Monograph
C03CA02 - Bumetanide |
Propably not porphyrinogenic |
PNP |
Rationale
51% of a bumetanide dose is excreted unchanged in urine. A clinical study indicates that bumetanide does not inhibit or induce CYP3A4.
Common side effects that be confused with an acute porphyria attack are abdominal pain, myalgia and muscle pain.
Therapeutic characteristics
Bumetanide is indicated for the treatment of all forms of oedema.
Common side effects that be confused with an acute porphyria attack are abdominal pain, myalgia and muscle pain. Other common side effects are headache, insomnia and hypernatremia. Less common side effects are nausea, vomiting, diarrhoea and obstipation.
Metabolism and pharmacokinetics
51% of the dose is excreted as unchanged drug in the urine (Howlett 1990). The elimination half-life is 1-2 hours.
In an in vivo study bumetanide had no effect on warfarin, a CYP3A4 substrate (Nilsson 1978). This may indicate that bumetanide does not inhibit or induce CYP3A4.
Bumetanide is listed as safe for use in patients with acute porphyria (Disler 1982, Eales 1979, Gorchein 1997, Moore 1997)
Personal communication
Thunell, patient reports (n=3): tolerated.
Andersson, patient report (n=2): tolerated.
IPNet drug reports
Uneventful use reported in 14 patients with acute porphyria.
References
| # | Citation details | PMID |
|---|---|---|
| * | Scientific articles | |
| 1. | Disler PB, Blekkenhorst, et al. Guidelines for drug prescription in patients with the acute porphyrias.
S Afr Med J. 1982 May 1;61(18):656-60. |
|
| 2. | Porphyria and the dangerous life-threatening drugs.
Eales L. S Afr Med J. 1979 Nov 24;56(22):914-7. |
515871 |
| 3. | Drug treatment in acute porphyria.
Gorchein A. Br J Clin Pharmacol. 1997 Nov;44(5):427-34. Review. |
9384458 |
| 4. | Metabolism of the diuretic bumetanide in healthy subjects and patients with renal impairment.
Howlett MR, Skellern GG, et al. Eur J Clin Pharmacol. 1990;38(6):583-6. |
2373133 |
| 5. | Drugs in the acute porphyrias--toxicogenetic diseases. Cell Mol Biol (Noisy-le-grand). 1997 Feb;43(1):89-94.
Moore MR, Hift RJ. |
9074793 |
| 6. | The effect of furosemide and bumetanide on warfarin metabolism and anticoagulant response.
Nilsson CM, Horton ES, Robinson DS. J Clin Pharmacol. 1978 Feb-Mar;18(2-3):91-4. |
624779 |
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