Burinex® (bumetanide) is a loop diuretic with a short duration of action. It is indicated for the treatment of oedema, particularly when associated with congestive heart failure, hepatic and renal diseases. It is available only with a doctor's prescription.

Contraindications

Although Burinex can be used to induce diuresis in renal insufficiency, any marked increase in blood urea or the development of oliguria or anuria during treatment of severe progressing renal disease are indications for stopping treatment with Burinex.

Hypersensitivity to bumetanide. Burinex should not be used in the presence of electrolyte depletion, precoma associated with hepatic cirrhosis or anuria.

As with other diuretics, Burinex should not be administered (on a continuous basis) to patients taking lithium salts.



Special warnings and precautions for use

Fluid and electrolyte state should be monitored regularly to avoid inadequate potassium levels or excessive loss of fluid.

Burinex should be used with caution in patients with potential obstruction of the urinary tract or with disorders rendering their electrolyte balance precarious.

Excessively rapid mobilisation of oedema, particularly in elderly patients, may give rise to sudden changes in cardiovascular pressure-flow relationships with circulatory collapse. This should be borne in mind during treatment with high oral doses of Burinex. Burinex may aggravate severe pre-existing electrolyte imbalance, particularly in patients on a low salt diet.

In patients with severe chronic renal failure treated with high doses of Burinex, there have been reports of severe generalised mucoskeletal pain sometimes associated with muscle spasm, occurring one or two hours after administration and lasting for up to 12 hours. Occasionally analgesic medication has been required to treat the pain. All patients recovered fully and there was no deterioration in their renal function. The cause of this pain is uncertain but may be a result of varying electrolyte gradients at the cell membrane level. Experience suggests that the incidence of such reactions is reduced by initiating treatment at 5-10 mg daily and titrating upwards, using a twice daily dosage regimen, at doses of 20 mg per day or more. When using more than 10 mg per day expert advice should be sought. Patients with chronic renal failure on high doses of bumetanide should remain under constant hospital supervision.

This preparation may induce hyperglycaemia, particularly in patients with latent diabetes.

Bone marrow depression rarely complicates treatment necessitating withdrawal of the drug.