Nasal Spray Form of Bumetanide May Help Treat Heart Failure

A new nasal spray version of bumetanide, a widely used diuretic, could offer an effective and convenient method to reduce tissue swelling in heart failure patients. Research presented at the American Heart Association's (AHA) Scientific Sessions 2024 and published in Circulation suggests this innovative approach may address limitations in traditional diuretic delivery methods.

Study Insights

The RSQ-777-02 clinical trial investigated the absorption and effectiveness of intranasal bumetanide compared to oral and intravenous (IV) formulations. The study involved 68 healthy adults and demonstrated several notable findings:

• The nasal spray achieved a similar blood concentration as the oral form but absorbed 33% faster.
• Onset of sodium excretion—a biomarker of diuretic response—occurred sooner with the nasal spray compared to oral administration.
• Variability in absorption was significantly lower for the nasal and IV forms (27%) than for the oral form (>40%), indicating more reliable dosing.
• Side effects were comparable across all methods, but the nasal spray had fewer treatment-emergent adverse events than the oral version.

The findings suggest that a nasal spray could provide a more consistent and rapid response compared to oral diuretics, which often show variable absorption in patients with fluid overload.

Significance for Heart Failure Treatment

Heart failure, a condition where the heart's ability to pump blood is diminished, often leads to fluid buildup in the lungs and other tissues. Diuretics like bumetanide are essential for managing swelling in heart failure, kidney disease, and liver disease. However, oral medications can become less effective during advanced heart failure due to impaired gut absorption—a phenomenon called "diuretic resistance."

Dr. Daniel Bensimhon, the study's presenting author, emphasized the potential value of the nasal spray: “Having a diuretic that does not rely on gut absorption to be effective may be a very important tool," particularly when patients are unable to take oral medication or it no longer works.

The nasal spray also offers the advantage of self-administration, which could reduce reliance on IV treatments typically administered in hospitals, alleviating the burden on healthcare systems.

Looking Ahead

While the findings are promising, the study's primary limitation is that it involved healthy adults without heart failure or related risk factors. Future research will evaluate the bioavailability and clinical effectiveness of intranasal bumetanide in patients with heart failure. If proven successful, this option may support at-home management of fluid overload, reducing the need for hospital admissions.

“We think this will be a valuable tool for treating heart failure by promoting care at home and potentially reducing the need for costly hospital admissions and readmissions,” Bensimhon added.

This advancement underscores the ongoing effort to develop more accessible and reliable treatments for heart failure, improving both patient outcomes and the efficiency of care delivery.