Reappraising Bumetanide in Heart Failure: Pharmacology, Comparative Effectiveness, and Opportunities for Contemporary Use

Bumetanide is a valuable loop diuretic utilized in the management of heart failure and chronic kidney disease. Although it accounts for less than 5% of all outpatient loop diuretic prescriptions, its oral bioavailability is highly predictable and generally superior to furosemide, which constitutes over 90% of diuretic prescriptions. Bumetanide is longer-acting and more potent than furosemide; however, many physicians utilize bumetanide as a second-line diuretic when furosemide is ineffective or when intestinal edema limits drug absorption. This review summarizes the pharmacology of bumetanide, its clinical application in patients with heart failure with reduced or preserved ejection fraction, and the factors that contribute to its underutilization despite several pharmacokinetic advantages.