HomeNDC LookupIngredientsBumetanide › 69238-1491-05
Bumetanide 2 mg Tablet, 500-count — NDC 69238-1491-05 package photo

Bumetanide 2 mg Tablet, 500-count

by Amneal Pharmaceuticals NY LLC · 500 TABLET in 1 BOTTLE (69238-1491-5)
NDC 69238-1491-05
🏷️ FDA NDC (as labeled) 69238-1491-5 billing pads the package segment with a zero
This package
Contains500-count Cost per ea$0.1767 NADAC Per package$88.35 / 500 tablets Pack sizes2 compare ↓
Also priced by: Medicaid pays $0.4161/unit · Part D plans $0.4554/unit — full pricing hub ↓
Also comes in: 100 tablets 69238-1491-01
Rx only Generic On market Non-controlled
🗂️ Data synced Jul 24, 2026 · sources: openFDA · FDA label (DailyMed) · FDA Orange & Purple Book · First Databank · CMS NADAC, ASP, Medicare & Medicaid · RxNorm
📋 All sources & update times →

🆔 Identity & classification

FDA NDC (as labeled) 69238-1491-5
Product NDC 69238-1491
11-digit billing NDC 69238149105
NCPDP billing unit EA — each (per item)
RxCUI 197417, 197418, 197419
UNII 0Y2S3XUQ5H
UPC 0369238149111, 0369238149012, 0369238148916
Application # ANDA209724
SPL Set ID 9188ab17-8539-48a5-905f-ad35ab5a0b93
Established class (EPC) Loop Diuretic
Physiologic effect Increased Diuresis at Loop of Henle
DEA schedule Non-controlled
Marketing category ANDA
Marketing status On market
FDA listing status Listed (active directory)
Marketing start 2017-10-18
Route ORAL
Dosage form TABLET
Substance BUMETANIDE
GPI-14 37200010000315
GPI class Bumetanide
GCN Seq No 008223
GCN 35022
HICL code 003664
Ingredient (HICL) Bumetanide
HIC1 code R
Therapeutic class — broad (HIC1) Kidney/Urinary Tract
HIC2 code R1
Therapeutic class — intermediate (HIC2) Affect Primarily Kidneys/Urinary Tract
HIC3 code R1M
Therapeutic class — specific (HIC3) Loop Diuretics
AHFS code 24:36.08.00
AHFS class Loop Diuretics (24:36)
FDB label name BUMETANIDE 2 MG TABLET
FDB brand name Bumetanide
Legend status F — Federal legend — prescription drug or device
TE code (Orange Book) AB · RLD · RS
Why two NDCs? The FDA registers this code as 69238-1491-5 — a 5-4-1 layout, and that's what's printed on the package and shown on DailyMed. For insurance claims, every NDC is standardized to a uniform 11-digit 5-4-2 format by adding a zero to the package segment → 69238-1491-05. Same drug, same package — only the format differs.
Where does this data come from?
Identifiers from the FDA openFDA NDC Directory and Structured Product Labeling; RxCUI from RxNorm (NLM); GPI from Medi-Span; GCN / HIC / AHFS / legend from First Databank.

🏷️ RxNorm drug class

This medicine belongs to the Loop Diuretic class.

Pharmacologic class Loop Diuretic
Drug family (ATC) Sulfonamides, plain
Where does this data come from?
Therapeutic classes from RxNorm RxClass (U.S. National Library of Medicine) — Established Pharmacologic Class (FDA), ATC drug family (WHO) and mechanism of action, matched by this product’s RxCUI.

🏭 Manufacturer & labeler

LabelerAmneal Pharmaceuticals NY LLC
Application holderAMNEAL PHARMACEUTICALS CO GMBH
FDA applicationANDA209724 (ANDA)
Labeler code69238
First marketedOct 2017
Product typeHuman Prescription Drug
Portfolio372 products on file
The labeler markets the product; the application holder owns the FDA approval. They’re often the same company but can differ (e.g. a repackager or an authorized generic). A mailing address / phone appears here when the manufacturer includes it in the product’s FDA label (not all do).
Where does this data come from?
Labeler, application holder and registered establishment from the FDA openFDA NDC Directory and Drugs@FDA; address/contact from the product’s FDA label.

🩺 Clinical

Label name BUMETANIDE 2 MG TABLET Ingredient Bumetanide
📖 What it is MedlinePlus · NLM

Bumetanide is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, and liver disease. Bumetanide is in a class of medications called diuretics ('water pills'). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.

Read the full MedlinePlus article ↗
📗 Our plain-language guide HelloPharmacist
  • Think of it as a very efficient 'water pill.' Your kidneys normally recycle most of the salt that flows through them, and water follows that salt back into your bloodstream. Bumeta...
  • What is bumetanide actually doing in my body?
  • Bumetanide works fast. If you take a tablet, you'll usually feel the urge to urinate within 30 to 60 minutes, with the strongest effect around 1 to 2 hours. Most of the diuretic ac...
  • When will I notice it working, and how long does it last?
📖 Read our full Bumetanide guide →
8
Nutrient depletion considerations

Bumetanide may be associated with lower levels of 8 nutrients — worth a chat with your pharmacist, not a cause for alarm.

An association is not a deficiency. Educational only — don't start or stop anything without professional guidance.
Where does this data come from?
Plain-language summary from MedlinePlus (U.S. National Library of Medicine); supplement & herbal interactions and nutrient depletion data from the Natural Medicines database; our full guide is HelloPharmacist editorial content.

💊 What it looks like

Color white
ShapeRound
ImprintAC42
Size11 mm
ScoringScored — splits in 2
One label can cover several strengths, so colors may be combined — always confirm a loose pill against the dispensed prescription label or a pharmacist.
Where does this data come from?
Physical description (imprint, shape, color, scoring, coating) from this product’s FDA Structured Product Labeling (SPL), mirrored from DailyMed / openFDA.

🧪 Inactive Ingredients / Excipients

Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.

💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.

  • UNII 3SY5LH9PMK
    Anhydrous lactose is a milk sugar with no water content. It acts as a filler and binder in tablets and capsules, adding bulk and helping ingredients stick together.
  • UNII 70097M6I30
    Magnesium stearate is a salt made from magnesium and stearic acid, a fatty substance. It's used in tablets and capsules as a lubricant and glidant to help ingredients flow smoothly during manufacturing and prevent sticking.
  • UNII OP1R32D61U
    Microcrystalline cellulose is a purified form of cellulose, a natural fiber from plant sources. It acts as a binder and filler in tablets and capsules, helping hold ingredients together and give the medicine its shape and size.
  • UNII O8232NY3SJ
    A plant-based carbohydrate derived from corn kernels. It acts as a filler to add bulk, a binder to hold ingredients together, and a disintegrant to help the tablet break apart in your stomach for absorption.

4 inactive ingredients listed in the exact product block matched to this NDC.

Where does this data come from?
Data sourced from official FDA Structured Product Labeling (SPL) via DailyMedingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.

Inactive ingredient FAQ

Are inactive ingredients the same for every manufacturer?
No. Inactive ingredients can differ by manufacturer, dosage form, strength, and package / product version.
Why might an inactive ingredient be missing?
Some SPLs do not provide a complete structured inactive-ingredient list, and older or unusual labels may only include the information in narrative text.
Can inactive ingredients matter?
Yes. They can matter for allergies, intolerances, dyes, gluten / lactose concerns, preservatives, and formulation differences — but confirm with a pharmacist or the manufacturer when it’s clinically important.

💲 Pricing

A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.

Price systemPer eaPer package
Retail pharmacies payNADAC · weekly $0.177 $88.35 / 500 tablets
Medicaid paysCMS SDUD · 12 mo $0.4161 $208.05 / 500 tablets
Medicare drug plans payPart D · Q2 2026 $0.4554 $227.70 / 500 tablets
NADAC price history (per ea) — tap or hover for the price & month
Dec 2021 Jul 2022 Dec 2025 Aug 2026 $0.448 $0.172
▼ Down 54% over the last 24 months.
Where does this data come from?
NADAC (National Average Drug Acquisition Cost) is the CMS weekly pharmacy-acquisition-cost survey — what pharmacies pay. ASP (Average Sales Price) is the CMS Medicare Part B drug-payment file, published quarterly. Medicaid pays is computed by us from CMS State Drug Utilization Data (total reimbursed ÷ units, trailing 12 months) — gross of rebates and inclusive of dispensing fees, so it reflects what Medicaid paid, not an acquisition cost. Medicare drug plans pay is the median negotiated point-of-sale unit cost across plans listing this NDC in the CMS quarterly Prescription Drug Plan pricing files, before rebates. The VA pays is the federal contract price (FSS, and the statutory Big 4 ceiling where listed) from the VA National Acquisition Center pharmaceutical price file. All are free public government data; each measures a different payer, so the figures are not directly comparable.

🔁 Therapeutic equivalents

ProductLabelerPackNADAC/unitTEStatusPrice vs. this
Bumetanide 2 mg 00185-0130-01 Sandoz 100 tablets $0.177 AB Availability likely
Bumetanide 2 mg 16571-0677-01 Rising 100 tablets $0.177 AB Availability likely
bumetanide 2 mg 23155-0902-01 Heritage 100 tablets $0.177 AB Availability likely
Bumetanide 2 mg 42799-0121-01 Edenbridge 100 tablets $0.177 AB Availability likely
Bumetanide 2 mg 43547-0898-10 Solco 100 tablets $0.177 AB Availability likely
Bumetanide 2 mg 50268-0132-15 AvPAK 50 tablets $0.177 AB Availability likely
Bumetanide 2 mg 51672-4225-01 Sun 100 tablets $0.177 AB Availability likely
Bumetanide 2 mgthis 69238-1491-05 Amneal 500 tablets $0.177 AB Availability likely
Bumetanide 2 mg 70756-0081-11 Lifestar 100 tablets $0.177 AB Availability likely
bumetanide 2 mg 72603-0299-01 NorthStar 100 tablets $0.177 AB Availability likely
Bumetanide 2 mg 72603-0901-01 NorthStar 100 tablets $0.177 AB Availability likely
Bumetanide 2 mg 72888-0021-01 Advagen 100 tablets $0.177 AB Availability likely
Bumetanide 2 mg 76282-0799-01 Exelan 100 tablets $0.177 AB Availability likely
Bumetanide 2 mg 60687-0535-01 American 100 tablets $0.302 AB Discontinued +71%
bumetanide 2 mg 68382-0527-01 Zydus 100 tablets $0.302 AB FDA listed +71%
Bumetanide 2 mg 00615-8616-39 NCS 30 tablets AB FDA listed
Bumetanide 2 mg 00781-8160-01 Sandoz 100 tablets AB FDA listed
Bumetanide 2 mg 00832-0542-10 Upsher-Smith 1000 tablets AB FDA listed
Bumex 2 mg 30698-0632-01 Validus 100 tablets AB FDA listed
Bumetanide 2 mg 50090-5663-00 A-S 90 tablets AB FDA listed
bumetanide 2 mg 50090-6137-00 A-S 90 tablets AB FDA listed
Bumetanide 2 mg 50090-6304-00 A-S 90 tablets AB FDA listed
Bumetanide 2 mg 50090-7350-00 A-S 90 tablets AB FDA listed
Bumetanide 2 mg 50090-7854-00 A-S 90 tablets AB FDA listed
Bumetanide 2 mg 50090-7876-00 A-S 90 tablets AB FDA listed
Bumetanide 2 mg 70518-4387-00 REMEDYREPACK 90 tablets AB FDA listed
Bumetanide 2 mg 70518-4478-00 REMEDYREPACK 90 tablets AB FDA listed
bumetanide 2 mg 70771-1026-00 Zydus 1000 tablets AB FDA listed
Bumetanide 2 mg 71335-2705-01 Bryant 30 tablets AB FDA listed
Bumetanide 2 mg 71335-2998-01 Bryant 100 tablets AB FDA listed
Bumetanide 2 mg 72162-2197-05 Bryant 500 tablets AB FDA listed
Bumetanide 2 mg 72205-0058-05 Novadoz 500 tablets AB FDA listed
Bumetanide 2 mg 81469-0223-01 First 100 tablets AB FDA listed
Bumetanide 2 mg 82804-0286-30 Proficient 30 tablets AB FDA listed
About this product: this is a generic version of the medicine. FDA equivalence ratings are shown when available, and other versions are listed above, least expensive first.
Where does this data come from?
Equivalents are other NDCs of the same ingredient, form and route from the openFDA NDC Directory, ranked least-expensive-first by NADAC. Therapeutic-equivalence (AB) ratings come from the FDA Orange Book; biologics use the FDA Purple Book for biosimilar & interchangeable status.

Availability & generic status

🏛️
2017
On the market since
Oct 2017
📍
2026
Currently FDA-listed
9 years listed
🔓
·
Generic on the market
this product is a generic
This is a generic drug

This product is an FDA-approved generic. Other versions of the same drug are listed under Therapeutic equivalents, least expensive first.

Where does this data come from?
Patents and exclusivity from the FDA Orange Book (small-molecule drugs), refreshed from public FDA data. Generic launch timing is an estimate, not a guarantee.

🗺️ Medicaid utilization & spend

📍 This exact package only: Medicaid data is reported per full 11-digit NDC — labeler, product and pack size — so every number here is for 69238-1491-05, not the drug overall. Other pack sizes report separately.
💊 Pharmacy benefit only: These are Medicaid outpatient pharmacy claims, billed by NDC. They exclude the medical benefit — clinic- or hospital-administered drugs billed under HCPCS J-codes — so drugs used mostly that way (e.g. Avastin, Lucentis, Keytruda) can look low or missing here. That’s expected, not an error.
📅 Q1 2025 – Q1 2026 · 5 quarters of data
ⓘ The newest quarter is usually incomplete when first published; states restate recent quarters in later CMS releases, so the latest figures typically revise upward. State coverage-policy changes can also shift quarter-to-quarter totals.
Prescriptions last 4 qtrs
13.3K
Units reimbursed last 4 qtrs
681.3K
Gross reimbursed last 4 qtrs
$283.5K
Avg / prescription
$21.26
Avg / unit
$0.4161
Latest quarter Q1 2026
3KRx
Medicaid pays / ea
$0.4161
gross reimbursed
vs
NADAC / ea
$0.1767
acquisition cost
=
Spread
+$0.2394
+135% vs cost
What Medicaid paid per ea (before rebates; includes the pharmacy’s dispensing fee) compared with NADAC — the average price pharmacies pay to buy the drug. A positive spread means Medicaid reimbursed more than the purchase price, before manufacturer rebates.
Fee-for-service vs managed care
37% FFS 63% MCO
Fee-for-service · 4,966 Rx Managed care · 8,370 Rx
State Medicaid map
Alaska: no data reported AK Maine: 7,416 units · 532 per 100k residents ME Washington: 7,447 units · 95.3 per 100k residents WA Idaho: 9,384 units · 478 per 100k residents ID Montana: no data reported MT North Dakota: 1,984 units · 253 per 100k residents ND Minnesota: 13,203 units · 230 per 100k residents MN Wisconsin: 26,136 units · 442 per 100k residents WI Michigan: 19,564 units · 195 per 100k residents MI New York: 32,770 units · 167 per 100k residents NY Vermont: no data reported VT New Hampshire: no data reported NH Oregon: 10,689 units · 253 per 100k residents OR Nevada: no data reported NV Wyoming: no data reported WY South Dakota: 1,250 units · 136 per 100k residents SD Iowa: 52,727 units · 1,644 per 100k residents IA Illinois: 69,720 units · 556 per 100k residents IL Indiana: 7,292 units · 106 per 100k residents IN Ohio: 56,518 units · 480 per 100k residents OH Pennsylvania: 67,668 units · 522 per 100k residents PA New Jersey: 6,859 units · 73.8 per 100k residents NJ Massachusetts: 3,778 units · 54.0 per 100k residents MA California: 34,887 units · 89.5 per 100k residents CA Utah: 15,799 units · 462 per 100k residents UT Colorado: 8,788 units · 150 per 100k residents CO Nebraska: 1,449 units · 73.3 per 100k residents NE Missouri: 12,253 units · 198 per 100k residents MO Kentucky: 30,802 units · 681 per 100k residents KY West Virginia: 3,919 units · 221 per 100k residents WV Virginia: 40,819 units · 468 per 100k residents VA Maryland: 6,705 units · 108 per 100k residents MD Connecticut: 21,068 units · 582 per 100k residents CT Rhode Island: no data reported RI Arizona: 4,646 units · 62.5 per 100k residents AZ New Mexico: 1,462 units · 69.2 per 100k residents NM Kansas: 11,819 units · 402 per 100k residents KS Arkansas: 2,391 units · 78.0 per 100k residents AR Tennessee: 9,936 units · 139 per 100k residents TN North Carolina: 19,524 units · 180 per 100k residents NC South Carolina: 9,648 units · 180 per 100k residents SC Delaware: 1,241 units · 120 per 100k residents DE Oklahoma: 2,938 units · 72.5 per 100k residents OK Louisiana: 4,131 units · 90.3 per 100k residents LA Mississippi: no data reported MS Alabama: no data reported AL Georgia: 4,682 units · 42.5 per 100k residents GA D.C.: 2,013 units · 296 per 100k residents DC Hawaii: no data reported HI Texas: 17,022 units · 55.8 per 100k residents TX Florida: 12,535 units · 55.4 per 100k residents FL
Units reimbursed · per 100k residents
42.51,644
gray = no data reported
Colors are per 100,000 residents, so big states don’t automatically dominate. Tap or hover a state for its actual totals.
Tap or hover a state
…for its Medicaid breakdown
🏆 Top states by units · per 100k residents
1 Iowa 1,644 /100k
2 Kentucky 681 /100k
3 Connecticut 582 /100k
4 Illinois 556 /100k
5 Maine 532 /100k
6 Pennsylvania 522 /100k
7 Ohio 480 /100k
8 Idaho 478 /100k
National units — by quarter
💵 About the dollar figures: “reimbursed” is what Medicaid paid pharmacies before confidential manufacturer rebates, so the program’s real net cost is lower than these numbers. Fee-for-service and managed-care claims are combined unless split above. Source: CMS State Drug Utilization Data; per-100k rates use 2023 Census population estimates.

💊 Medicaid utilization by pack size

Medicaid (SDUD) totals over the four most recent reported quarters for every package size of this drug — handy when a specific package (e.g. a starter/titration pack) carries little or no Medicaid volume on its own.
100 tablets69238-1491-01 35,177 Rx · $950,473
500 tablets this page69238-1491-05 13,336 Rx · $283,520
Drug total (last 4 qtrs): 48,513 Rx · 3,204,003 units · $1,233,994 gross reimbursed
Tap a pack size to open its page. Source: CMS State Drug Utilization Data, last 4 quarters.

📊 Medicare Part D spend CMS · PART D · 2026 (Q1)

Medicare Part D (outpatient prescription) spending for Bumetanide — the program that covers self-administered drugs. 19 manufacturers.
⚠️ Drug-level data: CMS publishes Part D spending by drug, not by NDC — these figures combine every manufacturer, strength and package size sold under the name Bumetanide. That’s a different level of aggregation than the Medicaid card above, which is specific to this exact 11-digit NDC (pack size included), so the two aren’t directly comparable.
Period
Total Part D spend
$19.5M
Claims incl. refills
663.7K
Beneficiaries
393.4K
Spend / beneficiary
$49.58
Spend / claim
$29.39
Trend by period
💵 About the dollar figures: spending is what Part D plans paid before confidential manufacturer rebates, so the program’s real net cost is lower. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part D Spending by Drug (data.cms.gov), updated quarterly.

🔬 Reported adverse events (FAERS)

Read carefully: FAERS reports are voluntary and unverified. Counts are not incidence, do not establish causation, are subject to reporting bias, and cannot be used to compare one drug to another. Shown for signal context only. Reports for Bumetanide — the ingredient across all brands.

Top reported reactions

Dyspnoea2,650
Fatigue1,734
Death1,695
Acute Kidney Injury1,692
Diarrhoea1,577
Nausea1,545
Dizziness1,295

Reporter sex

0 reports

Serious outcomes

Death4,122
Reports over time (by year) — tap or hover for the count & year
2019 2021 2023 2026 2,266 1,143
Most recent year is provisional (FAERS lags ~3 months).
Where does this data come from?
Adverse-event reports from the FDA Adverse Event Reporting System (FAERS) via openFDA. FAERS reports are voluntary and unverified — counts are not incidence and don’t establish causation.

📦 Packaging — all sizes for this product

Package NDCDescription Per unit Per pack Marketing startStatus
69238-1491-01 100 TABLET in 1 BOTTLE (69238-1491-1) $0.1767 / ea $17.67 2017-10-18 Active
69238-1491-05 You're viewing this 500 TABLET in 1 BOTTLE (69238-1491-5) $0.1767 / ea $88.37 2017-10-18 Active

You're viewing the largest of 2 pack sizes for this product.

This pack effectively ties for the lowest per-ea cost of the 2 priced pack sizes ($0.1767 NADAC).

This pack accounts for about 27% of this product's recent Medicaid fills; most go to the 100 tablets pack. See all packs ↓

Pack size FAQ

What quantity is in NDC 69238-1491-05?
NDC 69238-1491-05 is a 500-count package — 500 tablet in 1 bottle.
What is the difference between NDC 69238-1491-05 and NDC 69238-1491-01?
Both are Bumetanide 2 mg Tablet — the drug itself is identical. NDC 69238-1491-05 is the 500-count package, while NDC 69238-1491-01 is the 100 tablets package.
What NDC number is used to bill for this package of Bumetanide 2 mg Tablet?
Bill NDC 69238-1491-05 — the 11-digit billing format is 69238149105. Pharmacy and medical claims use the 11-digit form; the FDA label may print a shorter form of the same code.

Prices are the latest CMS NADAC pharmacy acquisition cost per NDC; per-pack figures are per-unit × pack quantity, shown only when the pack is denominated in the same measure NADAC prices.

📄 Full prescribing information FDA SPL

The complete FDA label for this product — the official prescribing information, verbatim, section by section. Jump with a chip, search within the label, or expand everything.
🚨 Boxed Warning 48 words

WARNING Bumetanide is a potent diuretic which, if given in excessive amounts, can lead to a profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required, and dose and dosage schedule have to be adjusted to the individual patient's needs (see DOSAGE AND ADMINISTRATION ).

🎯 Indications and Usage 77 words

INDICATIONS AND USAGE Bumetanide tablets are indicated for the treatment of edema associated with congestive heart failure, hepatic and renal disease, including the nephrotic syndrome. Almost equal diuretic response occurs after oral and parenteral administration of bumetanide. Therefore, if impaired gastrointestinal absorption is suspected or oral administration is not practical, bumetanide should be given by the intramuscular or intravenous route.

Successful treatment with bumetanide tablets following instances of allergic reactions to furosemide suggests a lack of cross-sensitivity.

⏱️ Dosage and Administration 207 words

DOSAGE AND ADMINISTRATION Individualize dosage with careful monitoring of patient response. Oral Administration The usual total daily dosage of bumetanide tablets are 0.5 mg to 2 mg and in most patients are given as a single dose. If the diuretic response to an initial dose of bumetanide tablets 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 tablets are 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 patients with hepatic failure, keep the dosage to a minimum. Because cross-sensitivity with furosemide has rarely been observed, bumetanide can be substituted at approximately a 1:40 ratio of bumetanide in proportion to furosemide in patients allergic to furosemide.

P arenteral Administration Bumetanide injection may be administered parenterally (intravenously and intramuscularly) to patients in whom gastrointestinal absorption may be impaired or in whom oral administration is not practical. Terminate parenteral treatment and institute oral treatment as soon as possible.

Contraindications 80 words

CONTRAINDICATIONS Bumetanide is contraindicated in anuria. Although bumetanide can be used to induce diuresis in renal insufficiency, any marked increase in blood urea nitrogen or creatinine, or the development of oliguria during therapy of patients with progressive renal disease, is an indication for discontinuation of treatment with bumetanide. Bumetanide is also contraindicated in patients in hepatic coma or in states of severe electrolyte depletion until the condition is improved or corrected.

Bumetanide is contraindicated in patients hypersensitive to this drug.

⚠️ Warnings ~1 min read

WARNINGS Volume and Electrolyte Depletion The dose of bumetanide should be adjusted to the patient's need. Excessive doses or too frequent administration can lead to profound water loss, electrolyte depletion, dehydration, reduction in blood volume and circulatory collapse with the possibility of vascular thrombosis and embolism, particularly in elderly patients. Hypokalemia Hypokalemia can occur as a consequence of bumetanide administration.

Prevention of hypokalemia requires particular attention in the following conditions: patients receiving digitalis and diuretics for congestive heart failure, hepatic cirrhosis and ascites, states of aldosterone excess with normal renal function, potassium-losing nephropathy, certain diarrheal states, or other states where hypokalemia is thought to represent particular added risks to the patient, i.e., history of ventricular arrhythmias. In patients with hepatic cirrhosis and ascites, sudden alterations of electrolyte balance may precipitate hepatic encephalopathy and coma.

Treatment in such patients is best initiated in the hospital with small doses and careful monitoring of the patient's clinical status and electrolyte balance. Supplemental potassium and/or spironolactone may prevent hypokalemia and metabolic alkalosis in these patients. Ototoxicity In cats, dogs and guinea pigs, bumetanide has been shown to produce ototoxicity.

In these test animals bumetanide was 5 to 6 times more potent than furosemide and, since the diuretic potency of bumetanide is about 40 to 60 times furosemide, it is anticipated that blood levels necessary to produce ototoxicity will rarely be achieved. The potential exists, however, and must be considered a risk of intravenous therapy, especially at high doses, repeated frequently in the face of renal excretory function impairment. Potentiation of aminoglycoside ototoxicity has not been tested for bumetanide.

Like other members of this class of diuretics, bumetanide probably shares this risk. Allergy to Sulfonamides Patients allergic to sulfonamides may show hypersensitivity to bumetanide. Th r ombocytopenia Since there have been rare spontaneous reports of thrombocytopenia from postmarketing experience, patients should be observed regularly for possible occurrence of thrombocytopenia.

🤒 Adverse Reactions ~1 min read

ADVERSE REACTIONS The most frequent clinical adverse reactions considered probably or possibly related to bumetanide are muscle cramps (seen in 1.1% of treated patients), dizziness (1.1%), hypotension (0.8%), headache (0.6%), nausea (0.6%) and encephalopathy (in patients with pre-existing liver disease) (0.6%). One or more of these adverse reactions have been reported in approximately 4.1% of patients treated with bumetanide. Serious skin reactions (i.e., Stevens-Johnson syndrome, toxic epidermal necrolysis) have been reported in association with bumetanide use.

Less frequent clinical adverse reactions to bumetanide are impaired hearing (0.5%), pruritus (0.4%), electrocardiogram changes (0.4%), weakness (0.2%), hives (0.2%), abdominal pain (0.2%), arthritic pain (0.2%), musculoskeletal pain (0.2%), rash (0.2%) and vomiting (0.2%). One or more of these adverse reactions have been reported in approximately 2.9% of patients treated with bumetanide. Other clinical adverse reactions, which have each occurred in approximately 0.1% of patients, are vertigo, chest pain, ear discomfort, fatigue, dehydration, sweating, hyperventilation, dry mouth, upset stomach, renal failure, asterixis, itching, nipple tenderness, diarrhea, premature ejaculation and difficulty maintaining an erection.

Laboratory abnormalities reported have included hyperuricemia (in 18.4% of patients tested), hypochloremia (14.9%), hypokalemia (14.7%), azotemia (10.6%), hyponatremia (9.2%), increased serum creatinine (7.4%), hyperglycemia (6.6%), and variations in phosphorus (4.5%), CO content (4.3%), bicarbonate (3.1%) and calcium (2.4%). Although manifestations of the pharmacologic action of bumetanide, these conditions may become more pronounced by intensive therapy. Also reported have been thrombocytopenia (0.2%) and deviations in hemoglobin (0.8%), prothrombin time (0.8%), hematocrit (0.6%), WBC (0.3%) and differential counts (0.1%).

There have been rare spontaneous reports of thrombocytopenia from postmarketing experience. Diuresis induced by bumetanide may also rarely be accompanied by changes in LDH (1.0%), total serum bilirubin (0.8%), serum proteins (0.7%), SGOT (0.6%), SGPT (0.5%), alkaline phosphatase (0.4%), cholesterol (0.4%) and creatinine clearance (0.3%). Increases in urinary glucose (0.7%) and urinary protein (0.3%) have also been seen.

To report SUSPECTED ADVERSE REACTIONS, contact Amneal Pharmaceuticals at 1-877-835-5472 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

🔄 Drug Interactions ~1 min read

Drug Interactions Drugs with Ototoxic Potential (see WARNINGS ) . Especially in the presence of impaired renal function, the use of parenterally administered bumetanide in patients to whom aminoglycoside antibiotics are also being given should be avoided, except in life-threatening conditions. Drugs with Nephrotoxic Potential There has been no experience with the concurrent use of bumetanide with drugs known to have a nephrotoxic potential.

Therefore, the simultaneous administration of these drugs should be avoided. Lithium Lithium should generally not be given with diuretics (such as bumetanide) because they reduce its renal clearance and add a high risk of lithium toxicity. Probenecid Pretreatment with probenecid reduces both the natriuresis and hyperreninemia produced by bumetanide.

This antagonistic effect of probenecid on bumetanide natriuresis is not due to a direct action on sodium excretion but is probably secondary to its inhibitory effect on renal tubular secretion of bumetanide. Thus, probenecid should not be administered concurrently with bumetanide. Indomethacin Indomethacin blunts the increases in urine volume and sodium excretion seen during bumetanide treatment and inhibits the bumetanide-induced increase in plasma renin activity.

Concurrent therapy with bumetanide is thus not recommended. Antihypertensives Bumetanide may potentiate the effect of various antihypertensive drugs, necessitating a reduction in the dosage of these drugs. Digoxin Interaction studies in humans have shown no effect on digoxin blood levels.

Anticoagulants Interaction studies in humans have shown bumetanide to have no effect on warfarin metabolism or on plasma prothrombin activity.

🤰 Pregnancy ~2 min read

Pregnancy T er atogenic Effects Bumetanide is neither teratogenic nor embryocidal in mice when given in doses up to 3,400 times the maximum human therapeutic dose. Bumetanide has been shown to be nonteratogenic, but it has a slight embryocidal effect in rats when given in doses of 3,400 times the maximum human therapeutic dose and in rabbits at doses of 3.4 times the maximum human therapeutic dose. In one study, moderate growth retardation and increased incidence of delayed ossification of sternebrae were observed in rats at oral doses of 100 mg/kg/day, 3,400 times the maximum human therapeutic dose.

These effects were associated with maternal weight reductions noted during dosing. No such adverse effects were observed at 30 mg/kg/day (1,000 times the maximum human therapeutic dose). No fetotoxicity was observed at 1,000 to 2,000 times the human therapeutic dose.

In rabbits, a dose-related decrease in litter size and an increase in resorption rate were noted at oral doses of 0.1 mg/kg/day and 0.3 mg/kg/day (3.4 and 10 times the maximum human therapeutic dose). A slightly increased incidence of delayed ossification of sternebrae occurred at 0.3 mg/kg/day; however, no such adverse effects were observed at the dose of 0.03 mg/kg/day. The sensitivity of the rabbit to bumetanide parallels the marked pharmacologic and toxicologic effects of the drug in this species.

Bumetanide was not teratogenic in the hamster at an oral dose of 0.5 mg/kg/day (17 times the maximum human therapeutic dose). Bumetanide was not teratogenic when given intravenously to mice and rats at doses up to 140 times the maximum human therapeutic dose. There are no adequate and well-controlled studies in pregnant women.

A small investigational experience in the United States and marketing experience in other countries to date have not indicated any evidence of adverse effects on the fetus, but these data do not rule out the possibility of harmful effects. Bumetanide should be given to a pregnant woman only if the potential benefit justifies the potential risk to the fetus.

🧒 Pediatric Use 66 words

Pediatric Use Safety and effectiveness in pediatric patients below the age of 18 have not been established. I n vitro studies using pooled sera from critically ill neonates have shown bumetanide to be a potent displacer of bilirubin (see CLINICAL PHARMACOLOGY : Pediatric Pharmacology ). The administration of bumetanide could present a particular concern if given to critically ill or jaundiced neonates at risk for kernicterus.

🆘 Overdosage 66 words

OVERDOSAGE Overdosage can lead to acute profound water loss, volume and electrolyte depletion, dehydration, reduction of blood volume and circulatory collapse with a possibility of vascular thrombosis and embolism. Electrolyte depletion may be manifested by weakness, dizziness, mental confusion, anorexia, lethargy, vomiting and cramps. Treatment consists of replacement of fluid and electrolyte losses by careful monitoring of the urine and electrolyte output and serum electrolyte levels.

🧬 Clinical Pharmacology ~3 min read

CLINICAL PHARMACOLOGY Bumetanide is a loop diuretic with a rapid onset and short duration of action. Pharmacological and clinical studies have shown that 1 mg bumetanide has a diuretic potency equivalent to approximately 40 mg furosemide. The major site of bumetanide action is the ascending limb of the loop of Henle.

The mode of action has been determined through various clearance studies in both humans and experimental animals. Bumetanide inhibits sodium reabsorption in the ascending limb of the loop of Henle, as shown by marked reduction of free-water clearance (CH 2 O) during hydration and tubular free-water reabsorption (T C H 2 O) during hydropenia. Reabsorption of chloride in the ascending limb is also blocked by bumetanide, and bumetanide is somewhat more chloruretic than natriuretic.

Potassium excretion is also increased by bumetanide, in a dose-related fashion. Bumetanide may have an additional action in the proximal tubule. Since phosphate reabsorption takes place largely in the proximal tubule, phosphaturia during bumetanide induced diuresis is indicative of this additional action.

This is further supported by the reduction in the renal clearance of bumetanide by probenecid, associated with diminution in the natriuretic response. This proximal tubular activity does not seem to be related to an inhibition of carbonic anhydrase. Bumetanide does not appear to have a noticeable action on the distal tubule.

Bumetanide decreases uric acid excretion and increases serum uric acid. Following oral administration of bumetanide the onset of diuresis occurs in 30 to 60 minutes. Peak activity is reached between 1 and 2 hours.

At usual doses (1 mg to 2 mg) diuresis is largely complete within 4 hours; with higher doses, the diuretic action lasts for 4 to 6 hours. Diuresis starts within minutes following an intravenous injection and reaches maximum levels within 15 to 30 minutes. Several pharmacokinetic studies have shown that bumetanide, administered orally or parenterally, is eliminated rapidly in humans, with a half-life of between 1 and 1½ hours.

Plasma protein-binding is in the range of 94% to 96%. Oral administration of carbon-14 labeled bumetanide to human volunteers revealed that 81% of the administered radioactivity was excreted in the urine, 45% of it as unchanged drug. Urinary and biliary metabolites identified in this study were formed by oxidation of the N-butyl side chain.

Biliary excretion of bumetanide amounted to only 2% of the administered dose. Pediatric Pharmacology Elimination of bumetanide appears to be considerably slower in neonatal patients compared with adults, possibly because of immature renal and hepatobiliary function in this population. Small pharmacokinetic studies of intravenous bumetanide in preterm and full-term neonates with respiratory disorders have reported an apparent half-life of approximately 6 hours, with a range up to 15 hours and a serum clearance ranging from 0.2 mL/min/kg to 1.1 mL/min/kg.

In a population of neonates receiving bumetanide for volume overload, mean serum clearance rates were 2.2 mL/min/kg in patients less than 2 months of age and 3.8 mL/min/kg in patients aged 2 to 6 months. Mean serum half-life of bumetanide was 2.5 hours and 1.5 hours in patients aged less than 2 months and those aged 2 to 6 months, respectively. Elimination half-life decreased considerably during the first month of life, from a mean of approximately 6 hours at birth to approximately 2.4 hours at 1 month of age.

In preterm neonates, mean serum concentrations following a single 0.05 mg/kg dose ranged from 126 mcg/L at 1 hour to 57 mcg/L at 8 hours. In another study, mean serum concentrations following a single 0.05 mg/kg dose were 338 ng/mL at 30 minutes and 176 ng/mL after 4 hours. A single dose of 0.1 mg/kg produced mean serum levels of 314 ng/mL at 1 hour, and 195 ng/mL at 6 hours.

Mean volume of distribution in neonates and infants has been reported to range from

0.26 L/kg to

0.39L/kg. The degree of…

📦 How Supplied / Storage and Handling ~1 min read

HOW SUPPLIED Bumetanide Tablets, USP for oral administration are available as: Bumetanide Tablets USP, 0.5 mg are supplied as white to off white, round biconvex, bisected and debossed “A” above and “16” below the bisect on one side and plain on the reverse side. They are available as follows: Bottles of 100: NDC 69238-1489-1 Bottles of 500: NDC 69238-1489-5 Bumetanide Tablets USP, 1 mg are supplied as white to off white, round biconvex bisected and debossed “AC” above and “41” below the bisect on one side and plain on the reverse side.

They are available as follows: Bottles of 100: NDC 69238-1490-1 Bottles of 500: NDC 69238-1490-5 Bumetanide Tablets USP, 2 mg are supplied as white to off white, round, biconvex, bisected and debossed “AC” above and “42” below the bisect on one side and plain on the reverse side. They are available as follows: Bottles of 100: NDC 69238-1491-1 Bottles of 500: NDC 69238-1491-5 Storage: Store at 20˚ to 25˚C (68˚ to 77˚F); excursions permitted between 15° to 30°C (59° to 86°F) [see USP Controlled Room Temperature]. Dispense contents in a tight, light-resistant container as defined in the USP with a child- resistant closure, as required.

Do not take improper broken tablets, if found in the container. Manufactured by: Amneal Pharmaceuticals Pvt. Ltd.

Oral Solid Dosage Unit Ahmedabad 382213, INDIA Distributed by: Amneal Pharmaceuticals LLC Bridgewater, NJ 08807 Rev. 11-2019-03

📋 Description 77 words

DESCRIPTION Bumetanide is a loop diuretic available as 0.5 mg, 1 mg and 2 mg tablets for oral administration; each tablet also contains the following inactive ingredients: anhydrous lactose, magnesium stearate, maize starch, microcrystalline cellulose, pregelatinized starch and talc. Chemically, bumetanide is 3-(butylamino)-4-phenoxy-5-sulfamoylbenzoic acid. It is a practically white powder having a calculated molecular weight of 364.42, and the following structural formula: C 17 H 2 0N 2 O 5 S Meets USP Dissolution Test 2. structure

Source: FDA Structured Product Labeling, mirrored from DailyMed / openFDA. Prefer the government’s original formatting? View this label on DailyMed ↗
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