Bumetanide - EM Doctors

1. About bumetanide

Bumetanide is a type of medicine called a diuretic. It's used to treat heart failure and the build up of fluid in your body (oedema).

Diuretics are sometimes called "water pills/tablets" because they make you pee more. This helps get rid of extra fluid in your body.

Bumetanide is only available on prescription. It comes as tablets and as a liquid that you swallow.

Bumetanide also comes mixed with another diuretic called amiloride to treat oedema.

2. Key facts

It's usual to take bumetanide once a day, in the morning or afternoon - or twice a day, in the morning and afternoon.
Most people need to pee about 30 minutes after taking bumetanide, and again within a few hours.
Do not take bumetanide after 4pm or you may have to wake up in the night to go to the toilet.
You can take bumetanide with or without food.

3. Who can and can't take bumetanide

Bumetanide can be taken by most adults and children, including babies.

Bumetanide isn't suitable for everyone. To make sure that it is safe for you, tell your doctor if you have:

had an allergic reaction to bumetanide or any other medicines in the past
low blood pressure
symptoms of dehydration, such as being thirsty, having a dry mouth and dark pee
liver disease
diabetes
difficulty peeing
gout

If you're going to have a glucose test tell your doctor you are taking bumetanide.

4. How and when to take it

How much to take

The usual dose in adults to treat heart failure or a build up of fluid in the body (oedema) is 1mg to 10mg a day or 5ml to 50ml a day if you're taking it as a liquid.

If you are over 65 your doctor may give you a lower dose.

For babies and children, your doctor will use your child's weight or age to work out the right dose.

How to take it

You can take bumetanide with or without food.

Swallow the tablets whole with a drink of water.

If you're taking bumetanide as a liquid, it will come with a plastic spoon or syringe to help you measure the correct amount. If you don't have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it won't give the right amount.

When to take it

It's usual to take bumetanide once a day in the morning or afternoon. If your doctor prescribes it twice a day, take it once in the morning and again in the afternoon.

You don't need to take bumetanide at the same time every day. You can occasionally take it at a different time if it's more convenient for you. For example, if you need to go out for a few hours in the morning and you won't be near a toilet.

Do not take bumetanide too late in the day (after 4pm) or at night, otherwise you may have to wake up to go to the toilet. Your pharmacist or doctor will tell you the best times for you to take your medicine.

What if I forget to take it?

Take your forgotten dose as soon as you remember, unless it is after 4pm. In this case, leave out the missed dose and take your next dose at the usual time.

Do not take a double dose to make up for a forgotten dose. If you often forget doses, it may help to set an alarm to remind you.

You could also ask your pharmacist for advice on other ways to help you remember your medicines.

What if I take too much?

Too much bumetanide can cause headaches, dizziness, a pounding or irregular heartbeat, fainting and thirst.

The amount of bumetanide that can lead to an overdose varies from person to person.

Urgent advice: Call your doctor or go to A&E if you take too much bumetanide and you:

feel unwell
are over 65 (even if you feel well)
have liver, kidney or heart problems (even if you feel well)

Find your nearest A&E department.

If you have to go to hospital take the bumetanide packet, or the leaflet inside it, plus any remaining medicine with you.

5. Side effects

Like all medicines, bumetanide can cause side effects although not everyone gets them. Side effects often get better as your body gets used to the medicine.

Common side effects

Common side effects of bumetanide happen in more than 1 in 100 people. They include:

peeing more than normal - most people need to pee within a few hours of taking bumetanide
feeling thirsty and dry mouth
losing a bit of weight (as your body loses water)
headaches
feeling confused or dizzy
muscle cramps or weak muscles

Serious side effects

Serious side effects are rare.

Tell your doctor straight away if you have:

unexplained bruising or bleeding, fever, sore throat and mouth ulcers - these could be signs of a blood disorder
ringing in your ears (tinnitus) or loss of hearing

Serious allergic reaction

In rare cases, bumetanide can cause a serious allergic reaction (anaphylaxis).

Immediate action required: Call 999 or go to A&E if:

you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
you're wheezing
you get tightness in the chest or throat
you have trouble breathing or talking
your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of bumetanide. For a full list see the leaflet inside your medicines packet.

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

peeing more than normal - this will last for about 6 hours after taking bumetanide. It's nothing to worry about, but if it's inconvenient for you, change the time you take bumetanide to one that suits you better (provided it's no later than 4pm). If peeing a lot is still a problem for you, talk to your doctor or pharmacist.
feeling thirsty - it's important not to get dehydrated, but how much you drink will depend on why you're taking bumetanide. Check with your doctor how much water you can drink while you're taking this medicine.
dry mouth - chew sugar-free gum or suck sugar-free sweets.
headaches - make sure you rest and drink fluids - ask your doctor how much you can drink while taking this medicine. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headaches last longer than a week or are severe.
feeling confused or dizzy - if bumetanide makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you don't faint, then sit until you feel better. Do not drive or use tools or machines while you're feeling dizzy or shaky.
muscle cramps or weak muscles - if you get unusual muscle pain or weakness which isn't from exercise or hard work, talk to your doctor. You may need a blood test to check what might be causing it.

7. Pregnancy and breastfeeding

Bumetanide isn't normally recommended in pregnancy or when breastfeeding. However, your doctor may prescribe it if they think the benefits of the medicine outweigh the risks.

If you're trying to get pregnant or you're already pregnant, talk to your doctor about the benefits and possible harms of taking bumetanide. This will depend on how many weeks pregnant you are and the reason you need to take it. There may be other treatments that are safer for you.

Bumetanide and breastfeeding

It is not known if bumetanide passes into breast milk. It's also possible that bumetanide may reduce the amount of milk you produce.

If you need to take bumetanide while you're breastfeeding, your doctor and midwife will monitor your baby's weight.

Talk to your doctor, as other medicines might be better while you're breastfeeding.

Non-urgent advice: Tell your doctor if you're:

trying to get pregnant
pregnant
breastfeeding

8. Cautions with other medicines

Some medicines can interfere with the way bumetanide works.

Tell your doctor if you're taking these medicines before starting bumetanide:

medicines which treat, or might give you an irregular heartbeat, including amiodarone, digoxin, disopyramide, flecainide and sotalol
medicines that change the level of potassium in your blood, such as potassium supplements, steroids, or other diuretics
medicines to treat mental health problems, such as amisulpride, lithium, pimozide and risperidone
non-steroidal anti-inflammatory medicine (NSAIDs), including diclofenac, ibuprofen and naproxen
medicines to treat high blood pressure, or those that have a side effect of low blood pressure

Taking bumetanide with everyday painkillers and remedies

Some painkillers and remedies contain a lot of sodium, which is found in salt. Too much salt can stop bumetanide working properly.

Medicines that contain a lot of salt include soluble paracetamol and soluble co-codamol, and some remedies for heartburn and indigestion.

Speak to a pharmacist or doctor to see if these medicines are safe for you to take alongside bumetanide.

Mixing bumetanide with herbal remedies and supplements

There's very little information about taking herbal remedies and supplements with bumetanide.

Important

For safety, tell your pharmacist or doctor if you're taking any other medicines, including herbal remedies, vitamins or supplements.

9. Common questions

How does bumetanide work?

Bumetanide is a type of medicine called a loop diuretic.

A diuretic makes your body get rid of extra fluid through your kidneys. A loop diuretic works on a specific part of the kidney called the "loop of Henle" to increase the salt and water you pee out.

This means you have less fluid in your tissues which helps get rid of swelling and a build up of fluid in the body (oedema).

How long does bumetanide take to work?

How long does it work for?

How long will I take it for?

Is it safe to take for a long time?

What happens if bumetanide doesn't work?

Can I drink alcohol with it?

During the first few days of taking bumetanide, it is best to stop drinking until you see how the medicine affects you. It may lower your blood pressure and make you feel dizzy.

If you feel OK, you can drink alcohol in moderation by following the national alcohol guidelines of no more than 14 units a week for men and women. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.

Are there similar medicines to bumetanide?

There are other diuretics that work in a similar way to bumetanide.

There are 3 different types of diuretic, each type works on a different part of the kidney:

loop diuretics including bumetanide, furosemide and torasemide can be used to treat heart failure. Torasemide and furosemide can also be used to treat high blood pressure.
thiazide diuretics such as bendroflumethiazide and indapamide, are used in low doses to treat high blood pressure, and in higher doses to treat heart failure.
potassium-sparing diuretics such as spironolactone and eplerenone, can be used to treat heart failure. These can also be used if you lose too much potassium with other diuretics.

What will happen if I come off it?

How much fluid should I drink while I'm taking bumetanide?

It's usually best to drink normally while you're taking bumetanide. A good rule is to drink enough fluid so that you're not thirsty for long periods. And to steadily increase your fluid intake when exercising and during hot weather. Passing pale, clear pee is a good sign that you're drinking enough.

However, if you have heart failure or kidney problems you might need to limit how much fluid you drink. Your doctor or nurse will tell you exactly how much you need to drink each day.

Is it safe to take bumetanide when I'm ill?

If you're ill with a fever (a high temperature above 38C), sweats and shaking, being sick (vomiting) or have severe diarrhoea, contact your doctor as you may need to stop taking bumetanide for 1 to 2 days until you are better.

You can start taking it again when you're eating and drinking normally.

If you take bumetanide when you have an illness that makes you dehydrated, it can make the dehydration worse.

Can I take bumetanide before surgery?

Can I take bumetanide to lose weight?

Is there any food or drink I need to avoid?

If you're taking a diuretic such as bumetanide, it's important not to have too much salt in your food because this can stop it working as well as it should.

Do not eat foods that have a lot of salt in them, such as processed foods or ready-meals. Do not add extra salt when you're cooking or at the table.

Also, do not buy salt substitutes instead of ordinary table salt, as they contain a lot of potassium, which can interfere with certain medicines or cause side effects.

Adults are generally advised to eat no more than 6 grams of salt a day. Your doctor will tell you if you need to eat even less than this.

Will it affect my contraception?

Will it affect my fertility?

Can lifestyle changes help?

You can boost your general health - plus the health of your heart - by making some key lifestyle changes. These will also help if you have high blood pressure or heart failure:

quit smoking - smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try to avoid secondhand smoke too.
drink alcohol sensibly - drinking too much alcohol raises blood pressure over time and also makes heart failure worse. Men and women shouldn't drink more than 14 units of alcohol a week.
be more active - regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It doesn't need to be too energetic - walking every day can help.
eat healthily - aim to eat a diet that includes plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products and lean proteins. It's a good idea to cut down on salt too, however, it's important not to go on a low-salt (or low-sodium) diet while taking this medicine, as that could make your sodium levels too low. People need salt in their diet but eating too much salt is the biggest cause of high blood pressure - the more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
manage stress - when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help avoid stress.
vaccinations - if you have heart failure, it's recommended that you have a flu jab every year and a pneumonia vaccination every 5 years. Ask your doctor about these vaccinations. You can have them free on the NHS if you have heart failure.