Clinical Pharmacology of the Loop Diuretics Furosemide and Bumetanide in Neonates and Infants

The loop diuretics furosemide and bumetanide are used widely for the management of fluid overload in both acute and chronic disease states. To date, most pharmacokinetic studies in neonates have been conducted with furosemide and little is known about bumetanide. The aim of this article was to revie...

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Bibliographic Details
Published in:Paediatric drugs 2012-08, Vol.14 (4), p.233-246
Main Author: Pacifici, Gian Maria
Format: Article
Language:English
Subjects:
Analysis
Diuretics
Dosage and administration
Infant health services
Internal Medicine
Medicine
Medicine & Public Health
Methods
Pediatric pharmacology
Pediatrics
Pharmacokinetics
Pharmacotherapy
Review Article
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Summary:The loop diuretics furosemide and bumetanide are used widely for the management of fluid overload in both acute and chronic disease states. To date, most pharmacokinetic studies in neonates have been conducted with furosemide and little is known about bumetanide. The aim of this article was to review the published data on the pharmacology of furosemide and bumetanide in neonates and infants in order to provide a critical analysis of the literature, and a useful tool for physicians. The bibliographic search was performed electronically using PubMed and EMBASE databases as search engines and March 2011 was the cutoff point. The half-life (t 1/2 ) of both furosemide and bumetanide is considerably longer in neonates than in adults and consequently the clearance (CL) of these drugs is reduced at birth. In healthy volunteers, plasma t 1/2 of furosemide ranges from 33 to 100 minutes, whereas in neonates it ranges from 8 to 27 hours. The volume of distribution (V d ) of furosemide undergoes little variation during neonate maturation. The dose of furosemide, administered by intermittent intravenous infusion, is 1mg/kg and may increase to a maximum of 2mg/kg every 24 hours in premature infants and every 12 hours in full-term infants. Comparison of continuous infusion versus intermittent infusion of furosemide showed that the diuresis is more controlled with fewer hemodynamic and electrolytic variations during continuous infusion. The appropriate infusion rate of furosemide ranges from 0.1 to 0.2mg/kg/h and when the diuresis is
ISSN:1174-5878
1179-2019
DOI:10.2165/11596620-000000000-00000