Ethacrynic acid is a type of medicine called a loop diuretic, just like furosemide. Doctors use it to help people who have problems with too much fluid in their body, like cirrhosis, heart failure, kidney problems, and high blood pressure.

Ethacrynic acid Uses:

Ethacrynic acid is a medication that can be taken by mouth or given through an IV. Here are the ways it can be used:

• When taken orally, ethacrynic acid helps manage swelling caused by congestive heart failure, liver disease, kidney disease, and unexplained swelling. It can also be used to treat edema that has no apparent cause and to care for fluid buildup in the abdomen caused by cancer or damage to the lymph nodes.
• When given through an IV, ethacrynic acid is used as a short-term treatment for children who are hospitalized with nephrotic syndrome or heart problems. This treatment is not given to babies.

Ethacrynic acid Dose in Adults

Note: Indicates the need for a quick commencement of diuresis (eg, in acute pulmonary edema, or when gastrointestinal absorption is impaired or oral medication is not feasible)

• For people with normal renal function, the equivalent oral dose:
  • Ethacrynic acid 50 mg = bumetanide 1 mg = torsemide 20 mg = furosemide 40 mg

Ethacrynic acid Dose in the treatment of Edema:

Ethacrynic acid Dose in Children

Note: Ethacrynic acid is a powerful diuretic and ought to be used for clinical disorders that are resistant to other diuretics or call for a quick reaction from the diuretic.

• Dose equivalency for adult patients with normal renal function (approximate):
  • Bumetanide 1 mg = furosemide 40 mg = torsemide 20 mg = ethacrynic acid 50 mg

Ethacrynic acid Dose in the treatment of Edema (diuresis):

The dosage instructions for this oral medication are:

• The initial dose is 1 milligram per kilogram of body weight, given once per day.
• Based on the experience of adult patients, the maximum initial dose should usually not be more than 25 to 50 milligrams per dose.
• The dosage can be increased every 2 to 3 days, up to a maximum of 3 milligrams per kilogram of body weight per day. This should be divided into three doses per day, with a daily maximum

Parenteral: Limited data available:

Please note that for the continuous IV infusion, the dosing is based on a study of 36 children who underwent postoperative cardiac surgery, and most patients showed improvement with a lower dose. Additionally, serum electrolytes should be closely monitored as hypokalemia and metabolic alkalosis were frequently observed in trials.

Pregnancy Risk Factor B

• Animal reproduction studies have not shown any adverse events.

Use of ethacrynic acid during breastfeeding

• The manufacturer suggests that the mother decide whether to stop nursing her infant or discontinue using the drug.
• This is in consideration of the possibility of serious adverse reactions.
• It is unknown if breast milk contains ethacrynic acids.

Ethacrynic acid Dose in Kidney Disease:

The manufacturer's labeling doesn't provided any dosage adjustments; use with caution. It is contraindicated in patients with anuria.

Ethacrynic acid Dose in Liver disease:

The manufacturer's labeling doesn't provided any dosage adjustments; use with caution.

Side effects of Ethacrynic acid:

• Cardiovascular:

  • Thrombophlebitis (With Intravenous Use)

• Central Nervous System:

  • Apprehension
  • Brain Disease (Patients With Preexisting Liver Disease)
  • Vertigo
  • Chills
  • Confusion
  • Fatigue
  • Headache

• Dermatologic:

  • Iga Vasculitis 
  • Skin Rash

• Endocrine & Metabolic:

  • Abnormal Phosphorus Levels (Variations)
  • Abnormal Serum Calcium (Variations)
  • Gout
  • Hyperuricemia (Reversible)
  • Hypoglycemia (Occurred In Two Uremic Patients Who Received Doses Above Those Recommended)
  • Hyponatremia
  • Variations In Bicarbonate
  • Hyperglycemia
  • Variations In CO2 Content

• Gastrointestinal:

  • Abdominal Distress
  • Abdominal Pain
  • Vomiting
  • Acute Pancreatitis (Rare)
  • Anorexia
  • Diarrhea
  • Dysphagia
  • Gastrointestinal Hemorrhage
  • Malaise
  • Nausea

• 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

Contraindications to Ethacrynic acid:

• Hypersensitivity to ethacrynic or any other component of the formulation
• anuria;
• History of severe diarrhea due to this product
• Infants

Warnings and precautions

• Fluid/electrolyte loss:

  • Correct electrolyte imbalances and monitor for them.
  • Contrary to thiazide diuretics, a loop diuretic can lower serum calcium levels.
  • Loop diuretics have a high potency; using them in excess might result in severe diuresis, fluid loss, and electrolyte loss.
  • Both close medical care and a dose assessment are necessary.
  • Patients with electrolyte problems can be predisposed to serious arrhythmias.

• Hypersensitivity reactions

  • It is rare, but ethacrynic acids has no crossreactivity with sulfonamides and sulfonylureas.

• Nephrotoxicity:

  • In order to avoid azotemia, oliguria and reversible rises in BUN or creatinine, monitor fluid status and renal function.
  • Close medical supervision is required for aggressive diuresis.

• Ototoxicity:

  • Ototoxicity is linked to rapid IV delivery, renal dysfunction, and high doses of other ototoxins. Compared to other loop diuretics, this occurs more frequently.

• Cirrhosis

  • To prevent hepatic enzyme, avoid electrolyte and acid/base imbalances in cirrhosis.

Ethacrynic acid: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• Renal function,
• serum electrolytes,
• blood pressure, and fluid status closely, including weight and I & O daily;
• hearing

How to administer Ethacrynic acid?

• IV: Due to local discomfort and irritability, SubQ or IM injections should not be administered.
• A single 100 mg IV dosage is too much. Over a period of many minutes, steadily administer the medication through the tubing of an ongoing infusion or by intravenous injection.
• To prevent potential thrombophlebitis, it is advised to utilise a fresh injection site if a second dose is required.

Mechanism of action of Ethacrynic acid:

• It inhibits sodium and chloride reabsorption in the ascending loop and distal renal tubule.
• This interferes with the chloride binding cotransport system and causes increased excretion of water and sodium, chloride and magnesium.

The onset of action:

• Diuresis:
  • Oral: ~30 minutes;
  • IV: 5 minutes

Peak effect:

• Oral: 2 hours;
• IV: 30 minutes

Duration:

• Oral: 12 hours;
• IV: 2 hours

Absorption:

• Oral: Rapid

Protein binding:

• More than 90 percent.

Metabolism:

• Hepatic (35% to 40%) to active cysteine conjugate

Half-life elimination:

• Normal renal function: 2-4 hours

Excretion:

• Feces and urine (30% to 60% as unchanged drug)

International Brand Names of Ethacrynic acid:

• Edecrin
• Reomax
• Uregyt
• Sodium Edecrin
• VPI-Ethacrynate Sodium
• Edecril
• Edecrin
• Edecrina
• Hydromedin
• Hydromedin i.v. [inj.]

Ethacrynic acid Brand Names in Pakistan:

There is no brand available in Pakistan.