[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Loop diuretics](https://durgical.com/en/pharmacology/classes/loop-diuretics/) › Bumetanide

[Pharmacology](https://durgical.com/en/pharmacology/) · [Loop diuretics](https://durgical.com/en/pharmacology/classes/loop-diuretics/)

# Bumetanide

A loop diuretic far more potent per milligram than furosemide, with fast onset and short action. Used for oedema.

Updated 2026-11-01

- Class: [Loop diuretics](https://durgical.com/en/pharmacology/classes/loop-diuretics/)
- Transporter: Na⁺-K⁺-2Cl⁻ cotransporter (NKCC2) of the loop of Henle
- ATC code: C03CA02

⇄**Na⁺-K⁺-2Cl⁻ cotransporter (NKCC2) of the loop of Henle**Bumetanide

ⓘ 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.

**Target in 3D:** Na⁺-K⁺-2Cl⁻ cotransporter (NKCC2) of the loop of Henle. PDB structure 9C0H (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/9C0H) · Drag to rotate · pinch to zoom

## 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 →](https://durgical.com/en/conditions/heart-failure/)
- Oedema from liver disease [Cirrhosis →](https://durgical.com/en/conditions/cirrhosis/)
- Oedema from kidney disease, including nephrotic syndrome [Chronic kidney disease →](https://durgical.com/en/conditions/chronic-kidney-disease/)

## Adverse effects

### Common

- Muscle cramps
- Dizziness and low blood pressure
- Hypokalaemia and other electrolyte losses
- High uric acid
- Headache and nausea

### Serious (rare, important)

- Severe fluid and electrolyte depletion
- Ototoxicity, especially with aminoglycosides or kidney failure
- Hepatic encephalopathy in cirrhosis from sudden electrolyte shifts

## 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.

## Memory aid

Bumetanide is the «big brother» of furosemide: a much smaller amount does the same job, faster and shorter.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/bumetanide/)

## Related drugs

- [Furosemide](https://durgical.com/en/pharmacology/furosemide/)
- [Torasemide](https://durgical.com/en/pharmacology/torasemide/)
- [Etacrynic acid](https://durgical.com/en/pharmacology/etacrynic-acid/)

## Related conditions

- [Heart failure](https://durgical.com/en/conditions/heart-failure/)
- [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/)
- [Chronic kidney disease](https://durgical.com/en/conditions/chronic-kidney-disease/)

[← Back to the class: Loop diuretics](https://durgical.com/en/pharmacology/classes/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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2c71a17e-ed76-4545-b23e-9f4997b13c2f) (DailyMed (U.S. National Library of Medicine), 2026); [Bumetanide: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a684051.html) (MedlinePlus (U.S. National Library of Medicine), 2017); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=C03CA02) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [RCSB PDB - 9C0H: Phosphorylated human NKCC1 in complex with bumetanide](https://www.rcsb.org/structure/9C0H) (RCSB Protein Data Bank, 2026).

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Representative model, for educational purposes only.

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