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Enbumyst
bumetanide nasal
Adult Dosing .
Dosage forms: SPRAY: 0.5 mg per actuation
edema
- [0.5-2 mg intranasally qd]
- Max: 2 mg/day; Info: for patients w/ CHF, hepatic disease, or renal disease; alternate nostrils w/ each spray; switch to PO ASAP
renal dosing
- [see below]
- anuria: contraindicated
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic coma: contraindicated
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- anuria
- electrolyte depletion, severe
- hepatic coma
- nasal mucosal abnormality (nasal use)
- nasal structural abnormality (nasal use)
- caution: hypersensitivity to sulfonamides
- caution: elderly patients
- caution: renal impairment
- caution: hepatic impairment
- caution: cirrhosis
- caution: ascites
- caution: diabetes mellitus
- caution: MI, acute
- caution: arrhythmia
- caution: hearing impairment
- caution: ototoxic agent use, concurrent
- caution: SLE
- caution: gout history
- caution: pancreatitis history
- caution: HTN, gestational
Drug Interactions .
Overview
bumetanide
loop diuretic
- OAT1 substrate
- OAT3 substrate
- antihypertensive agent
- binds to anion exchange resin/polymer
- decreases renal perfusion/fxn
- diuretic
- fluid/electrolyte loss
- hyperglycemic effects
- hyperuricemic effects
- hypocalcemia
- hypokalemia
- hypomagnesemia
- hyponatremia
- ototoxicity
Contraindicated
- desmopressin
- isocarboxazid
Avoid/Use Alternative
- acyclovir
- adefovir dipivoxil
- aldesleukin
- allopurinol
- amikacin
- amikacin inhaled
- amphotericin
- anthrax immune globulin
- aripiprazole lauroxil
- aspirin
- auranofin
- balsalazide
- botulism immune globulin
- capecitabine
- carboplatin
- cefepime
- cefpodoxime
- ceftazidime
- celecoxib
- cidofovir
- cisplatin
- clindamycin
- clofarabine
- colistimethate
- creatine
- cyclophosphamide
- cyclosporine
- cytomegalovirus immune globulin
- deferasirox
- deferoxamine
- diclofenac
- diclofenac topical
- diflunisal
- ethacrynic acid
- etodolac
- fenoprofen
- flucytosine
- flurbiprofen
- foscarnet
- furosemide
- ganciclovir
- gentamicin
- ibuprofen
- ibuprofen lysine
- ifosfamide
- immune globulin
- indomethacin
- iohexol
- iomeprol
- iopamidol
- irinotecan
- ketoprofen
- ketorolac
- lithium
- lofexidine
- lutetium Lu 177 vipivotide tetraxetan
- magnesium salicylate
- mannitol
- meclofenamate
- mefenamic acid
- meloxicam
- mesalamine
- mesalamine rectal
- methotrexate
- mitomycin
- nabumetone
- neomycin
- neomycin otic
- nusinersen
- olsalazine
- oxaliplatin
- oxaprozin
- pamidronate
- paromomycin
- pemetrexed
- penicillamine
- pentamidine
- pentostatin
- piroxicam
- plazomicin
- polymyxin B
- probenecid
- Rho(D) immune globulin
- rituximab
- ropeginterferon alfa-2b
- sirolimus
- sitagliptin
- sparsentan
- streptomycin
- streptozocin
- sulindac
- tacrolimus
- telavancin
- temsirolimus
- tenofovir alafenamide
- tenofovir disoproxil
- tiopronin
- tobramycin
- tobramycin inhaled
- tolmetin
- torsemide
- vaccinia immune globulin
- valacyclovir
- valganciclovir
- vancomycin
- vardenafil
- voclosporin
- zoledronic acid
Monitor/Modify Tx
- abiraterone acetate
- acarbose
- acetazolamide
- albuterol
- albuterol inhaled
- alendronate
- alfentanil
- alfuzosin
- aliskiren
- almotriptan
- aloe
- alogliptin
- amantadine
- amifostine
- amiloride
- amitriptyline
- amoxapine
- amphetamine
- apomorphine
- apraclonidine ophthalmic
- apremilast
- arformoterol inhaled
- aripiprazole bimonthly injection
- aripiprazole monthly injection
- aripiprazole oral
- armodafinil
- arsenic trioxide
- articaine
- asciminib
- asenapine
- asparaginase
- atogepant
- atomoxetine
- atropine ophthalmic
- avanafil
- axitinib
- azilsartan medoxomil
- benazepril
- benzphetamine
- berberine
- betamethasone
- betaxolol ophthalmic
- bethanechol
- bevacizumab
- bexagliflozin
- bismuth subsalicylate
- bortezomib
- brexpiprazole
- brigatinib
- brimonidine ophthalmic
- brimonidine topical
- bromocriptine
- budesonide
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- bupropion
- butalbital
- butorphanol
- cabergoline
- cabozantinib
- caffeine
- caffeine citrate
- calcitonin-salmon
- canagliflozin
- candesartan cilexetil
- cannabis
- captopril
- carbamazepine
- carfilzomib
- cariprazine
- carteolol ophthalmic
- cefprozil
- cefuroxime sodium
- cetuximab
- chloroprocaine
- chloroquine
- chlorothiazide
- chlorpromazine
- chlorthalidone
- cholestyramine
- cilostazol
- cinacalcet
- citalopram
- clomipramine
- clonidine
- clozapine
- cocaine
- codeine
- coenzyme Q-10
- colesevelam
- colestipol
- copanlisib
- corticotropin
- cortisone
- crizotinib
- danazol
- dapagliflozin
- darbepoetin alfa
- decitabine
- deflazacort
- denileukin diftitox
- denosumab
- desflurane
- desipramine
- desvenlafaxine
- dexamethasone
- dexlansoprazole
- dexmedetomidine
- dexmedetomidine injection
- dexmethylphenidate
- dextroamphetamine
- diazoxide
- dichlorphenamide
- diethylpropion
- digoxin
- dihydrocodeine
- dihydroergotamine
- dinutuximab
- dipyridamole
- docetaxel
- dofetilide
- doxapram
- doxazosin
- doxepin
- dronabinol
- droxidopa
- dulaglutide
- duloxetine
- eflornithine
- eletriptan
- emapalumab
- empagliflozin
- enalapril
- enalaprilat
- entacapone
- entrectinib
- enzalutamide
- ephedra
- ephedrine injection
- ephedrine oral
- epinephrine
- epinephrine inhaled
- epoetin alfa
- epoprostenol
- eptinezumab
- erenumab
- ergotamine
- ertugliflozin
- escitalopram
- esketamine
- eslicarbazepine acetate
- esomeprazole
- estetrol (contraceptive)
- estradiol (contraceptive)
- etelcalcetide
- ethanol
- ethinyl estradiol (contraceptive)
- etrasimod
- exenatide
- febuxostat
- fenfluramine
- fentanyl
- ferumoxytol
- fingolimod
- flaxseed
- flibanserin
- fludarabine
- fludrocortisone
- fluoxetine
- fluphenazine
- fluvoxamine
- formoterol inhaled
- fosinopril
- foslevodopa
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- galcanezumab
- garlic
- gilteritinib
- glimepiride
- glipizide
- glyburide
- guanfacine
- haloperidol
- hoodia
- hydralazine
- hydrochlorothiazide
- hydrocodone
- hydrocortisone
- hydromorphone
- hydroxocobalamin IV
- ibandronate
- ibrutinib
- iloperidone
- iloprost
- iloprost inhaled
- imipramine
- indapamide
- insulin
- irbesartan
- iron sucrose
- isoflurane
- isoproterenol
- isosorbide dinitrate
- isosorbide mononitrate
- isotretinoin
- itraconazole
- ketamine
- landiolol
- lanreotide
- lansoprazole
- leflunomide
- lenalidomide
- lenvatinib
- levalbuterol inhaled
- levobunolol ophthalmic
- levodopa
- levomilnacipran
- levorphanol
- levothyroxine
- licorice
- lidocaine
- linagliptin
- linezolid
- liothyronine
- liraglutide
- lisdexamfetamine
- lisinopril
- lixisenatide
- lorlatinib
- losartan
- loxapine
- lubiprostone
- lumacaftor/ivacaftor
- lumateperone
- lurasidone
- luspatercept
- magnesium citrate
- magnesium sulfate
- maraviroc
- meperidine
- mepivacaine
- metformin
- methadone
- methamphetamine
- methazolamide
- methohexital
- methoxy polyethylene glycol-epoetin beta
- methylene blue injection
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metoclopramide
- metolazone
- midazolam
- midodrine
- mifepristone
- miglitol
- milnacipran
- milrinone
- mirabegron
- mirtazapine
- modafinil
- moexipril
- molindone
- morphine
- motixafortide
- nalbuphine
- naphazoline ophthalmic
- naproxen
- naratriptan
- nateglinide
- nattokinase
- naxitamab
- necitumumab
- niacin (vitamin B3)
- nilotinib
- niraparib
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- nortriptyline
- obinutuzumab
- olanzapine
- oliceridine
- olmesartan medoxomil
- olodaterol inhaled
- omeprazole
- opicapone
- opium
- osilodrostat
- oxazepam
- oxcarbazepine
- oxycodone
- oxymetazoline nasal
- oxymetazoline ophthalmic
- oxymetazoline topical
- oxymorphone
- oxytocin
- ozanimod
- paliperidone
- palopegteriparatide
- panitumumab
- pantoprazole
- paroxetine
- patiromer
- pazopanib
- pegloticase
- pentazocine
- pentobarbital
- pentoxifylline
- perindopril
- perphenazine
- pexidartinib
- phendimetrazine
- phenelzine
- phenobarbital
- phentermine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- pioglitazone
- polyethylene glycol
- polyethylene glycol/electrolytes
- ponatinib
- ponesimod
- posaconazole
- pralsetinib
- pramipexole
- pramlintide
- prazosin
- prednisolone
- prednisone
- primidone
- procarbazine
- prochlorperazine
- promethazine
- propafenone
- propofol
- protriptyline
- pseudoephedrine
- quetiapine
- quinapril
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quinine
- rabeprazole
- ramipril
- ramucirumab
- rasagiline
- rasburicase
- regorafenib
- remifentanil
- remimazolam
- repaglinide
- rimegepant
- riociguat
- ripretinib
- risedronate
- risperidone
- rizatriptan
- romidepsin
- romosozumab
- ropinirole
- ropivacaine
- rosiglitazone
- rotigotine transdermal
- sacituzumab govitecan
- sacubitril
- safinamide
- salmeterol inhaled
- salsalate
- saxagliptin
- selegiline
- selegiline transdermal
- selinexor
- selpercatinib
- semaglutide
- sertraline
- sevelamer
- sevoflurane
- sildenafil
- silodosin
- siponimod
- sirolimus albumin-bound
- sodium benzoate
- sodium ferric gluconate complex
- sodium phenylacetate
- sodium phenylbutyrate
- sodium phosphate rectal
- sodium picosulfate
- sodium polystyrene sulfonate
- sodium thiosulfate
- sorafenib
- sotagliflozin
- sotalol
- spironolactone
- sufentanil
- sulfate bowel prep
- sumatriptan
- sunitinib
- tadalafil
- tafasitamab
- tagraxofusp
- tamsulosin
- tapentadol
- taurine
- telmisartan
- teprotumumab
- terazosin
- terbutaline
- teriflunomide
- testosterone
- tetrahydrozoline ophthalmic
- thalidomide
- thioridazine
- thiothixene
- thyroid
- timolol ophthalmic
- tirzepatide
- tivozanib
- tizanidine
- tolcapone
- topiramate
- tramadol
- trametinib
- trandolapril
- tranylcypromine
- trastuzumab
- trazodone
- treprostinil
- triamcinolone
- triamterene
- trifluoperazine
- trimipramine
- ubrogepant
- vadadustat
- valsartan
- vamorolone
- vandetanib
- vasopressin
- venlafaxine
- vilanterol inhaled
- vilazodone
- viloxazine
- vinblastine
- vincristine
- vinorelbine
- vonoprazan
- vortioxetine
- vosoritide
- willow bark
- yohimbe
- zavegepant
- ziprasidone
- ziv-aflibercept
- zolmitriptan
- zonisamide
Caution Advised
- cabotegravir
- fexinidazole
- gemfibrozil
- ginseng, Asian
- meropenem
- nitisinone
- pretomanid
- trimethoprim
- vaborbactam
Adverse Reactions .
Serious Reactions
- hypokalemia, severe
- electrolyte imbalance, severe
- metabolic alkalosis
- hypovolemia
- dehydration
- ECG abnormalities
- renal failure
- hepatic encephalopathy
- thrombocytopenia
- arrhythmia
- ototoxicity
- pancreatitis
- SLE exacerbation
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
Common Reactions
- hyperuricemia
- hypochloremia
- hypokalemia
- azotemia
- hyponatremia
- Cr elevated
- hyperglycemia
- electrolyte abnormalities
- muscle cramps
- dizziness
- hypotension
- hypovolemia
- headache
- nausea
- photosensitivity
Safety/Monitoring .
Monitoring Parameters
BUN/Cr, serum CO2, electrolytes frequently early in tx, then periodically; CBC; Plt; LFTs; urine/ blood glucose especially if diabetes or suspected latent diabetes
Look/Sound-Alike Drug Names
bumetanide confused with: budesonide
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; inadequate human data available, though risk of teratogenicity not expected based on limited human data w/ other loop diuretics; possible risk of decr. placental perfusion based on drug's mechanism of action
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding, esp. in high-risk infants; no human data available to assess risk of infant harm; no human data available, though possible decr. milk production based on limited human data w/ other loop diuretics
Pharmacology .
Metabolism: liver; CYP450: unknown
Excretion: urine 81% (45% unchanged), bile 2%; Half-life: 1-1.5h (PO or INJ form), 3h (nasal form)
Subclass: Diuretics, Loop
Mechanism of Action
inhibits loop of Henle and proximal and distal convoluted tubule sodium and chloride resorption
Formulary .
No Formulary Selected
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