Bumetanide is a type of medicine called a loop diuretic. Diuretics are sometimes referred to as 'water tablets'. They remove excess fluid from the body by increasing the production of urine.

What is it used for?

  • Removing excess fluid (oedema) from the body, due to conditions such as heart failure, liver cirrhosis or kidney failure.
  • High blood pressure (hypertension) in people whose blood pressure has not been lowered sufficiently with other medicines, or in people with impaired kidney function or heart failure.

How does it work?

  • Bumetanide is a type of medicine called a loop diuretic. Diuretics are sometimes referred to as 'water tablets'. They remove excess fluid from the body by increasing the production of urine.
  • Loop diuretics work by causing the kidneys to increase the amount of salts such as potassium and sodium that are filtered out of the blood and into the urine. When these salts are filtered out of the blood by the kidneys, water is also drawn alongside.
As diuretics increase the removal of salts from the blood, they also cause more water to be drawn out of the blood and into the urine.
  • Bumetanide is used to treat conditions where excess fluid has been retained in the body (oedema). For example, in heart failure, the pumping mechanism of the heart is less effective. This can cause fluid to build up in the ankles and the lungs (pulmonary oedema), which makes it difficult to breathe. Bumetanide helps the body to remove this excess fluid. Removing fluid from the blood vessels also decreases the pressure within the blood vessels. This makes it easier for a weak heart to pump blood around the body. Bumetanide is therefore used to relieve the symptoms of heart failure.
  • Bumetanide is also used to remove excess fluid that can accumulate in people with cirrhosis of the liver. This fluid may accumulate in the abdomen or in the legs (peripheral oedema).
  • Problems with blood circulation in the legs can also cause fluid retention and swelling of the ankles or lower legs, and this can also be treated with bumetanide.
  • At higher doses the amount of water drawn from the blood into the urine is much greater, therefore bumetanide is also used when there is reduced production of urine in people with kidney failure.
  • As bumetanide decreases the pressure within the blood vessels, it is also sometimes used to treat high blood pressure, usually in people resistant to other blood pressure lowering medicines.
  • How do I take it?

    • Bumetanide tablets and liquid can be taken either with or without food. The tablets should be swallowed with a drink of water.
    • The dose prescribed depends on the individual and the condition being treated. Follow the instructions given by your doctor. These will also be printed on the dispensing label that your pharmacist has put on the packet of medicine.
    • Bumetanide causes your kidneys to produce more urine, so it is best to take it in the morning. It starts to work in about an hour and its effects last for about six hours. If your doctor wants you to take two doses in a day, your second dose should be taken six to eight hours after the first. Avoid taking it in the evening or before going to bed, as this is likely to make you need to visit the toilet in the night. Seek further advice from your doctor or pharmacist.
    • Bumetanide may also be given by injection.

    Use with caution in

    • Elderly people.
    • Decreased kidney function.
    • Decreased liver function.
    • People who have difficulty passing urine (urinary retention).
    • Men with an enlarged prostate gland (prostatic hypertrophy).
    • Diabetes.
    • Gout.
    • People allergic to medicines from the sulphonamide group, eg the antibiotic sulfamethoxazole.

    Not to be used in

    • People who are not producing any urine.
    • People with low blood pressure (hypotension).
    • People with a low volume of circulating blood (hypovolaemia), for example due to dehydration, severe vomiting or bleeding.
    • People with very low levels of electrolytes such as potassium or sodium in their blood.
    • People with kidney failure caused by a drug or a medicine.
    • People with reduced levels of consciousness or who are in a coma as a result of liver cirrhosis.
    • This medicine is not recommended for children under 12 years of age.
    • This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

    If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

    Pregnancy and breastfeeding

    Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

    • The safety of this medicine during pregnancy has not been established. It should be avoided during pregnancy, particularly in the first and third trimesters, unless the expected benefit is greater than any possible risk to the developing baby. Seek further medical advice from your doctor.
    • It is not known if this medicine passes into breast milk. It may reduce the production of breast milk. It is not recommended for women who are breastfeeding. Seek further medical advice from your doctor.

    Side effects

    Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

    • Disturbances of the gut such as diarrhoea, constipation, indigestion, nausea, vomiting or abdominal pain.
    • Headache.
    • Dizziness.
    • Low blood pressure (hypotension).
    • Fatigue.
    • Dehydration.
    • Muscle cramps.
    • Decreased levels of sodium, potassium, magnesium or calcium in the blood (see warning section above for symptoms to look out for).
    • Increased blood uric acid level (hyperuricaemia), which can cause kidney problems and gout.
    • Increased blood sugar levels (hyperglycaemia).
    • Skin reactions such as rash, itching or hives.
    • Painful breasts or breast enlargement.
    • Hearing disturbances.
    • Decrease in the normal numbers of blood cells in the blood.

    The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

    For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

    How can this medicine affect other medicines?

    It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while having treatment with this one, to make sure that the combination is safe.

    This medicine is likely to have an additive effect with other medicines that decrease blood pressure, particularly medicines that are used to treat high blood pressure (antihypertensives). This may cause dizziness, which can usually be relieved by lying down until the symptoms pass. If you feel dizzy while taking this medicine in combination with other medicines that can lower blood pressure you should let your doctor know, as your doses may need adjusting.

    Other medicines that decrease blood pressure include the following:

    • ACE inhibitors, eg enalapril
    • aldesleukin
    • alpha-blockers such as prazosin
    • alprostadil
    • angiotensin II receptor antagonists such as losartan
    • antipsychotics such as chlorpromazine
    • baclofen
    • benzodiazepines, eg temazepam, diazepam
    • beta-blockers such as propranolol
    • calcium-channel blockers such as verapamil, nifedipine
    • clonidine
    • diazoxide
    • other diuretics, eg bendroflumethiazide
    • dopamine agonists, eg bromocriptine, apomorphine
    • hydralazine
    • levodopa
    • MAOI antidepressants, eg phenelzine
    • methyldopa
    • minoxidil
    • moxisylyte
    • moxonidine
    • nicorandil
    • nitrates, eg glyceryl trinitrate
    • tizanidine.

    If you are due to start treatment with an ACE inhibitor, angiotensin-II receptor antagonist, or alpha-blocker, your doctor may stop your treatment with bumetanide or reduce your dose for a few days beforehand, in order to avoid your blood pressure falling too low with the first dose of the new medicine.

    There may be an increased risk of side effects on the kidneys if this medicine is used in combination with the following medicines:

    • ACE inhibitors, eg captopril
    • certain antibiotics, eg aminoglycosides such as gentamicin or cephalosporins such as cefalexin
    • other diuretics
    • non-steroidal anti-inflammatory drugs (NSAIDs), eg indometacin, diclofenac, ibuprofen
    • platinum compounds, eg cisplatin.

    There may be an increased risk of side effects on the ears if this medicine is used in combination with the following medicines:

    • aminoglycoside antibiotics such as gentamicin
    • platinum componds, eg cisplatin
    • polymyxin
    • vancomycin.

    Bumetanide may increase the blood level of the medicine lithium. People taking lithium together with bumetanide should have the level of lithium in their blood closely monitored.

    Bumetanide can increase blood glucose levels and people with diabetes may therefore need increases in their dose of insulin or antidiabetic tablets. Blood sugar levels should be monitored.

    Bumetanide can decrease the amount of potassium in the blood. If it is used in combination with any of the following medicines, which can also lower potassium in the blood, the risk of a low blood potassium level (hypokalaemia) is increased:

    • acetazolamide
    • amphotericin
    • corticosteroids, such as hydrocortisone and prednisolone
    • beta 2 agonists, eg salbutamol, terbutaline
    • other diuretics, such as bendroflumethiazide
    • reboxetine
    • theophylline.

    If the level of potassium in your blood falls during treatment, this can increase the risk of side effects on the heart from various other medicines, including digoxin, certain antipsychotics and medicines for abnormal heart rhythms (anti-arrhythmics), eg amiodarone.

    The following medicines may oppose the blood pressure lowering and diuretic effects of bumetanide:

    • corticosteroids such as hydrocortisone, prednisolone
    • oestrogens such as those in the combined contraceptive pill
    • NSAIDs such as indometacin, diclofenac, ibuprofen.