Bumetanide

About Bumetanide

Bumetanide blocks salt reabsorption in the loop of Henle in the kidney, so water follows the salt into the urine. A tablet starts working within 30 to 60 minutes and the effect is largely over within four hours. The label puts 1 mg at about the strength of 40 mg of furosemide, so a small number on a bumetanide prescription is not a small dose.

The boxed warning says that in excess it can cause a profound loss of water and electrolytes, so it needs careful medical supervision and a dose and schedule set for each person. Blood tests check potassium and other electrolytes, kidney function, blood sugar and uric acid; low potassium is a particular concern for people taking digoxin. High, repeated injected doses in people with poor kidney function can damage hearing.

It is not used when the kidneys make no urine, in hepatic coma or with severe electrolyte depletion, and in cirrhosis with fluid in the abdomen the label advises starting it in hospital. People with a sulfonamide allergy may react to it, while people allergic to furosemide have been treated with it successfully. The label favors intermittent schedules, such as alternate days, for long-term control of swelling; the prescriber sets the schedule.

Enbumyst gives 0.5 mg from a single-use nasal spray for adults; its label says it is not for long-term use and should be replaced with oral diuretics as soon as practical.

Taking Bumetanide

How to take it

Usually once a day, though extra doses 4 to 5 hours apart or alternate-day schedules are used; take it exactly as prescribed. Follow any advice on salt or potassium-rich foods such as bananas. Each nasal spray device is used once, without priming.

If you miss a dose

Take it when you remember, unless the next dose is nearly due; then skip the missed dose. Do not take a double dose to make up for it.

Storage

At room temperature, tightly closed, away from heat and moisture. Do not freeze the nasal spray.

Interactions to know about

Aminoglycoside antibiotics such as gentamicin add to the risk of hearing damage, and drugs that can harm the kidneys are avoided. Lithium is generally not given with it, because levels can become toxic. Indomethacin and probenecid blunt its effect. Report ringing in the ears, hearing loss, unusual bruising, thirst, dry mouth or passing little urine.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Bumetanide differs from pharmacy to pharmacy

Generic tablets have many makers and cost pharmacies little, so the cash price is mostly the dispensing fee and margin, though a pharmacy that must order a strength in may quote more. Holding more than one strength means a fee for each fill. Bumex and the Enbumyst spray, one device per dose, are priced as brands, far above generic tablets.

Ways to pay less for Bumetanide without insurance

• If the prescription names Bumex, ask the prescriber to allow the generic.
• If you fill more than one strength, ask the prescriber whether one strength could cover your doses.
• Once the dose is stable, ask for a ninety-day supply from a pharmacy that stocks your strength.
• If the nasal spray is prescribed, ask how long you will need it.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Bumetanide

1. 1.How does this dose compare with my old furosemide dose?
2. 2.What time of day should I take it?
3. 3.What signs of dehydration or low potassium should I watch for?
4. 4.Should I eat more potassium-rich foods or take a supplement?
5. 5.Is my sulfa allergy a problem?

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