I'm working more at Providence Hospital and I find that the intensivists and cardiologists love the Bumex. This opinion is shared by some
prominant nephrologists. Unfortunately bumetanide suffers from the same short pharmacokinetics as furosemide: half life of about 90 minutes after oral or IV dosing. The big advantage bumetanide has over furosemide is more predictable bioavailability after oral dosing. Torsemide trumps both of them with excellent bioavailablity and a half-life of 210 minutes.
The reason that bumex is preferred is the beleif that it is a more potent diuretic than furosemide. According to Brater, all of the loop diuretics have similar potency and decisions among the loops should be based on pharmaokinetics (as opposed to pharmacodynamics). Here is the statement in his
NEJM review of diuretic therapy.
Phamacokinetics of
torsemide,
bumetanide and
furosemide from the package inserts. And here is the table from Brater's reveiw:
