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.

• 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.

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.

Dosage

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.

Call your doctor or go to A&E if:

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).

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

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.

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.

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.