Bumetanide

Commonly reported side effects of bumetanide include: hypokalemia and hyperuricemia. See below for a comprehensive list of adverse effects.

Applies to bumetanide: oral tablet

Other dosage forms:

• injection solution

Along with its needed effects, bumetanide may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking bumetanide:

More common

• Abdominal pain
• blurred vision
• confusion
• decreased urine output
• dizziness
• drowsiness
• dry mouth
• fast or irregular heartbeat
• flushed, dry skin
• fruit-like breath odor
• headache
• increased hunger
• increased thirst
• increased urination
• irritability
• joint pain, stiffness, or swelling
• loss of appetite
• loss of mental alertness
• lower back, side, or stomach pain
• mood or mental changes
• muscle pain or cramps
• nausea or vomiting
• numbness or tingling in the hands, feet, or lips
• shortness of breath
• sweating
• swelling of face, hands, feet, ankles, or lower legs
• troubled breathing
• unexplained weight loss
• unusual tiredness or weakness
• weak pulse

Rare

• Agitation
• back pain
• black, tarry stools
• bleeding gums
• blood in the urine or stools
• chest pain
• convulsions (seizures)
• deep or fast breathing with dizziness
• dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
• fever
• hallucinations
• hives
• increase in heart rate
• increased blood pressure
• numbness of feet, hands, and around the mouth
• pinpoint red spots on the skin
• rapid breathing
• stiff neck
• sunken eyes
• trembling, jerking of hands
• unusual bleeding or bruising
• weight gain
• wrinkled skin

Get emergency help immediately if any of the following symptoms of overdose occur while taking bumetanide:

Symptoms of overdose

• Difficulty breathing
• pain in chest, groin, or legs, especially the calves
• severe, sudden headache
• slurred speech
• sudden loss of coordination
• sudden, severe weakness or numbness in the arm or leg
• sudden, unexplained shortness of breath
• unusual drowsiness, dullness, or feeling of sluggishness
• vision changes

Some side effects of bumetanide may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Rare

• Decreased interest in sexual intercourse
• diarrhea
• difficulty with moving
• ear discomfort
• feeling of constant movement of self or surroundings
• inability to have or keep an erection
• itching skin
• loss in sexual ability, desire, drive, or performance
• muscle or bone pain
• muscle stiffness
• nipple tenderness
• pain, swelling, or redness in joints
• rash
• sensation of spinning
• shorter than usual time to ejaculation of semen
• trouble with hearing
• upset stomach

Applies to bumetanide: compounding powder, injectable solution, oral tablet

Metabolic side effects associated with bumetanide, as with other loop diuretics, occur in 7% to 20% of patients, and include hyponatremia, hypokalemia, hypochloremia, and hyperuricemia. These side effects may be more likely in patients with renal insufficiency. Glucose intolerance is reported in up to 14% of elderly patients. Hypokalemia may lead to increased renal tubular bicarbonate reabsorption, resulting in metabolic alkalosis.

Besides acting on the loop of Henle, bumetanide also inhibits phosphate reabsorption in the proximal tubule, resulting in phosphaturia. Since phosphorous is abundant in most diets, bumetanide-induced phosphaturia may not be significant except in malnourished patients, patients on life support, and patients with significant muscle weakness.

Calcium balance appears to remain neutral during treatment with a loop diuretic (i.e., furosemide, bumetanide). Although loop diuretics cause an increase in renal calcium excretion, this appears to be compensated for by a parathyroid-dependent increase in 1,25-dihydroxyvitamin D levels, which increases intestinal calcium absorption. Bone metabolism does not appear to be significantly affected by loop diuretics.

Musculoskeletal side effects have included muscle cramps in 1.1% and weakness in 0.2% of patients.

Renal insufficiency, manifested as a rise in serum creatinine and BUN, may occur in up to 7% of patients. It is usually due to extracellular fluid volume depletion and is readily reversible.

Cardiovascular side effects include hypotension in less than 2% of patients. Patients with a history of cardiac arrhythmias should be monitored closely because of the risk of hypokalemia.

Gastrointestinal side effects were reported in less than 2% of patients and included nausea, vomiting, loose stools, and constipation. There have been rare reports of hyperamylasemia and pancreatitis associated with bumetanide use.

Nervous system side effects, such as headache, dizziness, deafness, tinnitus, vertigo, and decreased hearing, are reported in less than 2% of patients. Encephalopathy after bumetanide administration is reported in patients with severe liver disease.

Severe hypersensitivity reactions such as Stevens-Johnson syndrome and recurrent urticaria have been reported in rare cases.

Hypersensitivity reactions are rare. Rash is reported in less than 1% of treated patients. Because cross-reactivity with furosemide is rare, bumetanide can be substituted at about a 1:40 dose ratio of bumetanide to furosemide in patients allergic to furosemide.

Dermatologic side effects have included pseudoporphyria, Stevens-Johnson syndrome, and toxic epidermal necrolysis.

Hematologic side effects are extremely rare. Cases of thrombocytopenia, mild anemia, and leukopenia have been reported.