hypokalaemia caused by diuretics can precipitate
encephalopathy.
The use of potassium-sparing diuretics avoids the need
to take potassium supplements.
▶Urinary retentionLoop diuretics can cause acute urinary
retention in children with obstruction of urinary outflow,
therefore adequate urinary output should be established
before initiating treatment.
lSIDE-EFFECTS
▶Common or very commonAsthenia.dehydration.dizziness
.electrolyte imbalance.gastrointestinal disorder.
headache.hypotension.metabolic alkalosis.muscle
complaints.nausea.skin reactions
▶UncommonBladder dilation.breast pain.chest discomfort
.diarrhoea.ear pain.urinary disorders.vertigo
▶Rare or very rareBone marrow disorders.hearing
impairment.photosensitivity reaction
▶Frequency not knownAcute kidney injury.agranulocytosis
.anaemia.arthralgia.auditory disorder (more common
with rapid intravenous administration, and in renal
impairment).cerebral ischaemia.confusion.deafness
(more common in renal impairment).diabetes mellitus.
dry mouth.embolism.encephalopathy.eosinophilia.
fever.gastrointestinal discomfort.gout.gynaecomastia.
haemolytic anaemia.hepatic disorders.hyperglycaemia.
hyperuricaemia.ischaemic heart disease.leucopenia.
malaise.metabolic acidosis.mucosal reaction.
musculoskeletal pain (with high doses in renal failure).
myocardial infarction.nephritis tubulointerstitial.
pancreatitis.paraesthesia.psychiatric disorder.severe
cutaneous adverse reactions (SCARs).shock.syncope.
tetany.thrombocytopenia.tinnitus (more common with
rapid intravenous administration, and in renal
impairment).urolithiases.vasculitis.visual impairment.
vomiting
lHEPATIC IMPAIRMENTHypokalaemia induced by loop
diuretics may precipitate hepatic encephalopathy and
coma—potassium-sparing diuretics can be used to prevent
this.
lRENAL IMPAIRMENTHigh doses or rapid intravenous
administration can cause tinnitus and deafness.
Dose adjustmentsHigh doses of loop diuretics may
occasionally be needed in renal impairment.
lMONITORING REQUIREMENTSMonitor electrolytes during
treatment.
eiiiiF 139Bumetanide
lINDICATIONS AND DOSE
Oedema in heart failure, renal disease, and hepatic
disease|Pulmonary oedema
▶BY MOUTH
▶Child 1 month–11 years: 15 – 50 micrograms/kg 1 – 4 times
a day (max. per dose 2 mg); maximum 5 mg per day
▶Child 12–17 years:Initially 1 mg, dose to be taken in the
morning, then 1 mg after 6 – 8 hours if required
Oedema in heart failure, renal disease, and hepatic
disease (severe cases)|Pulmonary oedema (severe
cases)
▶BY MOUTH
▶Child 12–17 years:Initially 5 mg daily, increased in steps
of 5 mg every 12 – 24 hours, adjusted according to
responselUNLICENSED USENot licensed for use in children under
12 years.
lINTERACTIONS→Appendix 1 : loop diuretics
lPREGNANCYBumetanide should not be used to treat
gestational hypertension because of the maternal
hypovolaemia associated with this condition.lBREAST FEEDINGNo information available. May inhibit
lactation.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension
Oral solution
▶Bumetanide (Non-proprietary)
Bumetanide 200 microgram per 1 mlBumetanide 1 mg/ 5 ml oral
solution sugar free sugar-free| 150 mlP£ 198. 00 DT = £ 198. 00
Tablet
▶Bumetanide (Non-proprietary)
Bumetanide 1 mgBumetanide 1 mg tablets| 28 tabletP£ 7. 35
DT = £ 1. 20
Bumetanide 5 mgBumetanide 5 mg tablets| 28 tabletP£ 7. 00
DT = £ 6. 98
eiiiiF 139Furosemide
(Frusemide)
lINDICATIONS AND DOSE
Oedema in heart failure, renal disease, and hepatic
disease|Pulmonary oedema
▶BY MOUTH
▶Neonate: 0. 5 – 2 mg/kg every 12 – 24 hours, alternatively
0. 5 – 2 mg/kg every 24 hours, if corrected gestational age
under^31 weeks.▶Child 1 month–11 years: 0. 5 – 2 mg/kg 2 – 3 times a day,
alternatively 0. 5 – 2 mg/kg every 24 hours, if corrected
gestational age of under 31 weeks, higher doses may be
required in resistant oedema; maximum 80 mg per day;
maximum 12 mg/kg per day
▶Child 12–17 years: 20 – 40 mg daily; increased to
80 – 120 mg daily, in resistant oedema
▶BY SLOW INTRAVENOUS INJECTION
▶Neonate: 0. 5 – 1 mg/kg every 12 – 24 hours, alternatively
0. 5 – 1 mg/kg every 24 hours, if corrected gestational age
under 31 weeks.▶Child 1 month–11 years: 0. 5 – 1 mg/kg every 8 hours (max.
per dose 40 mg every 8 hours) as required; maximum
6 mg/kg per day
▶Child 12–17 years: 20 – 40 mg every 8 hours as required,
higher doses may be required in resistant cases
▶BY CONTINUOUS INTRAVENOUS INFUSION
▶Child: 0. 1 – 2 mg/kg/hour
Oedema in heart failure, renal disease, and hepatic
disease following cardiac surgery|Pulmonary oedema
following cardiac surgery
▶BY CONTINUOUS INTRAVENOUS INFUSION
▶Child:Initially 100 micrograms/kg/hour, dose to be
doubled every 2 hours until urine output exceeds
1 mL/kg/hour
Oliguria
▶BY MOUTH
▶Child 12–17 years:Initially 250 mg daily, then increased
in steps of 250 mg every 4 – 6 hours (max. per dose 2 g)
if required
▶BY INTRAVENOUS INFUSION
▶Child 1 month–11 years: 2 – 5 mg/kg up to 4 times a day;
maximum 1 g per day
▶Child 12–17 years:Initially 250 mg, dose to be
administered over 1 hour, increased to 500 mg,
increased dose is given if satisfactory urine output not
obtained; dose administered over 2 hours, then
increased to 1 g, increased dose given if satisfactory
response not obtained within subsequent hour; dose to
be administered over 4 hours. If no response obtained
dialysis probably required; effective dose of up to 1 g140 Oedema BNFC 2018 – 2019
Cardiovascular system2