Bumetanide !
A loop diuretic far more potent per milligram than furosemide, with fast onset and short action. Used for oedema.
Updated 2026-11-01
The figure shows bumetanide bound to human NKCC1, the closely related cotransporter found outside the kidney; NKCC2, the renal target, belongs to the same family and binds loop diuretics in the same way.
Mechanism of action
Bumetanide blocks the Na⁺-K⁺-2Cl⁻ cotransporter (NKCC2) in the thick ascending limb of the loop of Henle, so sodium, potassium and chloride stay in the urine and water follows. It may also act a little in the proximal tubule, where it increases phosphate excretion.
- Bumetanide blocks NKCC2 in the thick ascending limb
- Na⁺, K⁺ and Cl⁻ stay in the urine and water follows
- Fast, short diuresis
- K⁺, Mg²⁺ and Ca²⁺ are lost too
Pharmacokinetics
- Distribution
- Highly bound to plasma proteins
- Metabolism
- Partly metabolised; part is excreted unchanged
- Elimination
- Mostly in the urine
- Half-life
- Between 1 and 1½ hours in adults; much longer in newborns
- Onset and duration
- IV: diuresis within minutes, peaking in 15 to 30 minutes
Indications
- Oedema from heart failure Heart failure →
- Oedema from liver disease Cirrhosis →
- Oedema from kidney disease, including nephrotic syndrome Chronic kidney disease →
Adverse effects
Common
- Muscle cramps
- Dizziness and low blood pressure
- Hypokalaemia and other electrolyte losses
- High uric acid
- Headache and nausea
Contraindications
- Anuria
- Hepatic coma
- Severe electrolyte depletion until corrected
- Hypersensitivity to bumetanide
Key interactions
- Aminoglycosides and other ototoxic drugs
- More ototoxicity; avoided with IV bumetanide in kidney impairment
- Indometacin
- Blunts the diuretic effect; the combination is not recommended
- Lithium
- Less lithium clearance and risk of toxicity
- Digoxin
- Hypokalaemia increases digoxin toxicity
What is monitored
- Potassium and other electrolytes
- Kidney function
- Weight and fluid balance
- Blood pressure
- Hearing
Administration and safety
- Given by mouth, IV or IM; IV doses are given slowly.
- Much more potent per milligram than furosemide: they are not interchangeable milligram for milligram, so check the drug name and product carefully.
- IV solutions are prepared fresh and used promptly.
Nursing care
- Before giving: blood pressure, potassium and kidney function.
- Daily weight, intake and output, signs of dehydration.
- Watch for low potassium and muscle cramps; ask about hearing changes.
- Teach: rise slowly, report dizziness, cramps or ringing in the ears.
Pregnancy and breastfeeding
Not a usual treatment in pregnancy; used only if clearly needed.
Test yourself
Think of the answer, then tap the question to see it.
How does bumetanide compare with furosemide?
Same target (NKCC2) and effects, but much more potent per milligram, with a fast onset and short action.
Which painkiller blunts the effect of bumetanide?
Indometacin (an NSAID), which reduces its natriuretic effect; the combination is not recommended.
Which patients can react to bumetanide because of another drug allergy?
People allergic to sulfonamides may also react to bumetanide.
Related drugs
Related conditions
← Back to the class: Loop diuretics
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - BUMETANIDE injection (DailyMed (U.S. National Library of Medicine), 2026); Bumetanide: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2017); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); RCSB PDB - 9C0H: Phosphorylated human NKCC1 in complex with bumetanide (RCSB Protein Data Bank, 2026).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.