Furosemide vs Bumetanide in Congestive Heart Failure (CHF): Should We Consider a Stepwise Approach?

Introduction: In CHF, Furosemide and Bumetanide are the most commonly used loop diuretics. Both medications, though effective in combating volume overload, have different mechanisms of action. We aim to compare the differences in the pharmacokinetics and pharmacodynamics of the two drugs and evaluate whether one should be preferred over the other as first line of treatment in CHF.


Methods: A detailed narrative review is conducted to identify literature (PubMed, Embase, UpToDate, and Google Scholar) comparing furosemide and bumetanide from 2021 to July 2025, using the keywords CHF, Furosemide, Bumetanide, Lasix, & Bumex. Out of the initially identified 4,790 articles, randomized controlled trials (RCTs), meta-analyses, & observational studies were identified, resulting in 1,010 articles. Data were synthesized to compare the two medications, using key outcome variables i.e, bioavailability, renal effects, pharmacokinetics, potency, and clinical outcomes via IBM WatsonX.data AI platform. The data were reevaluated and manually authenticated.


Results: Furosemide was the most frequently prescribed loop diuretic due to its availability and cost-effectiveness. However, variable bioavailability can lead to inconsistent diuretic responses. Although 60% of Furosemide is absorbed in the gut, the bioavailability tends to fluctuate between individuals and varies with the route of administration. Bumetanide has the advantage of being 40 times more potent in IV and 20 times more potent in oral forms than Furosemide. It has better bioavailability (80%), especially in patients with advanced heart failure or diuretic resistance. For various data, we also performed One-Way ANOVA for Independent Measures, Chi-square, Mann-Whitney U Test, and Z-test (two population proportions), and found renal function and heart failure severity were the key variables.


Conclusions: There was no significant statistical difference in rates of hospital readmissions and mortality with either drug, as with previous literature. However, it can be concluded that Furosemide, due to its cost-effectiveness, can be used as a first-line treatment, followed by Bumetanide (in a step-wise manner) due to its better bioavailability in advanced heart failure or diuretic resistance. A patient-centered approach should be used when determining the use of diuretics.