
- Nephritis (interstitial)
- G
- Gout
A mnemonic widely used in teaching
Its class
Loop diuretics
Other loop diuretics with a card:
Easily mixed up with thiazide and thiazide-like diuretics and mineralocorticoid receptor antagonists.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Heart failure, rhythm and angina
Bumetanide is one of 10 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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