Bumetanide
Bumetanide is a potent loop diuretic used for heart failure, refractory oedema and hypertension. It is approximately 40 times more potent by weight than furosemide and has more reliable oral absorption, supporting its use when furosemide is ineffective or absorption is poor.
- Chemical formula
- C15H20N2O5S
- CAS number
- 28395-03-1
- ATC code
- C03CA02
- Molecular weight
- 364.42 g/mol
- Drug class
- Loop diuretic
- Also known as
- Bumex, Burinex
What is it?
Bumetanide is a loop diuretic FDA-approved in 1983, marketed as Bumex (US) and Burinex (Europe), with widely available authorised generics. It is one of three commonly used loop diuretics alongside furosemide and torsemide. Bumetanide has more predictable oral bioavailability than furosemide and is approximately 40 times more potent by weight, which makes it useful when patients with heart failure or chronic kidney disease respond poorly to furosemide.
Mechanism of action
Bumetanide blocks the Na-K-2Cl cotransporter in the thick ascending limb of the loop of Henle, producing potent natriuresis and diuresis. Unlike thiazides, loop diuretics retain efficacy in patients with renal impairment, making them the diuretic class of choice when GFR is reduced. The diuretic effect develops within 30–60 minutes of oral dosing.
Pharmacokinetics
Bumetanide is rapidly and consistently absorbed after oral administration with bioavailability of 80–95% (compared with 50–60% and high variability for furosemide). Onset of diuresis is within 30–60 minutes, peak effect at 1–2 hours, and duration 4–6 hours. The terminal half-life is 1–1.5 hours, the shortest of the three loop diuretics. Hepatic metabolism predominates with about 65% renal excretion unchanged.
Indications
Bumetanide is approved for oedema in heart failure, hepatic cirrhosis or chronic kidney disease, and for refractory oedema unresponsive to other diuretics. According to current heart-failure guidelines, bumetanide is a useful alternative when furosemide absorption is variable or the patient is diuretic-resistant. The dose ratio of bumetanide:furosemide is approximately 1:40, so 1mg bumetanide corresponds to ~40mg furosemide.
Safety profile
Common adverse effects include hypokalaemia, hyponatraemia, hypomagnesaemia, dehydration, hyperuricaemia, hyperglycaemia, ototoxicity (rare, dose-dependent) and orthostatic hypotension. Sulfa allergy is a relative contraindication. Concurrent NSAIDs reduce diuretic efficacy. Serum potassium, sodium, magnesium, renal function and uric acid require periodic monitoring. The shorter duration of action compared with torsemide produces sharper diuretic peaks but smoother fluid balance over 24 hours requires divided dosing in some patients.
Products containing this ingredient
Frequently asked questions
Is bumetanide better than furosemide for heart failure? ▾
Bumetanide has more reliable oral absorption (80–95% bioavailability vs 50–60% for furosemide) and is approximately 40 times more potent by weight. It is useful when furosemide absorption is variable or patients are diuretic-resistant. According to current heart-failure guidelines, bumetanide is a reasonable alternative to furosemide when absorption issues drive treatment failure.
What lab tests are needed on bumetanide? ▾
Serum potassium, sodium, magnesium, renal function and uric acid are checked at baseline, 1–2 weeks after starting or any dose increase, and periodically thereafter. Hypokalaemia and hypomagnesaemia are common and may require oral supplementation, ACE inhibitor combination, or potassium-sparing agents. Glucose and weight are also tracked, particularly in heart failure.
How does bumetanide compare with torsemide? ▾
Both are loop diuretics with more reliable absorption than furosemide. Torsemide has a longer duration of action (6–8 hours) and once-daily dosing supports steady fluid balance. Bumetanide has a shorter duration (4–6 hours) and may produce sharper natriuresis but require divided dosing for stable balance. According to current practice, choice depends on the desired diuretic profile and prescriber familiarity.
The information on this website is provided for reference and educational purposes only. It does not replace consultation with a qualified healthcare professional.