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.