Bumetanide

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jul 22, 2024

Warnings

Bumetanide Risks, Warnings, and Complications

Bumetanide can cause or worsen health problems in certain high-risk individuals. Talk to your doctor or pharmacist about other treatment options for edema if you are at an increased risk of complications from this medication. Healthcare professionals prescribe this medicine only if the potential benefit justifies the risks. Some of the risks of taking bumetanide include:

Volume Depletion and Electrolyte Imbalance: Bumetanide is a strong diuretic - it is 40 times stronger than another commonly prescribed loop diuretic called furosemide (brand name Lasix). Large or too frequent doses of bumetanide can lead to acute profound water loss, decrease in serum electrolyte levels due to increased electrolyte output in urine, reduced blood volume, collapsed circulation, and an increased risk of vascular thrombosis and embolism (blood clots), particularly in older adults. Your doctor will prescribe the lowest dose of bumetanide needed to treat your condition. Follow the dosing instructions carefully. Do not increase the dose or dosing frequency unless your doctor tells you.
Hypokalemia: Hypokalemia (low potassium) can occur in patients receiving bumetanide. The risk is higher in people receiving diuretics and digitalis for congestive heart failure, those with liver cirrhosis and ascites, potassium-losing nephropathy, excess aldosterone with normal kidney function, certain conditions with diarrhea, and other conditions where low potassium can be dangerous, for example, in people with heart rhythm abnormalities. If you have liver cirrhosis and ascites, sudden changes in electrolyte balance can trigger hepatic encephalopathy (brain dysfunction due to liver dysfunction) and coma. Due to this risk, your doctor will start bumetanide treatment in the hospital with small doses and carefully monitor you. To prevent low potassium and metabolic alkalosis, your doctor may recommend eating potassium rich foods such as bananas and orange juice. They may also prescribe potassium supplements and/or potassium sparing diuretics such as spironolactone.
Ototoxicity: Animal studies have shown that bumetanide can be ototoxic (harmful to the ears). Researchers anticipate that the blood levels that could produce ototoxicity will be rarely achieved in humans, but the potential for ear damage is present, especially when bumetanide is given intravenously, at high doses, or with frequent dosing in patients with renal insufficiency. There is also a potential for bumetanide to add to the ototoxicity caused by aminoglycoside antibiotics.
Allergic Reactions: People who are allergic to a class of antimicrobials called sulfonamides (sulfa drugs) may also have allergic reactions to bumetanide. Tell your doctor if you have ever had an allergic reaction after taking any medication.
Thrombocytopenia: There have been some rare post-marketing reports of thrombocytopenia (low platelet levels) in patients treated with bumetanide. Your doctor will monitor you carefully for adverse effects. Keep all your medical and laboratory appointments during bumetanide drug therapy.

Precautions Before Starting Bumetanide

Tell your doctor if you are allergic to bumetanide, sulfonamide (sulfa) drugs, any of the active or inactive ingredients in bumetanide tablets, other diuretics, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor a complete list of medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible interactions between your medications.

Give your healthcare provider a complete medical history. Bumetanide may not be safe for people with certain medical conditions, such as progressive renal disease (kidney disease), liver disease, hepatic failure, heart disease, reduced cardiac function, or impaired glucose tolerance (diabetes).

This drug may be a potential risk in pregnant women. It is not known if the drug passes into breast milk. Tell your doctor if you are pregnant, could be pregnant, are planning a pregnancy soon, or are breast-feeding.

Precautions During Use of Bumetanide

Keep all your medical and laboratory appointments while taking bumetanide. Your healthcare professional may want to adjust your dose based on the therapeutic efficacy of the administered dose (your response and side effects). They may order certain blood tests to check for electrolyte disturbances and volume status.

Bumetanide can lower blood pressure and may make you dizzy and lightheaded. To prevent falls, get out of bed slowly and place your feet on the ground for a few minutes before standing up. Avoid drinking alcohol while on bumetanide as alcohol can make these side effects worse.

Tell your doctor if you become pregnant while on bumetanide.

Tell all your healthcare providers you are on bumetanide, especially before any surgery, including dental procedures.

Bumetanide Drug Interactions

Concomitant use of bumetanide with certain other drugs can affect how the medications work. Possible drug interactions between bumetanide and other medicines can increase the risk of severe adverse effects. The following medications can have drug interactions with bumetanide:

Medications prescribed for hypertension (high blood pressure)
Aminoglycoside antibiotics such as gentamicin (Garamycin), tobramycin (Tobi, Bethkis), and amikacin
Corticosteroids such as prednisone
Heart medications such as digoxin (Lanoxin)
Pain medications like indomethacin (Indocin, Tivorbex)
Psychiatric medications such as lithium (Lithobid)
Gout medications such as probenecid (Probalan, Probenemid)

The above list may not describe all possible interactions of bumetanide. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, over-the-counter medications, dietary supplements, and herbal remedies. Also, tell your health care professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medicines.

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