Bumetanide adverse effects

Equipotent doses of loop diuretics (furosemide, bumetanide, torsemide, ethacrynic acid) have similar efficacy. Ethacrynic acid is reserved for sulfa-allergic patients. Continuous infusions of loop diuretics appear to be more effective and to have fewer adverse effects than intermittent boluses. An initial IV loading dose (equivalent to furosemide 40 to 80 mg) should be administered before starting a continuous infusion (equivalent to furosemide 10 to 20 mg/hour). 

Furosemide, torsemide, and bumetanide are sulfonamide derivatives, hence chemically related to the thiazides. They share the thiazides adverse effects of serum uric acid elevation and diabetogenic potential. Ethacrynic acid (Edecrin) is chemically unrelated to other diuretics and does not appear to have diabetogenic potential. 

All sulfonamides and their derivatives, including carbonic anhydrase inhibitors, thiazides, furosemide, bumetanide, torsemide, diazoxide, and the sulfonylurea hypoglycemic agents, are cross-allergenic. The most common adverse effects are fever, skin rashes, exfoliative dermatitis, photosensitivity, urticaria, nausea, vomiting, diarrhea, and difficulties referable to the urinary tract (see below). Stevens-Johnson syndrome, although relatively uncommon (ie, less than 1% of treatment courses), is a particularly serious and potentially fatal type of skin and mucous membrane eruption associated with sulfonamide use. Other unwanted effects include stomatitis, conjunctivitis, arthritis, hematopoietic disturbances (see Urinary Tract Disturbances), hepatitis, and, rarely, polyarteritis nodosa and psychosis. 

Bumetanide, piretanide and ethacrynic acid are similar to frusemide. Torasemide is also similar, but has also been demonstrated to be an effective antihypertensive agent at lower (non-natriuretic) doses (2.5-5 mg/d) than those used for oedema (5-40 mg). Ethacrynic acid is less widely used as it is more prone to cause adverse effects, especially nausea and deafness. 

Etaciynic acid (ethacrynic acid) is a loop diuretic with similar actions to furosemide and bumetanide. However, it has more adverse effects than the other loop diuretics and offers no clear advantages. 

Four highly predictable adverse effects are associated ilh furosemide and bumetanide ... 

A diuretic structurally related to furosemide is bumetanide. This compound also functions as a high-ceiling diuretic in the ascending limb of the loop of Henle. It has a duration of action of approximately 4 hours. The uses of this compound are similar to those described for furosemide. The dose of bumetanide is 0.5 to 2 mg/day given as a single dose. Adverse effects are similar to those induced by furosemide. 

Electrolyte A randomised controlled trial of 60 children with autism or Asperger s syndrome (3-11 years old) who received bumetanide (1 mg per day) or placebo for 3 months showed the adverse effect of mild hypokalemia (3.5,3.4, 3.1, 3.5, 3.5 and 3.4 ml ) in six of the bumetanide-treated children, but only one child was removed from the study due to hypokalemia [21]. 

The loop diuretics increase the renal excretion of lithium after single-dose intravenous administration in both animals (711) and man (712). Furosemide has been used to treat lithium intoxication (713). The effect of etacrynic acid is larger than those of furosemide and bumetanide (712). However, long-term treatment with furosemide and bumetanide can cause lithium intoxication in some patients (714,715), perhaps by causing sodium depletion and a secondary increase in lithium reabsorption. An adverse interaction of lithium during long-term therapy with etacrynic acid is therefore theoretically likely. 

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