ISSUE1752
- Jean-Marie Pflomm, Pharm.D., Editor in Chief has disclosed no relevant financial relationships.
- Michael Viscusi, Pharm.D., Associate Editor has disclosed no relevant financial relationships.
- Review the efficacy and safety of bumetanide nasal spray (Enbumyst) for treatment of edema.
Enbumyst (Corstasis), a nasal spray formulation of the loop diuretic bumetanide, has been approved by the FDA for (short-term) treatment of edema associated with congestive heart failure, renal disease (including nephrotic syndrome), or hepatic disease in adults. It is the first diuretic nasal spray formulation to become available in the US. Bumetanide has been available for years in oral and IV formulations.
LOOP DIURETICS — Loop diuretics (e.g., furosemide, bumetanide, torsemide) are more effective for management of edema than thiazide-type diuretics (e.g., hydrochlorothiazide). They are often administered intravenously in patients who require rapid diuresis or have edema that is resistant to high doses of oral diuretics.1-3 IV loop diuretics are inexpensive, but they generally must be given by a healthcare professional.
Two subcutaneous formulations of furosemide administered via an on-body infusor (Furoscix and Lasix ONYU) are FDA-approved for short-term treatment of edema in adults with chronic heart failure. Furoscix is also approved for use in patients with edema due to chronic kidney disease (including nephrotic syndrome).4,5
CLINICAL STUDIES — No new efficacy trials were required for FDA approval of Enbumyst. In an open-label, crossover pharmacokinetic study, peak bumetanide plasma concentrations and overall drug exposure were similar with oral and intranasal bumetanide, and the diuretic, natriuretic, and kaliuretic effects of intranasal bumetanide were similar to those with the oral and IV formulations of the drug in 68 healthy subjects.6 No data are available on the use of intranasal bumetanide in patients with edema, but intranasal administration should be effective in patients with reduced absorption of oral diuretics due to gut edema.
ADVERSE EFFECTS — The most commonly reported adverse effects of intranasal bumetanide have been hypovolemia and headache.
DOSAGE, ADMINISTRATION, AND COST — Enbumyst is intended for short-term use; patients should be switched to oral diuretic therapy as soon as practical. The drug is supplied in cartons containing 12 nasal spray devices, each of which delivers a single spray containing 0.5 mg of bumetanide. The usual dosage is 0.5-2 mg (1-4 sprays) administered intranasally once daily. If multiple sprays are required for a single dose, alternating between nostrils is recommended. According to the label, one 0.5-mg spray can be substituted for 10 mg of IV furosemide. One carton of 12 devices costs $1197.7
- Drugs for chronic heart failure. Med Lett Drugs Ther 2025; 67:81.
- Y Ikeda et al. Association between intestinal oedema and oral loop diuretic resistance in hospitalized patients with acute heart failure. ESC Heart Fail 2021; 8:4067. doi:10.1002/ehf2.13525
- SS Suri and SV Pamboukian. Optimal diuretic strategies in heart failure. Ann Transl Med 2021; 9:517. doi:10.21037/atm-20-4600
- In brief: Furoscix - a subcutaneous furosemide infusor for heart failure. Med Lett Drugs Ther 2023; 65:14.
- In brief: A second subcutaneous furosemide infusor (Lasix ONYU) for heart failure. Med Lett Drugs Ther 2026; 68:47.
- AP Ambrosy et al. Randomized study comparing a novel intranasal formulation of bumetanide with oral and intravenous formulations. Circulation 2025; 151:737. doi:10.1161/circulationaha.124.072949
- Approximate WAC. WAC = wholesaler acquisition cost or manufacturer's published price to wholesalers; WAC represents a published catalogue or list price and may not represent an actual transactional price. Source: AnalySource® Monthly. March 5, 2026. Reprinted with permission by First Databank, Inc. All rights reserved. ©2026. www.fdbhealth.com/drug-pricing-policy.
Previous article