NEODOSE

INDICATIONS

• Heart Failure or Edema: Diuretic used in patients with renal insufficiency, congestive heart failure, or significant edema that is refractory to furosemide. In neonates with pulmonary hypertension, supportive care with diuretics may be used cautiously for signs of right-sided heart failure

CONTRAINDICATIONS

• Anuria
• Hepatic coma until the condition is improved or corrected
• Severe electrolyte depletion until the condition is improved or corrected

PRECAUTIONS

• Concomitant Use:
  • Use with lithium, probenecid, indomethacin, aminoglycosides, and drugs with ototoxic or nephrotoxic potential is not recommended.
• Endocrine & Metabolic:
  • Hypokalemia may occur; therefore, use caution in patients on low-salt diets, receiving digitalis and diuretics for congestive heart failure, with hepatic cirrhosis and ascites, in states of aldosterone excess with normal renal function, potassiumlosing nephropathy, certain diarrheal states, or other states where hypokalemia may add risks to the patient (eg, history of ventricular arrhythmias); monitoring and possible addition of potassium supplementation or potassium-sparing diuretics recommended.
  • Hypocalcemia, hypomagnesemia, and hyperuricemia may occur; monitoring recommended.
• Hematologic:
  • Thrombocytopenia has been reported; monitoring recommended.
• Hepatic:
  • Sudden electrolyte alterations in patients with hepatic cirrhosis andascites mayprecipitate hepatic encephalopathy and coma; initiation should be done on an inpatient basiswith small doses and careful monitoring.
• Immunologic:
  • Patients with a sulfonamide allergy may showhypersensitivity to bumetanide.
• Neurologic:
  • Kernicterus could occur in critically ill or jaundiced neonates at risk for kernicterus; bumetanide displaces bilirubin.
• Otic:
  • Ototoxicity may occur, with an increased risk with IV therapy, frequent and high doses, and impaired renal function
• Renal:
  • Reversible elevations in BUN and creatinine may occur, particularly in patients with dehydration and renal insufficiency.
  • Progressive renal disease with a marked increase in BUN or creatinine or development of oliguria; discontinue.

ADVERSE EFFECTS

Water and electrolyte imbalances occur frequently, especially hyponatremia, hypokalemia, and hypochloremic alkalosis. Potentially ototoxic, but less so than furosemide. May displace bilirubin from albumin binding sites when given in high doses or for prolonged periods.

Bumetanide is a potent diuretic which, if given in excessive amounts, can lead to profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required, and dose and dosage schedule have to be adjusted to the individual patient’s needs

ADMINISTRATION

Intravenous:

• Give undiluted over 1 to 2 minutes.

Oral:

• The intravenous formulation, diluted in sterile water and given orally, has been used successfully in infants with congenital heart disease.

MONITORING

Serum electrolytes and urine output. Assess patients receiving digoxin concurrently for potassium depletion. Follow weight changes.