Loop diuretics (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Note: Furosemide 40mg is equivalent to bumetanide 1mg

 

FUROSEMIDE - (First line)

Therapy notes

Heart failure guidance.

Formulation and dosage details

Formulation:

Tablets 20mg, 40mg, 500mg

Dosage:

Oedema, initially 40mg in the morning, twice daily dosage may be required for nocturnal dyspnoea; maintenance, 20mg to 40mg daily or 40mg on alternate days, higher doses may be required in some patients.

Formulation and dosage details

Formulation:

Oral solution 50mg/5mL

Dosage:

Oedema, initially 40mg in the morning, twice daily dosage may be required for nocturnal dyspnoea; maintenance, 20mg to 40mg daily or 40mg on alternate days, higher doses may be required in some patients.

Formulation and dosage details

Formulation:

Injection 20mg/2mL, 50mg/5mL, 250mg/25mL

Dosage:

By slow intravenous injectionorintramuscular injection, initially 20 to 50mg; by intravenous infusion, refer to BNF (maximum rate 4mg/minute).

BUMETANIDE

Therapy notes

Note: November 2023: Bumetanide 1mg and 5mg tablet shortage.  See MSAN.

Recommendation from the renal & cardiology teams:

  • It is important that patients do not miss diuretics altogether if they run out of bumetanide tablets, or it is not available.
  • Switch patients to furosemide tablets if bumetanide is not available.
  • As a general guide oral furosemide 40mg is approximately equivalent to oral bumetanide 1mg. Some variation can be seen, particularly for patients on higher doses of bumetanide, so patients will need to be more closely monitored.
  • The patient should be advised to seek advice if they have symptoms of low blood pressure or start to become more swollen.
  • Additional renal function testing is not required unless the patient develops symptoms described above.
  • No new patients should be started on bumetanide at present as it is unlikely that they will be able to continue on this over the next few months.
  • Torasemide (non-formulary) is an alternative treatment if a patient is intolerant of furosemide. Torasemide 10mg is equivalent to 0.5mg to 1mg bumetanide. Patients will need to be more closely monitored, as above.

Formulation and dosage details

Formulation:

Tablets 1mg, 5mg

Dosage:

By mouth: 1mg in the morning; twice daily dosage and higher doses for some patients may be required.

Formulation and dosage details

Formulation:

Oral liquid 1mg/5mL

Dosage:

By mouth: 1mg in the morning; twice daily dosage and higher doses for some patients may be required.

Formulation and dosage details

Formulation:

Injection 2mg/4mL unlicensed

Dosage:

By intravenous injection: 1 to 2mg repeated after 20 minutes if necessary; by intravenous infusion, 2 to 5mg over 30 to 60 minutes.

Editorial Information

Document Id: F040