This medicine blocks the reabsorption of sodium and fluid from the kidney tubules.
Burinex is in a class of diuretics that also includes furosemide (Lasix) and torsemide (Demadex).
The powerful diuretic effect of burinex can cause the loss of large amounts of body fluid, leading to dehydration and loss of electrolytes such as sodium, potassium, magnesium, and calcium.
Therefore, careful medical supervision is necessary during treatment to prevent adverse effects.
Chemical formula of burinex
- The active ingredient is bumetanide C17H20N2O5S.
Burinex is available as 0.5, 1, and 2 mg tablets and 0.25 mg / ml injections.
Burinex mechanism of action
Burinex inhibits sodium reabsorption in the ascending limb of the loop of Henle during hydropenia.
Chloride reabsorption in the ascending limb is also blocked by burinex.
Potassium excretion is also increased by burinex, in a dose-related manner.
Burinex may have an additional action on the proximal tubule.
The recommended dose for most patients is 0.5 to 2 mg orally daily.
Doses can be increased every 4 to 5 hours up to a maximum dose of 10 mg per day.
When oral administration is not possible, intravenous or intramuscular injections can be used instead of tablets.
The intravenous dose is 1 mg initially followed by 0.5 to 2 mg per hour, and the intramuscular dose is 0.5 to 10 mg daily.
Dosage of burinex and other loop diuretics varies greatly for each patient, and dosages must be carefully adjusted by clinicians.
An intermittent dosing schedule, in which burinex tablets are given every other day or for 3 to 4 days, with rest periods of 1 to 2 days, is recommended as the safest and most effective method for continuous control of edema. .
In patients with hepatic impairment, the dose should be kept to a minimum.
Because cross-sensitivity to furosemide has rarely been observed, burinex can be substituted for a 1:40 ratio of burinex to furosemide in patients with furosemide allergies.
Burinex side effects
Strong diuretics like burinex can cause low levels of potassium, magnesium, sodium, and calcium in the blood.
In addition, fluid losses can occur leading to dehydration.
Symptoms of dehydration can include:
- Dry mouth.
- Soft spot.
- Reduced kidney function.
- Arrhythmias of the heart.
- Muscle pains.
Inner ear problems in the form of tinnitus (ringing in the ear) and hearing loss have been associated with loop diuretics such as burinex.
These inner ear effects are much more common with intravenous use of these medications.
High concentrations of uric acid in the blood that lead to attacks of gouty arthritis can occur during diuretic therapy with burinex.
Warnings and Contraindications
The dose of burinex should be adjusted to the needs of each patient.
Burinex is believed to pose particular added risks to the patient with a history of ventricular arrhythmias, as electrolyte disturbances can predispose a patient to serious cardiac arrhythmias.
Prevention of hypokalemia requires special attention in the following conditions:
- Potassium-depleting nephropathy.
- In certain diarrheal states or other states where there is hypokalemia.
Serum potassium should be measured periodically and potassium supplements or potassium-sparing diuretics should be added if necessary.
Supplemental potassium and / or spironolactone may prevent hypokalemia and metabolic alkalosis in these patients.
Elevations of uric acid in the blood (hyperuricemia) can occur, which has been asymptomatic in the cases reported to date.
In addition to reversible elevations in blood urea nitrogen, abnormal creatinine levels can occur , especially in association with dehydration and particularly in patients with renal failure.
Fluid status and kidney function must be monitored to prevent oliguria and azotemia.
Periodic determinations of other electrolytes are recommended in patients treated with high doses or for prolonged periods, particularly in those on low-salt diets.
Diuretics have been shown to increase urinary magnesium excretion and this can lead to hypomagnesemia.
Loop diuretics such as burinex can also decrease serum calcium levels by increasing urinary calcium excretion with resulting hypocalcemia.
Treatment in such patients is best started in the hospital with small doses and careful monitoring of the patient’s clinical status and electrolyte balance.
Potentiation of aminoglycoside ototoxicity has not been proven for burinex, but like other members of this class of diuretics, burinex likely shares this risk.
The risk of ototoxicity occurs with rapid intravenous administration.
Hypersensitivity to burinex or sulfonamides has been documented, patients allergic to sulfonamides may show hypersensitivity to burinex.
Since there have been reports of thrombocytopenia, patients should be observed regularly for the possible occurrence of the condition.
Studies in normal subjects receiving burinex revealed no adverse effects on glucose tolerance, plasma insulin, glucagon, and growth hormone levels, but there is a potential for an effect on glucose metabolism.
For this reason, regular blood sugar determinations should be made, especially in patients with diabetes or suspected latent diabetes.
Patients on treatment should be observed regularly for possible blood dyscrasias, liver damage, or idiosyncratic reactions, which have been occasionally reported.
Use in neonates at risk of kernicterus should be avoided, as the drug is a potent bilirubin displacer in neonates.
If given in the morning hours before surgery, the drug can reduce the volume of the patient and blood pressure can be labile during general anesthesia.
Concomitant administration with an antihypertensive agent may increase the risk of hypotension.
It should be used with caution during pregnancy, and can be given only if the benefits outweigh the risks, as human studies are not yet available.
Regarding breastfeeding, it is unknown whether the drug is excreted in breast milk, so it is recommended not to use the drug while breastfeeding.
Burinex can cause low levels of potassium, calcium, and magnesium in the blood.
These changes can increase the risk of toxicity from digoxin (Lanoxin) if used together.
The combination of burinex with other diuretics such as metolazone (zaroxolyn), hydrochlorothiazide or chlorthalidone (Hygroton) can exaggerate the losses of potassium and magnesium.
The body’s ability to eliminate lithium may be decreased in patients receiving burinex.
Therefore, careful monitoring of lithium blood levels is recommended when taking burinex and lithium together to prevent increases in lithium levels and toxicity.
Indomethacin (Indocin) can reduce the diuretic and blood pressure-lowering effects of other loop diuretics, such as furosemide, and can probably do the same for burinex.
Other non-steroidal anti-inflammatory drugs, such as ibuprofen (Motrin), naproxen (Naprosyn) can interact similarly.
Concomitant use of burinex and aminoglycosides may increase the risk of hearing impairment as both agents can affect hearing.