ethacrynic acid

Contraindicated in:

Hypersensitivity
Hepatic coma or anuria.

Use Cautiously in:

Severe liver disease (may precipitate hepatic coma; concurrent use with potassium-sparing diuretics may be necessary)
Electrolyte depletion
Diabetes mellitus
Increasing azotemia
OB: Lactation: Safety not established
Geri: Possible ↑ risk of side effects at usual doses, especially hypotension and electrolyte imbalance.

Adv. Reactions/Side Effects ⬆ ⬇

CNS: confusion, fatigue, headache, nervousness, vertigo.

EENT: hearing loss, tinnitus.

CV: hypotension.

GI: abdominal pain, anorexia, diarrhea, dry mouth, dysphagia, nausea, vomiting.

GU: azotemia, excessive urination, hematuria.

Derm: rash.

Endo: hyperglycemia, hyperuricemia.

F and E: dehydration, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis, hypocalcemia.

Hemat: AGRANULOCYTOSIS, neutropenia, thrombocytopenia.

Misc: fever.

Interactions ⬆ ⬇

Drug-Drug:

↑hypotension with antihypertensives, nitrates, or acute ingestion of alcohol.
↑risk of hypokalemia with other diuretics, amphotericin B, stimulant laxatives, and corticosteroids.
Hypokalemia may ↑ risk of digoxin toxicity and ↑ risk of arrhythmia in patients taking drugs that prolong the QT interval.
↓lithium excretion, may cause lithium toxicity.
↑risk of ototoxicity with aminoglycosides.
May ↑ the effectiveness of warfarin,.
NSAIDS↓ effects of ethacrynic acid.

Availability ⬆ ⬇

(Generic available)

Tablet: 25 mg;
Injection: 50 mg/vial;

Route/Dosage ⬆ ⬇

PO (Adults): 50–100 mg/day in 1–2 divided doses; may ↑ dose by 25–50 mg every few days until desired response (maximum dose = 400 mg/day).
PO (Children >1 mo): 1 mg/kg/dose once daily; may be ↑ every 2–3 days to a maximum of 3 mg/kg/day.
IV (Adults): 0.5–1 mg/kg/dose (maximum = 100 mg/dose); may repeat dose every 8–12 hr if needed.
IV (Children >1 mo): 1 mg/kg/dose, may repeat dose if indicated q 8–12 hr.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule.
Increases renal excretion of water, sodium, chloride, magnesium, hydrogen, and calcium.
Effectiveness persists in impaired renal function.

Therapeutic Effects:

Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions).

Classifications ⬆ ⬇

Therapeutic Classification: diuretics

Pharmacologic Classification: loop diuretics

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed after oral administration. IV administration results in complete bioavailability.

Distribution: Unknown.

Protein Binding: >90%.

Metabolism/Excretion: 35–40% metabolized by liver; 60% eliminated unchanged by kidneys.

Half-life: 2–4 hr.

Time/Action Profile ⬆ ⬇

(diuretic effect)

ROUTE	ONSET	PEAK	DURATION
PO	30 min	2 hr	6–8 hr
IV	5 min	30 min	2 hr

Patient/Family Teaching ⬆ ⬇

Instruct patient to take ethacrynic acid as directed. Take missed doses as soon as possible; do not double doses.
- Caution patient to change positions slowly to minimize orthostatic hypotension. Caution patient that the use of alcohol, exercise during hot weather, or standing for long periods during therapy may enhance orthostatic hypotension.
- Instruct patient to consult health care professional regarding a diet high in potassium.See Appendix M.
- Advise patient to obtain weight at the same time each day (preferably in the morning after urinating) and to keep a daily log of the results. Advise patient to contact health care professional of weight gain more than 3 lbs in one day.
- Advise patient to consult health care professional before taking OTC medication or herbal products concurrently with this therapy.
- Instruct patient to notify health care professional of medication regimen before treatment or surgery.
- Advise patient to contact health care professional immediately if muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities occurs.
- Advise patients with diabetes to monitor blood glucose closely; may cause increased blood glucose levels.
- Emphasize the importance of routine follow-up examinations.
- Geri: Caution older patients or their caregivers about increased risk for falls. Suggest strategies for fall prevention.

Pronunciation ⬆ ⬇

Code ⬆

NDC Code^*

0054- West-Ward Pharmaceuticals Corp.
0054-0415- Ethacrynic Acid 0054-0415-25- 100 TABLET in 1 BOTTLE (0054-0415-25)

0054- West-Ward Pharmaceuticals Corp.
0054-0415- Ethacrynic Acid 0054-0415-29- 500 TABLET in 1 BOTTLE (0054-0415-29)

25010- Aton Pharma, Inc.
25010-215- EDECRIN 25010-215-15- 100 TABLET in 1 BOTTLE (25010-215-15)

42799- Edenbridge Pharmaceuticals, LLC
42799-405- Ethacrynic Acid 42799-405-01- 100 TABLET in 1 BOTTLE (42799-405-01)

47781- Alvogen, Inc.
47781-497- Ethacrynic acid 47781-497-01- 100 TABLET in 1 BOTTLE (47781-497-01)

49884- Par Pharmaceutical, Inc.
49884-276- Ethacrynic Acid 49884-276-01- 100 TABLET in 1 BOTTLE (49884-276-01)

50228- ScieGen Pharmaceuticals Inc
50228-334- Ethacrynic Acid 50228-334-01- 100 TABLET in 1 BOTTLE (50228-334-01)

50228- ScieGen Pharmaceuticals Inc
50228-334- Ethacrynic Acid 50228-334-10- 1000 TABLET in 1 BOTTLE (50228-334-10)

50228- ScieGen Pharmaceuticals Inc
50228-334- Ethacrynic Acid 50228-334-30- 30 TABLET in 1 BOTTLE (50228-334-30)

52817- TRUPHARMA LLC
52817-367- Ethacrynic acid 52817-367-10- 100 TABLET in 1 BOTTLE (52817-367-10)

52817- TRUPHARMA LLC
52817-367- Ethacrynic acid 52817-367-60- 60 TABLET in 1 BOTTLE (52817-367-60)

52817- TRUPHARMA LLC
52817-367- Ethacrynic acid 52817-367-90- 90 TABLET in 1 BOTTLE (52817-367-90)

60429- Golden State Medical Supply, Inc.
60429-887- Ethacrynic Acid 60429-887-01- 100 TABLET in 1 BOTTLE (60429-887-01)

68682- Oceanside Pharmaceuticals
68682-011- ethacrynic acid 68682-011-10- 100 TABLET in 1 BOTTLE (68682-011-10)

69238- Amneal Pharmaceuticals NY LLC
69238-1126- Ethacrynic Acid 69238-1126-1- 100 TABLET in 1 BOTTLE (69238-1126-1)

72134- Agnitio Inc.
72134-003- Ethacrynic acid 72134-003-01- 100 TABLET in 1 BOTTLE (72134-003-01)

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Indications ⬇

Contraind./Precautions ⬆ ⬇