Loop Diuretic Pregnancy: No adequate data in pregnant women; should not be used during pregnancy unless clearly necessary and only when the potential benefit justifies the potential risk to the foetus. Insufficient information on excretion in breast milk — should not be taken by nursing mothers.

Bumetanide

Brand names: Burinex

Bumetanide is a loop diuretic used for oedema and for fluid overload in heart failure.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Usually 1 mg (5 ml of the 0.2 mg/ml oral solution) as a single oral dose

Route: Oral

Frequency: Once daily, given in the morning or early evening; the dosage should be adjusted according to the patient's response

Source product: Bumetanide 0.2 mg/ml Oral Solution (UK SPC §4.2). Applies to adults, adolescents and children aged 12 years and older. ELDERLY: adjust dosage according to response — a dose of 0.5 mg bumetanide per day may be sufficient in some elderly patients. PAEDIATRIC: Bumetanide Liquid should not be used for children under 12 years of age. No maximum dose is stated in the retrieved UK SPC §4.2. HIGH-DOSE CAUTION (§4.8): in patients with severe chronic renal failure given high doses, severe generalised musculoskeletal pain (sometimes with muscle spasm) occurring 1–2 hours after administration and lasting up to 12 hours has been reported — the lowest reported dose causing this was 5 mg by intravenous injection and the highest 75 mg orally as a single dose; experience suggests the incidence is reduced by initiating treatment at 5–10 mg daily and titrating upwards using a twice daily regimen at doses of 20 mg per day or more. CROSS-CHECK (US labelling, openFDA — NOT the UK SPC): usual total daily oral dosage 0.5 mg to 2 mg, usually as a single dose; if the response to an initial dose is inadequate a second or third dose may be given at 4- to 5-hour intervals up to a maximum daily dose of 10 mg; an intermittent schedule (alternate days, or 3–4 days on with 1–2 day rest periods) is recommended as the safest and most effective method for continued control of oedema; keep the dosage to a minimum in hepatic failure.

Dose adjustments

Renal

No numeric renal dose adjustment is stated. Bumetanide can be used to induce diuresis in renal insufficiency, but any marked increase in blood urea or the development of oliguria or anuria during treatment of severe progressing renal disease is an indication for stopping treatment (§4.3). Patients with chronic renal failure on high doses should remain under constant hospital supervision (§4.4).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE AND ADMINISTRATION Individualize dosage with careful monitoring of patient response. Oral Administration The usual total daily dosage of bumetanide tablets is 0.5 mg to 2 mg and in most patients is given as a single dose. If the diuretic response to an initial dose of bumetanide tablets is not adequate, in view of its rapid onset and short duration of action, a second or third dose may be given at 4- to 5- hour intervals up to a maximum daily dose of 10 mg. An intermittent dose schedule, whereby bumetanide tablets are given on alternate days or for 3 to 4 days with rest periods of 1 to 2 days in between, is recommended as the safest and most effective method for the continued control …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-01-08. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Hepatic coma
Marked increase in blood urea, or development of oliguria or anuria during treatment of severe progressing renal disease — an indication for stopping bumetanide
Care should be taken in states of severe electrolyte depletion
Hereditary fructose intolerance (this oral solution contains sorbitol 275 mg/ml)

Side effects

Electrolyte and metabolic disturbance: hypokalaemia, hyponatraemia, hypomagnesaemia, hypocalcaemia, hypochloraemic alkalosis, dehydration, hyperuricaemia/gout, hyperglycaemia, hyperlipidaemia
Orthostatic hypotension, hypotension; headache, dizziness
Gastrointestinal disorder: nausea, vomiting, diarrhoea, abdominal pain
Ear and labyrinth: tinnitus, deafness
Severe cutaneous adverse reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis (can be life-threatening or fatal); also rash, urticaria, dermatitis, photosensitivity, pruritus
Blood: thrombocytopenia, leukopenia, agranulocytosis, bone marrow failure; acute renal failure; myalgia, muscle spasm, arthralgia; gynaecomastia

Interactions

Lithium — serum lithium levels may be increased, with increased lithium toxicity including cardiotoxic and neurotoxic effects; monitor lithium levels carefully and adjust the lithium dose if necessary (§4.5)
Nephrotoxic or ototoxic drugs — use bumetanide with caution in patients already receiving them (§4.4)
Antidiabetic therapy — periodic checks on urine and blood glucose should be made in diabetics and patients suspected of latent diabetes (§4.4, cross-referring to §4.5)
Sulfonamides/thiazides — potential risk of hypersensitivity to bumetanide in patients with known hypersensitivity to these (§4.4)
NOTE: SPC §4.5 was truncated at the source-fetch limit — the full interactions section was not retrieved and must be checked

Clinical monograph

How it works

It inhibits the sodium-potassium-chloride co-transporter in the ascending loop of Henle, producing a brisk diuresis with loss of sodium, potassium and water.

Prescribing in practice

Monitor U&E for hypokalaemia, hyponatraemia and dehydration, which can be marked with vigorous diuresis.
It is more reliably absorbed orally than furosemide, making it useful where gut-wall oedema impairs furosemide absorption.
Gout can be precipitated, and ototoxicity is a risk with high intravenous doses or rapid administration, particularly in renal impairment.

Monitoring

Monitor renal function, electrolytes (especially potassium and sodium) and fluid/volume status, with closer review during dose titration or intercurrent illness.

Counselling the patient

Expect increased passing of urine; take earlier in the day to avoid disturbed sleep.
Report muscle cramps, marked weakness, dizziness on standing or significant thirst, which may indicate salt or fluid imbalance.

Evidence & guidelines

Established loop diuretic for oedema and heart failure (NICE NG106).

Reference: ESC Heart Failure Guidelines 2021; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways