the warmers Ethacrynic Acid Overview Side Effects Dosage Professional Interactions More Pregnancy Warnings Breastfeeding Warnings User Reviews Drug Images Support Group Q & A Pricing & Coupons Pronunciation (eth a KRIN ik AS id) Index Terms Ethacrynate Sodium Dosage Forms Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Solution Reconstituted, Intravenous, as ethacrynate sodium: Sodium Edecrin: 50 mg (1 ea) Generic: 50 mg (1 ea) Tablet, Oral: Edecrin: 25 mg [scored] Generic: 25 mg Slideshow Diabetic Nerve Pain: Symptoms And Treatment Brand Names: U.S. Edecrin Sodium Edecrin Pharmacologic Category Diuretic, Loop Pharmacology Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and distal renal tubule, interfering with the chloride-binding cotransport system, thus causing increased excretion of water, sodium, chloride, magnesium, and calcium Absorption Oral: Rapid Metabolism Hepatic (35% to 40%) to active cysteine conjugate Excretion Feces and urine (30% to 60% as unchanged drug) Onset of Action Diuresis: Oral: ~30 minutes; IV: 5 minutes; Peak effect: Oral: 2 hours; IV: 30 minutes Duration of Action Oral: 12 hours; IV: 2 hours Half-Life Elimination Normal renal function: 2-4 hours Protein Binding >90% Use: Labeled Indications Oral: Management of edema associated with congestive heart failure; hepatic cirrhosis or renal disease; short-term management of ascites due to malignancy, idiopathic edema, and lymphedema; short-term management of hospitalized pediatric patients, other than infants, with congenital heart disease or the nephrotic syndrome IV: Indicated when a rapid onset of diuresis is desired (eg, in acute pulmonary edema, or when gastrointestinal absorption is impaired or oral medication is not feasible) Contraindications Hypersensitivity to ethacrynic acid or any component of the formulation; anuria; history of severe watery diarrhea caused by this product; infants Dosing: Adult Note: Oral dose equivalency (approximate) for patients with normal renal function (Brater 1983; Cody 1994; Vargo 1995): Ethacrynic acid 50 mg = bumetanide 1 mg = torsemide 20 mg = furosemide 40 mg Edema: Oral: 50 to 200 mg/day in 1 to 2 divided doses; may increase in increments of 25 to 50 mg at intervals of several days to a maximum of 400 mg/24 hours. IV: 0.5 to 1 mg/kg/dose (maximum: 100 mg/dose); repeat doses not routinely recommended; however, if indicated, repeat doses every 8 to 12 hours. Dosing: Geriatric Oral: Initial: 25 to 50 mg/day Dosing: Pediatric Edema: Oral: Children: 1 mg/kg/dose once daily; increase at intervals of 2 to 3 days as needed, to a maximum of 3 mg/kg/day. Dosing: Renal Impairment There are no dosage adjustments provided in the manufacturer's labeling; use with caution. Contraindicated in patients with anuria. Dosing: Hepatic Impairment There are no dosage adjustments provided in the manufacturer's labeling; use with caution. Reconstitution IV formulation should be diluted in D5W or NS (1 mg/mL) and infused over several minutes. Extemporaneously Prepared A 1 mg/mL oral suspension may be made with ethacrynic acid powder. Dissolve 120 mg ethacrynic acid powder in a small amount of 10% alcohol. Add a small amount of 50% sorbitol solution and stir. Adjust pH to 7 with 0.1N sodium hydroxide solution. Add sufficient quantity of 50% sorbitol solution to make a final volume of 120 mL. Add methylparaben 6 mg and propylparaben 2.4 mg as preservatives. Stable for 220 days at room temperature. Das Gupta V, Gibbs CW Jr, and Ghanekar AG, "Stability of Pediatric Liquid Dosage Forms of Ethacrynic Acid, Indomethacin, Methyldopate Hydrochloride, Prednisone and Spironolactone," Am J Hosp Pharm , 1978, 35(11):1382-5.568384 Handbook on Extemporaneous Formulations , Bethesda, MD: American Society of Hospital Pharmacists, 1987. Administration Injection should not be given SubQ or IM due to local pain and irritation. Single IV doses should not exceed 100 mg. Administer slowly through the tubing of a running infusion or by direct IV injection over a period of several minutes. If a second dose is needed, it is recommended to use a new injection site to avoid possible thrombophlebitis. Dietary Considerations This product may cause a potassium loss. Your healthcare provider may prescribe a potassium supplement, another medication to help prevent the potassium loss, or recommend that you eat foods high in potassium, especially citrus fruits. Do not change your diet on your own while taking this medication, especially if you are taking potassium supplements or medications to reduce potassium loss. Too much potassium can be as harmful as too little. Storage Store at 25 C (77 F); excursions permitted to 15 C to 30 C (59 F to 86 F). Discard unused reconstituted solution after 24 hours. Drug Interactions Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Allopurinol: Loop Diuretics may enhance the adverse/toxic effect of Allopurinol. Loop Diuretics may increase the serum concentration of Allopurinol. Specifically, Loop Diuretics may increase the concentration of Oxypurinol, an active metabolite of Allopurinol. Monitor therapy Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. Consider therapy modification Aminoglycosides: Loop Diuretics may enhance the adverse/toxic effect of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Monitor therapy Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy Angiotensin-Converting Enzyme Inhibitors: Loop Diuretics may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Loop Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Monitor therapy Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Monitor therapy Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Monitor therapy Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Beta2-Agonists: May enhance the hypokalemic effect of Loop Diuretics. Monitor therapy Bilastine: Loop Diuretics may enhance the QTc-prolonging effect of Bilastine. Monitor therapy Bile Acid Sequestrants: May decrease the absorption of Loop Diuretics. Consider therapy modification Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Monitor therapy Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Canagliflozin: May enhance the hypotensive effect of Loop Diuretics. Management: If canagliflozin is combined with a loop diuretic, monitor for symptoms of intravascular volume depletion and hypotension. Canadian product labeling recommends avoiding the combination of canagliflozin and loop diuretics. Consider therapy modification Cardiac Glycosides: Loop Diuretics may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of loop diuretics. Monitor therapy Cefazedone: May enhance the nephrotoxic effect of Loop Diuretics. Monitor therapy Cefotiam: Loop Diuretics may enhance the nephrotoxic effect of Cefotiam. Monitor therapy Ceftizoxime: Loop Diuretics may enhance the nephrotoxic effect of Ceftizoxime. Monitor therapy Cephalothin: Loop Diuretics may enhance the nephrotoxic effect of Cephalothin. Monitor therapy Cephradine: May enhance the nephrotoxic effect of Loop Diuretics. Monitor therapy CISplatin: Loop Diuretics may enhance the nephrotoxic effect of CISplatin. Loop Diuretics may enhance the ototoxic effect of CISplatin. Monitor therapy Corticosteroids (Orally Inhaled): May enhance the hypokalemic effect of Loop Diuretics. Monitor therapy Corticosteroids (Systemic): May enhance the hypokalemic effect of Loop Diuretics. Monitor therapy CycloSPORINE (Systemic): May enhance the adverse/toxic effect of Loop Diuretics. Monitor therapy Desmopressin: Loop Diuretics may enhance the hyponatremic effect of Desmopressin. Avoid combination Diacerein: May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Monitor therapy Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Dofetilide: Loop Diuretics may enhance the QTc-prolonging effect of Dofetilide. Monitor therapy DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Monitor therapy Empagliflozin: May enhance the hypotensive effect of Loop Diuretics. Monitor therapy Foscarnet: Loop Diuretics may increase the serum concentration of Foscarnet. Consider therapy modification Fosphenytoin: May diminish the diuretic effect of Loop Diuretics. Monitor therapy Furosemide: May enhance the ototoxic effect of Ethacrynic Acid. Avoid combination Herbs (Hypertensive Properties): May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy Ipragliflozin: May enhance the adverse/toxic effect of Loop Diuretics. Specifically, the risk for intravascular volume depletion may be increased. Monitor therapy Ivabradine: Loop Diuretics may enhance the arrhythmogenic effect of Ivabradine. Monitor therapy Levodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa. Monitor therapy Levosulpiride: Loop Diuretics may enhance the adverse/toxic effect of Levosulpiride. Avoid combination Licorice: May enhance the hypokalemic effect of Loop Diuretics. Monitor therapy Lithium: Loop Diuretics may decrease the serum concentration of Lithium. Loop Diuretics may increase the serum concentration of Lithium. Monitor therapy Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Methotrexate: May diminish the therapeutic effect of Loop Diuretics. Loop Diuretics may increase the serum concentration of Methotrexate. Methotrexate may increase the serum concentration of Loop Diuretics. Management: Monitor for increased methotrexate and/or loop diuretic levels/toxicity with concomitant use of these agents and monitor for decreased therapeutic effects of loop diuretics. Methotrexate and/or loop diuretic dose reductions may be necessary. Consider therapy modification Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Neuromuscular-Blocking Agents: Loop Diuretics may diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Loop Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Monitor therapy Nonsteroidal Anti-Inflammatory Agents: May diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended. Consider therapy modification Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Consider therapy modification Opioid Analgesics: May enhance the adverse/toxic effect of Diuretics. Opioid Analgesics may diminish the therapeutic effect of Diuretics. Monitor therapy Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Phenytoin: May diminish the diuretic effect of Loop Diuretics. Monitor therapy Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Monitor therapy Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Probenecid: May enhance the adverse/toxic effect of Loop Diuretics. Probenecid may diminish the diuretic effect of Loop Diuretics. Probenecid may increase the serum concentration of Loop Diuretics. Management: Monitor for decreased diuretic effects or increased adverse effects of loop diuretics with concomitant use of probenecid. Bumetanide prescribing information recommends against concomitant use of probenecid. Monitor therapy Promazine: Loop Diuretics may enhance the QTc-prolonging effect of Promazine. Avoid combination Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy Reboxetine: May enhance the hypokalemic effect of Loop Diuretics. Monitor therapy RisperiDONE: Loop Diuretics may enhance the adverse/toxic effect of RisperiDONE. Management: Consider alternative diuretic therapy (e.g., thiazides) to more potent diuretics (e.g., furosemide) in elderly patients receiving risperidone. Patients who require use of more potent diuretic therapy should be closely monitored and adequately hydrated. Consider therapy modification Salicylates: May diminish the diuretic effect of Loop Diuretics. Loop Diuretics may increase the serum concentration of Salicylates. Monitor therapy Sodium Phosphates: Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with diuretics, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, hydrate adequately and monitor fluid and renal status. Consider therapy modification Tobramycin (Oral Inhalation): Loop Diuretics may enhance the nephrotoxic effect of Tobramycin (Oral Inhalation). Loop Diuretics may enhance the ototoxic effect of Tobramycin (Oral Inhalation). Monitor therapy Topiramate: Loop Diuretics may enhance the hypokalemic effect of Topiramate. Monitor therapy Vitamin K Antagonists (eg, warfarin): Ethacrynic Acid may increase the serum concentration of Vitamin K Antagonists. Monitor therapy Xipamide: May enhance the adverse/toxic effect of Loop Diuretics. Specifically, the risk of hypovolemia, electrolyte disturbances, and prerenal azotemia may be increased. Monitor therapy Yohimbine: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy Test Interactions May lead to false-negative aldosterone/renin ratio (ARR) (Funder 2016). Adverse Reactions Frequency not defined. Cardiovascular: Thrombophlebitis (with intravenous use) Central nervous system: Apprehension, brain disease (patients with preexisting liver disease), chills, confusion, fatigue, headache, vertigo Dermatologic: IgA vasculitis (in patient with rheumatic heart disease), skin rash Endocrine & metabolic: Abnormal phosphorus levels (variations), abnormal serum calcium (variations), gout, hyperglycemia, hyperuricemia (reversible), hypoglycemia (occurred in two uremic patients who received doses above those recommended), hyponatremia, variations in bicarbonate, variations in CO2 content Gastrointestinal: Abdominal distress, abdominal pain, anorexia, diarrhea, dysphagia, gastrointestinal hemorrhage, malaise, nausea, vomiting, acute pancreatitis (rare) Genitourinary: Hematuria Hematologic & oncologic: Agranulocytosis, severe neutropenia, thrombocytopenia Hepatic: Abnormal hepatic function tests, jaundice Local: Local irritation, local pain Ophthalmic: Blurred vision Otic: Deafness (temporary or permanent), tinnitus Renal: Increased serum creatinine Miscellaneous: Fever Warnings/Precautions Concerns related to adverse effects: Fluid/electrolyte loss: Loop diuretics are potent diuretics; excess amounts can lead to profound diuresis with fluid and electrolyte loss; close medical supervision and dose evaluation are required. Watch for and correct electrolyte disturbances; adjust dose to avoid dehydration. In contrast to thiazide diuretics, a loop diuretic can also lower serum calcium concentrations. Electrolyte disturbances can predispose a patient to serious cardiac arrhythmias. Hypersensitivity reactions: Can rarely occur, however, ethacrynic acid has no cross-reactivity to sulfonamides or sulfonylureas. Nephrotoxicity: Monitor fluid status and renal function in an attempt to prevent oliguria, azotemia, and reversible increases in BUN and creatinine; close medical supervision of aggressive diuresis required. Ototoxicity: Rapid IV administration, renal impairment, excessive doses, and concurrent use of other ototoxins is associated with ototoxicity; has been associated with a higher incidence of ototoxicity than other loop diuretics. Disease-related concerns: Cirrhosis: In cirrhosis, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy. Concurrent drug therapy issues: Antihypertensives: Coadministration of antihypertensives may increase the risk of hypotension. Special populations: Surgical patients: If given the morning of surgery, ethacrynic acid may render the patient volume depleted and blood pressure may be labile during general anesthesia. Other warnings and precautions: Diuretic resistance: For some patients, despite higher doses of loop diuretic treatment, an adequate diuretic response cannot be attained. Diuretic resistance can usually be overcome by intravenous administration, the use of two diuretics together (eg, furosemide and chlorothiazide), or the use of a diuretic with a positive inotropic agent. When such combinations are used, serum electrolytes need to be monitored even more closely (Cody 1994; ACC/AHA [Yancy 2013]; HFSA 2010). Monitoring Parameters Blood pressure, renal function, serum electrolytes, and fluid status closely, including weight and I & O daily; hearing Pregnancy Risk Factor B Pregnancy Considerations Adverse events have not been observed in animal reproduction studies. Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience loss of strength and energy, headache, lack of appetite, vomiting, or nausea. Have patient report immediately to prescriber signs of fluid and electrolyte problems (mood changes, confusion, muscle pain or weakness, abnormal heartbeat, severe dizziness, passing out, tachycardia, increased thirst, seizures, loss of strength and energy, lack of appetite, urinary retention or change in amount of urine passed, dry mouth, dry eyes, or nausea or vomiting); signs of high blood sugar (confusion, fatigue, increased thirst, increased hunger, polyuria, flushing, fast breathing, or breath that smells like fruit); severe dizziness; passing out; hearing impairment/loss; tinnitus; vision changes; chills; burning or numbness feeling; vomiting blood; black, tarry, or bloody stools; hematuria; confusion; or severe diarrhea (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients. Next Interactions Print this page Add to My Med List More about ethacrynic acid Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Images Drug Interactions Support Group Pricing & Coupons En Español 1 Review Add your own review/rating Drug class: loop diuretics Consumer resources Ethacrynic acid ... +4 more Professional resources Ethacrynate Sodium (AHFS Monograph) Ethacrynic Acid (AHFS Monograph) Ethacrynate Sodium Injection (FDA) Ethacrynic Sodium (FDA) Ethacrynic Sodium Injection (FDA) Other brands: Edecrin , Sodium Edecrin Related treatment guides Ascites Edema Nonobstructive Oliguria Pulmonary Edema Renal Failure} Drug Status Rx Availability Prescription only B Pregnancy Category No proven risk in humans N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA WADA Class Anti-Doping Classification Ethacrynic acid Rating 1 User Review 8.0 /10 1 User Review 8.0 Rate it! Manufacturers Par Pharmaceutical, Inc. Roxane Laboratories, Inc. West-Ward Pharmaceuticals Drug Class Loop diuretics Related Drugs loop diuretics furosemide , Lasix , torsemide , bumetanide , Bumex , Demadex Nonobstructive Oliguria furosemide , Lasix , torsemide , Demadex , dopamine , Edecrin , More... Renal Failure furosemide , Lasix , torsemide , Demadex , Edecrin , Sodium Edecrin , More... Ascites furosemide , Lasix , triamterene , torsemide , bumetanide , Bumex , More... 2 more conditions... Ethacrynic acid Images Ethacrynic acid systemic 25 mg (EDECRIN VRX 205) View larger images} } to break down
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