Product Overview
[Drug Name]
Generic Name: Bumetanide Tablets
Trade Name: Liliaobumetanide Tablets (1mg x 10 tablets)
Pinyin Code: LiLiao BuMeiTaNiPian
[Main Ingredients]
The main ingredient of this product is bumetanide.
[Properties]
This product is white tablets.
[Indications/Main Functions]
1. Edema diseases including congestive heart failure, cirrhosis, and renal disease (nephritis, nephropathy, and acute and chronic renal failure due to various causes). This class of drugs may still be effective, especially when other diuretics are ineffective. It can also be used in combination with other drugs to treat acute pulmonary edema and acute cerebral edema. 2. Hypertension. In stepwise treatment of hypertension, this class of drugs is not the first choice for the treatment of essential hypertension. However, it is particularly suitable when thiazides are ineffective, especially when accompanied by renal insufficiency or hypertensive crisis occurs. 3. Prevention of acute renal failure: This medication is used for various causes of insufficient renal blood perfusion, such as dehydration, shock, poisoning, anesthesia accidents, and circulatory insufficiency. Prompt administration while correcting hypovolemia can reduce the risk of acute tubular necrosis. 4. Hyperkalemia and hypercalcemia. 5. Dilutional hyponatremia, especially when the blood sodium concentration is below 120 mmol/L. 6. Syndrome of excessive antidiuretic hormone secretion (SIADH). 7. Acute drug poisoning, such as barbiturate poisoning. 8. May be effective in some cases not responsive to furosemide.
[Specifications]
1mg*10 tablets (Li Le)
[Dosage and Administration]
1. For the treatment of edematous diseases or hypertension in adults, start with 0.5-2 mg orally daily. Repeat every 4-5 hours as needed, up to a maximum daily dose of 10-20 mg. Intermittent dosing is also possible, with one dose taken every other day. 2. For children with small children, administer orally at a dose of 0.01-0.02 mg/kg per day based on body weight, or every 4-6 hours if necessary.
[Adverse Reactions]
Common adverse reactions are related to fluid and electrolyte imbalances, especially with high doses or prolonged use. These include orthostatic hypotension, shock, hypokalemia, hypochloremia, hypochloremic alkalosis, hyponatremia, hypocalcemia, and associated thirst, fatigue, muscle aches, and arrhythmias. Less common adverse reactions include allergic reactions (including rashes and even cardiac arrest), dizziness, headache, anorexia, nausea, vomiting, abdominal pain, diarrhea, pancreatitis, muscle rigidity, bone marrow suppression leading to granulocytopenia, thrombocytopenic purpura, and aplastic anemia, liver damage, paresthesia of the fingers and toes, hyperglycemia, positive urine glucose, exacerbation of pre-existing diabetes, and hyperuricemia. Tinnitus and hearing impairment are common with high-dose rapid intravenous injection (doses greater than 4-15 mg per minute). These symptoms are usually transient, but a few are irreversible, especially when used concurrently with other ototoxic drugs. In the setting of hypercalcemia, nephrolithiasis may occur. There are also reports of idiopathic edema exacerbated by this drug. Spermatorrhea and erectile dysfunction in unmarried men are rare. Muscle aches and chest pain may occur with high doses. The effect on glucose metabolism may be less than that of furosemide.
[Contraindications]
Not yet established.
[Drug Interactions]
1. Adrenal glycogen, mineralocorticoids, adrenocorticotropic hormone, and estrogen can reduce the diuretic effect of this drug and increase the risk of electrolyte imbalances, especially hypokalemia. 2. Non-steroidal anti-inflammatory analgesics can reduce the diuretic effect of this drug and increase the risk of renal damage, related to their inhibition of prostaglandin synthesis and reduced renal blood flow. 3. Concomitant use with sympathomimetics and anticonvulsants can weaken the diuretic effect. 4. Concomitant use with flufibrate (clofibrate) can enhance the effects of both drugs and may cause muscle soreness and stiffness. 5. Concomitant use with dopamine can enhance the diuretic and antihypertensive effects of this drug. 6. Alcohol, alcohol-containing preparations, and medications that can lower blood pressure can enhance the diuretic and antihypertensive effects of this drug. Concomitant use with barbiturates and anesthetics can easily cause orthostatic hypotension. 7. This drug can decrease uric acid excretion and increase serum uric acid levels. Therefore, when used in combination with gout medications, the dosage of the medication should be adjusted appropriately. 8. Reduces the efficacy of hypoglycemic drugs. 9. Reduces the effects of anticoagulants and antifibrinolytics, primarily due to a decrease in blood volume after diuresis, which leads to increased coagulation factor concentrations in the blood, and improved hepatic blood supply and increased hepatic synthesis of coagulation factors due to diuresis. 10. This drug potentiates the effects of non-depolarizing muscle relaxants, which is related to a decrease in serum potassium. 11. Concomitant use with antibiotics such as amphotericin, cephalosporin, and aminoglycosides may increase nephrotoxicity and ototoxicity, especially in patients with pre-existing renal impairment. 12. Concomitant use with antihistamines may increase ototoxicity, leading to tinnitus, dizziness, and vertigo. 13. Concomitant use with lithium significantly increases nephrotoxicity and should be avoided. 14. Intravenous administration of this drug after taking fluoral hydrate may cause sweating, facial flushing, and increased blood pressure. This is related to increased conversion of bound thyroid hormone to free thyroid hormone, leading to enhanced catabolism. 15. Concomitant use with sodium bicarbonate may increase the risk of hypoxic alkalosis.
[Precautions]
1. Cross-allergy. Patients allergic to sulfonamides and thiazide diuretics may also be allergic to this drug. 2. Interference with diagnosis: It can cause elevated blood sugar and positive urine glucose, especially in patients with diabetes or prediabetes. Excessive dehydration can temporarily increase blood uric acid and urea nitrogen levels. Blood Na+, Cl+, K+, Ca2+, and Mg2+ concentrations can decrease. 3. Use with caution in the following situations: ① Anuria or severe renal impairment; the latter requires higher doses, so the dosing interval should be extended to avoid side effects such as ototoxicity; ② Diabetes; ③ Hyperuricemia or a history of gout; ④ Severe liver impairment, as water and electrolyte imbalances can induce hepatic coma; Acute myocardial infarction, where excessive diuresis can precipitate shock; Pancreatitis or a history of this condition; Patients prone to hypokalemia, especially those using digitalis or with ventricular arrhythmias; Prostatic hypertrophy. 4. Follow-up examinations: ① Blood electrolytes, especially for patients taking concomitant digitalis or corticosteroids, or for those with impaired liver and kidney function; ② Blood pressure, especially for antihypertensive use, high-dose use, or use in the elderly; ③ Renal function; ④ Liver function; Blood sugar; Serum uric acid; ① Acid-base balance; Hearing. 5. Animal studies suggest that this drug can delay fetal growth and ossification. Its effect on newborns and nursing mothers is unclear. It can increase urinary phosphate excretion and interfere with urinary phosphate determination. 6. Use with caution in athletes.
[Pediatric Use]
This drug has a significantly prolonged half-life in newborns, so the dosing interval should be extended.
[Elderly Use]
The elderly are more likely to experience hypotension, electrolyte imbalances, thrombosis, and renal impairment when using this drug.
[Overdose]
This drug has similar effects on water and electrolyte excretion to furosemide, with a diuretic effect 20-60 times greater than furosemide. It primarily inhibits active sodium chloride reabsorption in the thick-walled ascending limb of the medullary tubule. It also inhibits sodium reabsorption in the proximal tubule, but has no effect on the distal tubule, resulting in a less potent potassium excretion effect than furosemide. It inhibits the activity of prostaglandin degrading enzymes, increasing prostaglandin E2 levels and thus exerting a vasodilatory effect. Dilation of renal vasodilation, reduced renal vascular resistance, and increased renal blood flow, particularly in the deep renal cortex, are crucial for bumetanide's diuretic effect and form the theoretical basis for its use in preventing acute renal failure. Furthermore, unlike other diuretics, bumetanide increases tubular fluid flow without decreasing glomerular filtration rate, possibly due to reduced chloride flow through the macula densa, thereby weakening or disrupting glomerular-tubular balance. Bumetanide dilates the pulmonary capacitance veins and reduces pulmonary capillary permeability. Combined with its diuretic effect, this reduces venous return and lowers left ventricular end-diastolic pressure, potentially aiding the treatment of acute left ventricular failure. Since bumetanide can reduce pulmonary capillary permeability, it provides a theoretical basis for the treatment of adult respiratory distress syndrome.
