Diuretic Conversion Guideline

Introduction to Diuretic Conversion

• The American College of Cardiology and European Heart Journal recommend that the equivalent dose of Lasix (furosemide) for a patient taking Bumex (bumetanide) 1mg is 40mg, as bumetanide is approximately 40 times more potent than furosemide on a milligram-to-milligram basis 1, 2

Pharmacokinetic Differences

• The duration of action of bumetanide is slightly shorter (3-6 hours) compared to furosemide (6-8 hours), according to the American College of Cardiology 1

Conversion Ratios

• The European Journal of Heart Failure suggests maintaining the 1:40 ratio for IV to IV conversion (1mg bumetanide IV = 40mg furosemide IV) 3
• The European Heart Journal recommends maintaining the 1:40 ratio for oral to oral conversion (1mg bumetanide PO = 40mg furosemide PO) 2
• The European Society of Cardiology suggests that the initial IV furosemide dose should be at least equivalent to the effective oral bumetanide dose using the 1:40 conversion ratio when converting from oral bumetanide to IV furosemide 4

Special Considerations

• Using a lower conversion ratio than 1:40 will result in underdosing of furosemide, according to Praxis Medical Insights 4
• The European Journal of Heart Failure recommends closely monitoring urine output, electrolytes, renal function, and blood pressure after conversion, and considering combination therapy with thiazide diuretics in cases of diuretic resistance 3