May lead to profound diuresis with fluid and electrolyte loss. Rapid I.V. administration, renal impairment, excessive doses, and concurrent use of other ototoxins is associated with ototoxicity. Use in sulfonylurea allergy is specifically contraindicated. In cirrhosis, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy. Co-administration of antihypertensives may increase the risk of hypotension. Bumetanide is a potent displacer of bilirubin (avoid use in neonates at risk for kernicterus). May decrease lithium excretion. Loop diuretics (e.g. bumetanide, ethacrynic acid, furosemide, torsemide) are diuretics of choice for most patients with congestive heart failure. Possible effects on glucose metabolism should be considered (potassium depletion has been associated with impaired insulin secretion). Blood dyscrasias (especially thrombocytopenia), liver damage, or idiosyncratic reactions reported occasionally. Diuretics, including bumetanide, can increase serum total cholesterol concentrations in some patients (increases in low-density lipoprotein cholesterol and/or very low-density lipoprotein cholesterol subfractions). It is not known whether bumetanide is mutagenic or carcinogenic in humans.