Urinide 1

Indication
Hypertension, Heart failure, Oedema, Nephrotic syndrome
Administration
May be taken with or without food. May be taken w/ meals to reduce GI discomfort.
Adult Dose
Oral Oedema Adult: 1 mg once daily. Give 2nd dose 6-8 hr later if necessary. Elderly: 0.5 mg daily. Refractory oedema Adult: Initially, 5 mg daily increased by 5 mg every 12-24 hr as required. High doses may be divided in 2-3 doses. Max: 10 mg/day. Hypertension Adult: 0.5-1 mg daily. Max: 5 mg/day. Parenteral Emergency cases of oedema Adult: 0.5-1 mg via slow IV/IM inj, subsequently adjust dose according to response. Intravenous Pulmonary oedema Adult: 1-2 mg IV repeated 20 min later if necessary, or 2-5 mg in 500 ml of a suitable infusion fluid given over 30-60 min.

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Contraindication
Hypersensitivity, progressive renal failure and anuria, hepatic coma, severe electrolyte depletion.
Mode of Action
Bumetanide induces diuresis by inhibiting reabsorption of water and electrolytes (sodium and chloride) in the ascending loop of Henle and proximal renal tubule.
Precaution
Pregnancy, lactation; regular monitoring of serum electrolytes (especially potassium, calcium, magnesium); in case of hypokalemia, potassium supplements/potassium-sparing diuretics added. Monitor blood-glucose, BUN, creatinine levels as well as blood counts. Sulfonamide allergy. CHF patients on digitalis, K losing nephropathy, hepatic cirrhosis and ascitis, diarrhoeal states. Lactation: Unknown whether drug is excreted in breast milk; use with caution

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Side Effect
>10% Hyperuricemia (18%),Hypochloremia (15%),Hypokalemia (15%),Azotemia (11%) 1-10% Hyponatremia (9%),Hyperglycemia (7%),Increased serum creatinine (7%),Variations in phosphorus (5%),Variations in CO2 content (4%),Variations in bicarbonate (3%),Variations in calcium (2%),Dizziness (1%),Muscle cramps (1%),Ototoxicity (1%) <1% Asterixis,Dehydration,Hypotension,Orthostatic hypotension,Pruritus,Rash,Renal failure,Serious skin reactions (ie, Stevens-Johnson syndrome, toxic epidermal necrolysis),Vertigo,Vomiting Potentially Fatal: Encephalopathy (in patients with preexisting liver disease). _ Pregnancy Category Note Pregnancy category: C Lactation: Unknown whether drug is excreted in breast milk; use with caution _ Interaction Reduced diuretic and natriuretic actions by probenecid. Indometacin blunts action of bumetanide; concurrent usage with antihypertensives may increase risk of orthostatic hypotension. Potentially Fatal: Avoid concurrent usage with ototoxic drugs such as aminoglycoides and nephrotoxic drugs. Reduced lithium excretion via kidneys. _