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Dose‐ranging evaluation of bumetanide pharmacodynamics in critically ill infants
Author(s) -
Sullivan Janice E.,
Witte Madolin K.,
Yamashita Toyoko S.,
Myers Carolyn M.,
Blumer Jeffrey L.
Publication year - 1996
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1016/s0009-9236(96)90199-x
Subject(s) - critically ill , pharmacodynamics , bumetanide , medicine , dose ranging study , critical illness , intensive care medicine , pharmacokinetics , pharmacology , chemistry , cotransporter , organic chemistry , sodium , double blind , alternative medicine , pathology , placebo
Objectives Determine the diuretic effects of single intravenous doses of bumetanide in volume‐overloaded critically ill infants. Methods A prospective, open‐label study was carried out in 56 infants aged 0 to 6 months who required diuretic therapy. Each patient received a single intravenous dose of bumetanide. Doses selected in sequential order ranged from 0.005 to 0.10 mg/kg. Determinations of urine volume, electrolytes, creatinine levels, and osmolality were performed before (collected from −2 to −4 hours to time 0) and at 1, 2, 3, 4, 6, and 12 hours after bumetanide dosing. Serum samples collected at time 0 and at 5, 15, 30, 60, 120, 180, 240, 360, and 480 minutes and urine aliquots collected at time 0, 0 to 1, 1 to 2, 2 to 3, 3 to 4, 4 to 6, and 6 to 12 hours were analyzed for bumetanide concentration. Individual changes in urine flow rate and electrolyte excretion were plotted against corresponding bumetanide excretion rates, taken as the effective dose of the drug. Results Peak bumetanide excretion rates increased linearly with increasing doses of drug. Time course patterns for urine flow rate and electrolyte excretion were similar for all dosage groups. Urine flow rate and electrolyte excretion increased linearly up to a bumetanide excretion rate of approximately 7 μg/kg/hr and either plateaued (urine flow rate) or declined at a bumetanide excretion rate of > 10 μg/kg/hr. Diuretic efficiency of bumetanide was maximal at doses of 0.005 to 0.010 mg/kg but decreased at higher doses. Conclusions Maximal diuretic responses occurred at a bumetanide excretion rate of about 7 μg/kg/hr, corresponding to doses of 0.035 to 0.040 mg/kg. Higher doses produced a proportionately higher bumetanide excretion rate but no increased diuretic effect. Lower doses of bumetanide had the greatest diuretic efficiency, suggesting that continuous infusion of low doses of bumetanide or intermittent low‐dose boluses may produce optimal diuretic responses in critically ill infants. Clinical Pharmacology & Therapeutics (1996) 60 , 424–434; doi: