Drug Class Description

Generic Name

Drug Description

Presentation

Indications

Adult Dosage

For oral administration.

Most patients require a daily dose of 1 mg which can be given as a single morning or early evening dose. Depending on the patient's response, a second dose can be given six to eight hours later. In refractory cases, the dose can be increased until a satisfactory diuretic response is obtained, or infusions of Burinex can be given.

Child Dosage

Not recommended for children under 12 years of age.

Elderly Dosage

Adjust dosage according to response. A dose of 0.5 mg bumetanide per day may be sufficient in some elderly patients.

Contra Indications

Although Burinex can be used to induce diuresis in renal insufficiency, any marked increase in blood urea or the development of oliguria or anuria during treatment of severe progressing renal disease are indications for stopping treatment with Burinex.

Hypersensitivity to Burinex. Burinex is contra-indicated in hepatic coma and care should be taken in states of severe electrolyte depletion.

As with other diuretics, Burinex should not be administered concurrently with lithium salts. Diuretics can reduce lithium clearance resulting in high serum levels of lithium.

Special Precautions

Excessively rapid mobilisation of oedema, particularly in elderly patients, may give rise to sudden changes in cardiovascular pressure-flow relationships with circulatory collapse. This should be borne in mind when Burinex is given in high doses intravenously or orally. Electrolyte disturbances may occur, particularly in those patients taking a low salt diet. Regular checks of serum electrolytes, in particular sodium, potassium, chloride and bicarbonate, should be performed and replacement therapy instituted where indicated.

Encephalopathy may be precipitated in patients with pre-existing hepatic impairment.

Burinex should be used with caution in patients already receiving nephrotoxic or ototoxic drugs.

Interactions

Like other diuretics, Burinex shows a tendency to increase the excretion of potassium which can lead to an increase in the sensitivity of the myocardium to the toxic effects of digitalis. Thus the dose may need adjustment when given in conjunction with cardiac glycosides.

Burinex may potentiate the effects of antihypertensive drugs. Therefore, the dose of the latter may need adjustment when Burinex is used to treat oedema in hypertensive patients.

As with other diuretics, Burinex may cause an increase in blood uric acid. Periodic checks on urine and blood glucose should be made in diabetics and patients suspected of latent diabetes.

Patients with chronic renal failure on high doses of Burinex should remain under constant hospital supervision.

Certain non-steroidal anti-inflammatory drugs have been shown to antagonise the action of diuretics.

Adverse Reactions

Reported reactions include abdominal pain, vomiting, dyspepsia, diarrhoea, stomach and muscle cramps, arthralgia, dizziness, fatigue, hypotension, headache, nausea, encephalopathy (in patients with pre-existing hepatic disease), fluid and electrolyte depletion, dehydration, hyperuricaemia, raised blood urea and serum creatinine, hyperglycaemia, abnormalities of serum levels of hepatic enzymes, skin rashes, pruritus, urticaria, thrombocytopenia, gynaecomastia and painful breasts. Bone marrow depression associated with the use of Burinex has been reported rarely but it has not been proven definitely to be attributed to the drug. Hearing disturbance after administration of Burinex is rare and reversible.

High dose therapy:

In patients with severe chronic renal failure given high doses of Burinex, there have been reports of severe, generalised musculoskeletal pain sometimes associated with muscle spasm, occurring one to two hours after administration and lasting up to 12 hours. The lowest reported dose causing this type of adverse reaction was 5 mg by intravenous injection and the highest was 75 mg orally in a single dose. All patients recovered fully and there was no deterioration in their renal function. The cause of this pain is uncertain but it may be a result of varying electrolyte gradients at the cell membrane level.

Experience suggests that the incidence of such reactions is reduced by initiating treatment at 5-10 mg daily and titrating upwards using a twice daily dosage regimen at doses of 20 mg per day or more.

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