Bumex (Bumetanide) – Oral

What Is Bumex?

Bumex (bumetanide) is a prescription-only medication used to treat swelling caused by excess fluid in the body.

Excess fluid can be caused by certain conditions such as congestive heart failure, liver disease, and kidney disease.

Bumex works on parts of the kidneys and blocks certain chemicals, such as sodium (salt), chloride, calcium, and potassium, from being absorbed back into the body. This allows the kidneys to get rid of extra water and sodium through urine, reducing fluid in the body. Bumex belongs to a class of medications known as loop diuretics.

Bumetanide is a strong fluid-lowering drug (diuretic), so it can sometimes cause too much water and electrolytes (like potassium) in the blood to be lost, leading to severe health problems. It is important to follow up with your healthcare provider regularly and undergo labs as instructed.

Bumex is available as a tablet to be taken by mouth.

What Is Bumex Used For?

The Food and Drug Administration (FDA) approved Bumex to reduce excess fluid in the body that is caused by congestive heart failure, liver disease, and kidney disease. As a loop diuretic, it helps your kidneys get rid of excess water and salt from the body through the urine.

How to Take Bumex

Always follow the directions given to you by your healthcare provider on how to take Bumex. The appropriate dose is patient-specific, and careful monitoring of your individual response is required when taking this medication.

Due to how this medication works, it is best to take it in the morning since it causes frequent urination. It is not recommended to take it at bedtime since it can keep you up at night due to the urge to urinate.

Storage

Store Bumex tablets in a cool, dry place at room temperature (between 68 and 77 degrees F). Do not expose it to hot or cold temperatures for long periods. These environments can impact how well your medication works. Do not freeze this medication. Keep your pills out of reach of children and pets to prevent accidental consumption.

Since it is not a medication requiring extra care, getting refills for it should not be difficult. Generally, it is best to contact your pharmacist before running out of the medication to put in a refill request.

Off-Label Uses

Along with reducing excess fluid levels, Bumex has been studied as an off-label treatment for other conditions. A healthcare provider may prescribe off-label treatments when the decision is supported by scientific evidence or expert clinical experience.

Some well-established off-label uses are listed below: 

• High blood pressure (hypertension)
• Frequent urination at night: Bumex reduces salt and water levels before bedtime to help with nighttime awakenings due to the urge to urinate.
• Advanced chronic kidney disease (CKD): When used along with another diuretic called chlorthalidone, Bumex was shown to be useful in providing additional control with high blood pressure and too much fluid in the body.

The following are newer off-label uses for Bumex that have shown some results but require additional research:

• Bumex has been used along with another medication called phenobarbital to treat seizures in newborns.
• Bumex has also been found to improve the symptoms of autism spectrum disorder (ASD) in children.

What Are the Side Effects of Bumex?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Bumex is a medication that requires close monitoring. The following are common side effects that have been observed:

• Muscle cramps
• Dizziness
• Low blood pressure (hypotension)
• Headache
• Nausea
• Low blood levels of sodium 
• Low blood levels of chlorine
  

Severe Side Effects

The following are serious side effects that have occurred while taking this medication. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects can include the following:

• Impaired hearing: This includes loss of hearing and decreased hearing.
• Changes in heart rhythm: This can include a heartbeat that is too fast, too slow, or irregular.
• Hypokalemia (low potassium): Symptoms can include muscle cramps and pain, weakness, fatigue, paralysis, constipation, and respiratory failure.
• Dehydration: Symptoms can include increased thirst, dry mouth and nose, fatigue and muscle weakness or pain, headache, dizziness, and urinating less or having dark urine.
• Kidney failure: Symptoms can include a gradual decrease in urine output, fluid retention (swelling in the legs, ankles, or feet), nausea, shortness of breath, and fatigue.

There are no documented side effects occurring after Bumex was stopped.

Dosage: How Much Bumex Should I Take?

Modifications

Due to the possible effects of this medication, there may be changes to how it is used. Therefore, it is important for users to be aware of the following when taking Bumex.

Pregnancy

There are no well-controlled studies of Bumex use during pregnancy. Bumex should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing or Breastfeeding

It is not known whether the active ingredient of Bumex is excreted in breast milk. As a general rule, it is not recommended to breastfeed while taking Bumex since the drug may be passed to the infant in breast milk.

Children

The safety and efficacy of this medication in children 17 and under have not been established.

Older Adults

People who are 65 and older are more likely to have decreased kidney function. Care should be taken when choosing a dose, and it may be useful to monitor kidney function.

Missed Dose

If you miss a dose of Bumex, you should take it as soon as you remember. If the time when you remember happens to be close to the next scheduled dose, skip the missed dose and only take the upcoming scheduled dose.

Overdose: What Happens If I Take Too Much Bumex?

Overdosing on Bumex can lead to severe water loss and electrolyte loss as well as dehydration and decreased blood volume with the possibility of forming life-threatening blood clots.

Common signs of electrolyte loss include:

• Weakness
• Dizziness
• Mental confusion
• Feeling tired
• Vomiting
• Muscle cramps

Severe electrolyte loss can be life-threatening and require hospitalization for proper treatment. Your healthcare provider may need to replace your fluids and electrolytes.

Precautions

What Are Reasons I Shouldn’t Take Bumex?

You should not be prescribed Bumex if:

• Your kidneys are unable to produce urine.
• You are in a coma due to liver disease.
• You're experiencing severe electrolyte loss.

Bumex should also be discontinued if you experience an increase in blood urea nitrogen (BUN) or creatinine or if you develop low urine output (oliguria) during therapy.

What Other Medications Interact With Bumex?

Although rare, Bumex has the potential to cause hearing damage.

Due to this, the use of antibiotics that can also cause hearing damage should be avoided unless specifically instructed otherwise by a healthcare provider.

The following are antibiotics that can affect hearing:

• Streptomycin
• Amikacin
• Gentamicin

There's also limited information on using Bumex with medications that can damage the kidneys. Therefore, it is not recommended to use these drugs together.

The following medications can cause injury to the kidneys:

• Gengraf, Neoral, Sandimmune (cyclosporine)
• Prograf (tacrolimus)
• Trexall, Rasuvo (methotrexate)

Bumex has been shown to increase the effect of medications that lower blood pressure. Due to this interaction, your blood pressure medications may require a lower dose. The following are common medications used to control high blood pressure:

• Zestril (lisinopril)
• Toprol XL, Lopressor (metoprolol)
• Norvasc (amlodipine)

What Medications Are Similar?

Bumex belongs to a class of medications known as loop diuretics. The following are also part of this drug class:

• Lasix (furosemide)
• Demadex (torsemide)

Diuretics are a broad class of medications. Other diuretics that target different parts of the kidneys are listed below:

• Thialitone (chlorthalidone)
• Microzide (hydrochlorothiazide)
• Aldactone (spironolactone)

This is a list of drugs commonly used to reduce fluid levels in the body. It is not a list of drugs recommended to take with Bumex. In fact, you should not take these drugs together. Talk to your pharmacist or a healthcare provider if you have any questions.

How Can I Stay Healthy While Taking Bumex?

To stay healthy while taking Bumex, follow your healthcare provider's directions on how and when to take it.

You should also drink enough water to prevent dehydration. Generally, the National Academy of Sciences recommends 13 8-ounce cups per day for men and nine 8-ounce cups per day for women. However, actual water intake needs can vary depending on factors that include your age, how much you sweat, and your level of physical activity. Talk to your healthcare provider about how much water you should be drinking.

Additionally, try to maintain a healthy diet and exercise regimen. For exercising, you can start with an achievable goal that works for you and slowly increase the frequency and intensity as tolerated. Talk to your healthcare provider before starting any new exercise plans.

The author would like to recognize and thank Cody Ryan Thomas for contributing to this article.