BNF for Children 2011-2012

BNFC 2011–2012 2.2.2 Loop diuretics 79BUMETANIDECautions see notes aboveContra-indications see notes aboveHepatic impairment see notes aboveRenal impairment see notes abovePregnancy see notes aboveBreast-feeding no information available; may inhibitlactationSide-effects see notes above; also gynaecomastia,breast pain, musculoskeletal pain (associated withhigh doses in renal failure)Licensed use not licensed for use in children under12 yearsIndication and doseOedema in heart failure, renal disease, andhepatic disease; pulmonary oedema. By mouthChild 1 month–12 years 15–50 micrograms/kg1–4 times daily (max. single dose 2 mg); do notexceed 5 mg dailyChild 12–18 years 1 mg in the morning, repeatedafter 6–8 hours if necessary; severe cases up to5 mg daily. By intravenous injectionChild 12–18 years 1–2 mg, repeated after 20minutes if necessary. By intravenous infusion over 30–60 minutesChild 1 month–12 years 25–50 micrograms/kgChild 12–18 years 1–5 mgAdministration for intravenous infusion, dilute withGlucose 5% or Sodium Chloride 0.9%; concentrationsabove 25 micrograms/mL may cause precipitationBumetanide (Non-proprietary) ATablets, bumetanide 1 mg, net price 28-tab pack =£1.12; 5 mg, 28-tab pack = £4.33Oral liquid, bumetanide 1 mg/5 mL, net price 150 mL= £128.00Injection, bumetanide 500 micrograms/mL, net price4-mL amp = £1.79Burinex c (LEO) ATablets, scored, bumetanide 1 mg, net price 28-tabpack = £1.52; 5 mg, 28-tab pack = £9.67Extemporaneous formulations available seeExtemporaneous Preparations, p. 6FUROSEMIDE(Frusemide)Cautions see notes above; also hypoproteinaemia mayreduce effect and increase risk of side-effects; hepatorenalsyndrome; risk of ototoxicity may be reducedby giving high oral doses in 2 or more divided doses;effect may be prolonged in neonates; some liquidpreparations contain alcohol, caution especially inneonates; interactions: Appendix 1 (diuretics)Contra-indications see notes aboveHepatic impairment see notes aboveRenal impairment see notes above; also lower rate ofinfusion may be necessaryPregnancy see notes aboveBreast-feeding amount too small to be harmful; mayinhibit lactationSide-effects see notes above; also intrahepaticcholestasis and goutIndication and doseOedema in heart failure, renal disease, andhepatic disease; pulmonary oedema. By mouthNeonate 0.5–2 mg/kg every 12–24 hours (every24 hours if postmenstrual age under 31 weeks)Child 1 month–12 years 0.5–2 mg/kg 2–3 timesdaily (every 24 hours if postmenstrual age under31 weeks); higher doses may be required in resistantoedema; max. 12 mg/kg daily, not to exceed80 mg dailyChild 12–18 years 20–40 mg daily, increased inresistant oedema to 80–120 mg daily. By slow intravenous injectionNeonate 0.5–1 mg/kg every 12–24 hours (every24 hours if postmenstrual age under 31 weeks)Child 1 month–12 years 0.5–1 mg/kg repeatedevery 8 hours as necessary; max. 2 mg/kg (max.40 mg) every 8 hoursChild 12–18 years 20–40 mg repeated every 8hours as necessary; higher doses may be requiredin resistant cases. By continuous intravenous infusionChild 1 month–18 years 0.1–2 mg/kg/hour (followingcardiac surgery, initially 100 micrograms/kg/hour, doubled every 2 hours until urine outputexceeds 1 mL/kg/hour)Oliguria. By mouthChild 12–18 years initially 250 mg daily; ifnecessary, dose increased in steps of 250 mg givenevery 4–6 hours; max. single dose 2 g (rarely used). By intravenous infusionChild 1 month–12 years 2–5 mg/kg up to 4 timesdaily (max. 1 g daily)Child 12–18 years initially 250 mg over 1 hour(rate not exceeding 4 mg/minute), increase to500 mg over 2 hours if satisfactory urine output notobtained, then give a further 1 g over 4 hours if nosatisfactory response within subsequent hour, if noresponse obtained dialysis probably required;effective dose (up to 1 g) can be repeated every 24hoursAdministration for administration by mouth, tabletscan be crushed and mixed with water or injectionsolution diluted and given by mouth.For intravenous injection, give over 5–10 minutes at ausual rate of 100 micrograms/kg/minute (notexceeding 500 micrograms/kg/minute), max. 4 mg/minute.For intravenous infusion, dilute with Sodium Chloride0.9% to a concentration of 1–2 mg/mL; glucosesolutions unsuitable (infusion pH must be above 5.5)2 Cardiovascular system