Worst Pills, Best Pills

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Drug Profile

The information on this site is intended to supplement and enhance, not replace, the advice of a physician who is familiar with your medical history. Decisions about your health should always be made ONLY after detailed conversation with your doctor.

Limited Use [what does this mean?]
Generic drug name: bumetanide (byoo MET a nide)
Brand name(s): BUMEX
GENERIC: available FAMILY: Loop Diuretics
Find the drug label by searching at DailyMed.

Limited Use [what does this mean?]
Generic drug name: furosemide (fur OH se mide)
Brand name(s): LASIX
GENERIC: available FAMILY: Loop Diuretics
Find the drug label by searching at DailyMed.

Pregnancy and Breast-feeding Warnings [top]

Pregnancy Warning

These drugs caused fetal harm in animal studies, including growth retardation, delayed development of the bones in the spine, problems with kidney function, and death. Because of the potential for serious adverse effects to the fetus, these drugs should not be used by pregnant women.

Breast-feeding Warning

These drugs are known to be excreted either in animal or human milk. Because of the potential for serious adverse effects in nursing infants, you should not take these drugs while nursing.

Safety Warnings For This Drug [top]

Warning: Thiamine Deficiency With Furosemide

Studies have shown that significant amounts of thiamine (vitamin B1) are lost in the urine of people using furosemide (LASIX) and that patients therefore become thiamine deficient. The researchers found that replenishing thiamine, by taking one 100 milligram pill of thiamine hydrochloride daily for seven weeks, significantly improved heart function in patients who were using furosemide.[1],[2]
It is likely that after replacing the significant thiamine losses with these larger doses, the daily maintenence dose will be less. For now, however, we recommend the use of 100 milligrams of thiamine hydrochloride a day for at least seven weeks in people who have used furosemide chronically. If there seems to be an improvement in your heart status, and your physician agrees, you should continue with a daily dose of about 50 milligrams of thiamine as long as you are taking furosemide.

Heat Stress Alert

These drugs can affect your body’s ability to adjust to heat, putting you at risk of “heat stress.” If you live alone, ask a friend to check on you several times during the day. Early signs of heat stress are dizziness, lightheadedness, faintness, and slightly high temperature. Call your doctor if you have any of these signs. Drink more fluids (water, fruit and vegetable juices) than usual—even if you’re not thirsty—unless your doctor has told you otherwise. Do not drink alcohol.

Facts About This Drug [top]

Bumetanide and furosemide are very strong “water pills” (diuretics) with many adverse effects. They are used to treat fluid retention and high blood pressure. If you are over 60, you should use bumetanide only for reducing fluid retention, and then only if you have decreased kidney function[3] and have already tried a milder drug such as hydrochlorothiazide (ESIDRIX, HYDRODIURIL, MICROZIDE) or the more proven and less expensive furosemide without success.[4] People over 60 years old who have...

Bumetanide and furosemide are very strong “water pills” (diuretics) with many adverse effects. They are used to treat fluid retention and high blood pressure. If you are over 60, you should use bumetanide only for reducing fluid retention, and then only if you have decreased kidney function[3] and have already tried a milder drug such as hydrochlorothiazide (ESIDRIX, HYDRODIURIL, MICROZIDE) or the more proven and less expensive furosemide without success.[4] People over 60 years old who have normal kidney function should rarely, if ever, use bumetanide or furosemide.[5]

The World Health Organization recommends that furosemide should not be used for the treatment of high blood pressure in older adults because it has been associated with the occurrence of stroke.[6] Older adults are more likely than others to develop blood clots, shock, dizziness, confusion and insomnia, and to have an increased risk of falling while taking bumetanide or furosemide.[7]

If you have high blood pressure, the best way to reduce or eliminate your need for medication is by improving your diet, losing weight, exercising, and decreasing your salt and alcohol intake. Mild hypertension can be controlled by proper nutrition and exercise. If these measures do not lower your blood pressure enough and you need medication, hydrochlorothiazide (ESIDRIX, HYDRODIURIL, MICROZIDE), a water pill, is the drug of choice, starting with a low dose of 12.5 milligrams daily. It also costs less than other blood pressure drugs.

There is growing evidence that thiazide diuretics, such as hydrochlorothiazide, significantly decrease the rate of bone mineral loss in both men and women because they reduce the amount of calcium lost in the urine.[8] Research now suggests that thiazide diuretics may protect against hip fracture.[9]

If your high blood pressure is more severe, and hydrochlorothiazide alone does not control it, another family of high blood pressure-lowering drugs may be added to your treatment. In this case, your doctor would prescribe the hydrochlorothiazide and the second drug separately, with the dose of each drug adjusted to meet your needs, rather than using a product that combines the drug in a fixed combination.

Whatever drugs you take for high blood pressure, once your blood pressure has been normal for a year or more, a cautious decrease in dose and renewed attention to nondrug treatment may be worth trying, according to The Medical Letter.[10]

An editorial in the British Medical Journal (BMJ) stated: “Treatment of hypertension is part of preventive medicine and like all preventive strategies, its progress should be regularly reviewed by whoever initiates it. Many problems could be avoided by not starting antihypertensive treatment until after prolonged observation....Patients should no longer be told that treatment is necessarily for life: the possibility of reducing or stopping treatment should be mentioned at the outset.”[11]

The May 2012 issue of Worst Pills, Best Pills News highlighted a recent BMJ study indicating that patients taking several types of commonly used antihypertensive medications are at increased risk of developing gout, a type of arthritis.

The BMJ study also showed that a small number of other antihypertensive drugs appear to have the opposite effect, decreasing the risk of gout.

All patients should be informed of the risk of gout with diuretics, beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors) and non-lorsartan angiotensin II receptor blockers (ARBs) when starting these medications or whenever the dose of the medications is increased [12].

The April 2013 issue of Worst Pills, Best Pills News discusses another recent BMJ study. This study suggests that an increased risk of acute kidney injury (AKI) is associated with combining nonsteroidal anti-inflammatory drugs (NSAIDs) with two antihypertensive drugs: a diuretic plus either an ACE inhibitor or an ARB. The risk was found to be highest during the first 30 days of starting an NSAID in patients who also are already taking a diuretic plus an ACE inhibitor or an ARB.

The study found that patients currently using a triple-therapy combination — a diuretic, an ACE inhibitor or an ARB, and an NSAID — have a 31 percent greater risk of developing AKI compared with current users of a diuretic plus an ACE inhibitor or an ARB without an NSAID.[13]

Before You Use This Drug [top]

Do not use if you have or have had:

  • a sensitivity to sulfa drugs (sulfonamides) or yellow dye #5

Tell your doctor if you have or have had:

  • allergies to drugs
  • diabetes
  • kidney, liver, or pancreas problems
  • gout
  • hearing loss
  • recent heart attack
  • history of irregular heartbeats
  • lupus erythematosus
  • salt- or sugar-restricted diet
  • pregnancy or are breast-feeding
  • have diarrhea
  • low urine output

Tell your doctor about any other drugs you take, including aspirin, herbs, vitamins, and other nonprescription products.

When You Use This Drug [top]

  • Check with your doctor to make certain your fluid intake is adequate and appropriate. Because bumetanide is a very strong water pill, you are in danger of becoming dehydrated.
  • You may feel dizzy when rising from a lying or sitting position. When getting up from bed, hang your legs over the side of the bed for a few minutes, then get up slowly. When getting up from a chair, stay beside the chair until you are sure that you are not dizzy. 
  • Bumetanide and furosemide will cause your body to lose potassium, an important mineral. See section on potassium supplementation for information on how to make sure you get enough potassium.
  • Bumetanide can cause a loss of hearing, which is usually temporary but may be permanent. The risk of hearing loss is greater if you are also using amphotericin B or an antibiotic from the aminoglycoside family such as gentamicin (GARAMYCIN) or tobramycin (TOBREX).
  • If you plan to have any surgery, including dental, tell your doctor that you take this drug.
  • Do not take other drugs without first talking to your doctor—especially nonprescription drugs for appetite control, asthma, colds, coughs, hay fever, or sinus problems.

How to Use This Drug [top]

  • If you miss a dose, take it as soon as you remember, but skip it if it is almost time for the next dose. Do not take double doses.
  • Do not share your medication with others.
  • Take the drug at the same time(s) each day.
  • Take with food or milk to avoid stomach irritation.
  • Tablet may be crushed and mixed with food or drink.
  • If you are taking bumetanide more than once a day, try to take the last dose before 6 p.m. This will help you avoid interrupting your sleep to go to the bathroom.
  • Store at room temperature with lid on tightly. Do not store in the bathroom. Do not expose to heat, moisture, or strong light. Keep out of reach of children.

Interactions with Other Drugs [top]

The following drugs, biologics (e.g., vaccines, therapeutic antibodies), or foods are listed in Evaluations of Drug Interactions 2003 as causing “highly clinically significant” or “clinically significant” interactions when used together with any of the drugs in this section. In some sections with multiple drugs, the interaction may have been reported for one but not all drugs in this section, but we include the interaction because the drugs in this section are similar to one another. We have also included potentially serious interactions listed in the drug’s FDA-approved professional package insert or in published medical journal articles. There may be other drugs, especially those in the families of drugs listed below, that also will react with this drug to cause severe adverse effects. Make sure to tell your doctor and pharmacist the drugs you are taking and tell them if you are taking any of these interacting drugs:

ACTH, acebutolol, ALFENTA, alfentanil, amlodipine, CAPOTEN, captopril, cephalexin, charcoal, chlorpropamide, cholestyramine, cisplatin, DIABINESE, digoxin, ELIXOPHYLLIN, ESKALITH, INDERAL, INDERAL LA, KEFLEX, LANOXICAPS, LANOXIN, lithium, LITHOBID, LITHONATE, LOCHOLEST, NEBCIN, NORVASC, PLATINOL, propranolol, QUESTRAN, SECTRAL, SLO-BID, THEO-24, theophylline.

Adverse Effects [top]

Call your doctor immediately if you experience:

  • signs of potassium loss: dry mouth, increased thirst, irregular heartbeat, mood or mental changes, muscle cramps or pain, nausea, vomiting, unusual tiredness or weakness, weak pulse
  • skin rash or hives
  • chest pain
  • nipple tenderness
  • black, tarry stools
  • blood in urine or stools
  • cough or hoarseness
  • fever
  • chills
  • joint, lower back, or side pain
  • painful or difficult urination
  • pinpoint red spots on skin
  • ringing or buzzing in ears or hearing loss
  • dizziness or lightheadedness
  • severe stomach pain with nausea or vomiting
  • unusual bleeding or bruising
  • yellow eyes or skin
  • yellow vision

Call your doctor if these symptoms continue:

  • dizziness, lightheadedness
  • diarrhea
  • loss of appetite
  • upset stomach
  • headache
  • blurred vision
  • premature ejaculation or difficulty with erection
  • chest pain

Periodic Tests[top]

Ask your doctor which of these tests should be done periodically while you are taking this drug:

  • blood pressure
  • complete blood count
  • blood levels of sodium, potassium, chloride, calcium, sugar, and uric acid
  • liver function tests
  • kidney function tests
  • weight measurement
  • carbon dioxide measurement

last reviewed March 31, 2021