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Burinex ® Tablets

Burinex is a high-ceiling loop diuretic with fast onset and long duration of action.

Ingredient: Bumetanide 1 mg
Multinational Partner: LEO
Launch Date: October 4, 1978
Pack: Box of 2 strips each of 10 tablets

Product General

Disease Area

Edema (from the Greek "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid in the interstitium, which are locations beneath the skin or in one or more cavities of the body. It is clinically shown as swelling. Generally, the amount of interstitial fluid is determined by the balance of fluid homeostasis, and increased secretion of fluid into the interstitium or impaired removal of this fluid may cause edema.

Five factors can contribute to the formation of edema:

  1. It may be facilitated by increased hydrostatic pressure 
  2. Reduced oncotic pressure within blood vessels;
  3. Increased blood vessel wall permeability as in inflammation;
  4. Obstruction of fluid clearance via the lymphatic system; or,
  5. Changes in the water retaining properties of the tissues themselves. Raised hydrostatic pressure often reflects retention of water and sodium by the kidney

Some of the causes of edema include:

  1. Low albumin (hypoalbuminemia): Albumin and other proteins in the blood act like sponges to keep fluid in the blood vessels. Low albumin may contribute to edema, but isn't usually the sole cause.
  2. Allergic reactions: Edema is a usual component of most allergic reactions. In response to the allergic exposure, the body allows nearby blood vessels to leak fluid into the affected area.
  3. Obstruction of flow: If the drainage of fluid from a body part is blocked, fluid can back up. A blood clot in the deep veins of the leg can result in leg edema. A tumor blocking lymph or blood flow will cause edema in the affected area.
  4. Critical illness: Burns, life-threatening infections, or other critical illnesses can cause a whole-body reaction that allows fluid to leak into tissues almost everywhere. Widespread edema throughout the body can result.
  5. Edema and heart disease (congestive heart failure): When the heart weakens and pumps blood less effectively, fluid can slowly build up, creating leg edema. If fluid buildup occurs rapidly, fluid in the lungs (pulmonary edema) can develop.
  6. Edema and liver disease: Severe liver disease (cirrhosis) results in an increase in fluid retention. Cirrhosis also leads to low levels of albumin and other proteins in the blood. Fluid leaks into the abdomen (called ascites), and can also produce leg edema.
  7. Edema and kidney disease: A kidney condition called nephrotic syndrome can result in severe leg edema, and sometimes whole-body edema (anasarca).
  8. Edema and pregnancy: Due to an increase in blood volume during pregnancy and pressure from the growing womb, mild leg edema is common during pregnancy. However, serious complications of pregnancy such as deep vein thrombosis and preeclampsia can also cause edema.
  9. Cerebral edema (brain edema): Swelling in the brain can be caused by head trauma, low blood sodium (hyponatremia), high altitude, brain tumors, or an obstruction to fluid drainage (hydrocephalus). Headaches, confusion, and unconsciousness or coma can be symptoms of cerebral edema.

Diagnosis of edema:

A GP (general practitioner, primary care physician) will want to determine what the underlying cause of the edema is. The patient will be asked questions about his/her:

  • Medical history.
  • Current state of health.
  • How long the signs and symptoms have existed.
  • How permanent or intermittent the signs and symptoms are.
  • Whether the patient has had edema before.

 

The physician will also carry out a physical exam. If there are indications that there may be an underlying medical condition causing the edema the doctor may order some tests, these may include:

  • A chest X-ray
  • Blood tests
  • Urine tests
  • Liver function tests
  • Heart function tests

 

 

Insert leaflet

TABLETS:

Bumetanide 1 mg – For oral use

INDICATIONS:

BURINEX is indicated whenever diuretic therapy is required in the treatment of oedema e.g. associated with congestive heart failure, cirrhosis of the liver, renal diseases including the nephrotic syndrome. Acute pulmonary oedema, drug–induced fluid retention, and drug poisoning that can be treated by forced diuresis. Hypertension.

DOSAGE:

Orally: 1 mg daily.

In refractory cases the dose can be increased gradually till a satisfactory response has been obtained. Rarely will it be necessary to exceed a dose of 4 mg daily. The 5 mg tablet is for use in resistant oedema due to renal insuffi-ciency and where higher doses are required. In high dose therapy consideration should be given to a twice daily dosing.

Children: The dose is calculated on the basis of 0.03–0.06 mg/kg daily.

Elderly: Adjust dosage according to response; a dose of 0.5 mg daily may be sufficient in some elderly patients.

Publications

1-Documents Section

Anticonvulsant action of Burinex


Burinex and Hepatic impairment


Comprehensive review of loop diuretics


Burinex; A potent diuretic

Guidelines
Heart Failure guidelines 2013

Attached Files

2006_heart_failure_guideline_sec_111.pdf
05020.pdf
Q & A
Examide (torsemide) is the new generation of loop diuretics and supposed to be more potent. Does BURINEX have a weak diuretic effect in comparison to Examide?

Growing evidence demonstrates more favorable pharmacokinetic profiles of torsemide & bumetanide compared with furosemide. Furthermore, torsemide may be more efficacious and safer than furosemide in patients with HF. A trial comparing all 3 drugs would be required to confirm torsemide as the primary loop diuretic in patients with HF, but based upon limited current evidence, we recommend torsemide over furosemide. Currently, little evidence exists to support either torsemide or bumetanide as first line treatment over furosemide in patients with other edematous disease states. The Annals of Pharmacotherapy: Vol. 43, No. 11, pp. 1836-1847. 2009

Is it the First Choice to treat any Ascitis related to liver cirrhosis? or encephalopathy may develop?

Bumetanide was compared with furosemide in patients with ascites, a complication of chronic liver disease. In an open, parallel, randomized trial, 43 patients received bumetanide and 16 patients received furosemide. They were treated up to 28 weeks. Weight loss & decrease in abdominal girth following diuretic action occurred in both groups but was statistically significant only in the bumetanide treated patients. No evidence of hepatic encephalopathy developed during this study, and only one patient on furosemide was discontinued as a result of severe electrolyte imbalance. HF Herlong et al. A comparison of bumetanide and furosemide in the treatment of ascites. Cooperative study. J Clin Pharmacol. 1981 Nov-Dec;21(11-12 Pt 2):701-5.

Is BURINEX safe in a dose of more than 0.5 mg?

The usual total daily dosage of bumetanide is 0.5 to 2 mg and in most patients is given as a single dose. If the diuretic response to the initial dose of bumetanide is not adequate, in view of its rapid onset and short duration of action, a second or third dose may be given at 4 to 5 hour intervals up to a maximum daily dose of 10 mg. An intermittent dose schedule, whereby bumetanide is given on alternate days or for 3 to 4 days with rest periods of 1 to 2 days in between, is recommended as the safest and most effective method for the continued control of edema. In some patients, especially those with renal failure receiving high doses, myalgias and muscle tenderness have been described. Bumetanide has been administered without difficulty to patients having side effects from other loop diuretics. Flamenbaum W, Friedman R. Pharmacology, therapeutic efficacy, and adverse effects of bumetanide, a new "loop" diuretic. Pharmacotherapy. 1982 Jul-Aug;2(4):213-22. Oral administration of 12 mg of bumetanide per day in 12 patients with renal insufficiency submitted to periodic hemodialysis, the predialysis natremia levels varied from 133 to 138 mEq/l (p less than 0.01) under the effect of the medication and this coincided with a significant increase of the diuresis. As a secondary effect, the authors recorded myalgia of variable intensity without significant changes in the serum enzymes of muscular origin. Del Río Vázquez A. [Result of the administration of high doses of bumetanide to patients with chronic renal failure who are on a program of hemodialysis. Med Clin (Barc). 1979 Jan 25;72(2):71-3.

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