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:
Form of Medication
Frequency of Repeat Doses
50 to 200 mg per day, divided into 1 or 2 doses
400 mg per 24 hours
Spaced several days apart
0.5 to 1 mg per kilogram of body weight per dose
100 mg per dose
Every 8 to 12 hours (if necessary)
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:
Form of Medication
0.5 to 1 mg per kilogram of body weight per dose
50 mg per dose
Every 8 to 24 hours
Continuous IV infusion
Usual initial rate: 0.1 mg per kilogram of body weight per hour, titrated to effect.
0.5 mg per kilogram of body weight per hour
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:
- Thrombophlebitis (With Intravenous Use)
Central Nervous System:
- Brain Disease (Patients With Preexisting Liver Disease)
- Iga Vasculitis
- Skin Rash
Endocrine & Metabolic:
- Abnormal Phosphorus Levels (Variations)
- Abnormal Serum Calcium (Variations)
- Hyperuricemia (Reversible)
- Hypoglycemia (Occurred In Two Uremic Patients Who Received Doses Above Those Recommended)
- Variations In Bicarbonate
- Variations In CO2 Content
- Abdominal Distress
- Abdominal Pain
- Acute Pancreatitis (Rare)
- Gastrointestinal Hemorrhage
Hematologic & Oncologic:
- Severe Neutropenia
- Abnormal Hepatic Function Tests
- Local Irritation
- Local Pain
- Blurred Vision
- Deafness (Temporary Or Permanent)
- Increased Serum Creatinine
Contraindications to Ethacrynic acid:
- Hypersensitivity to ethacrynic or any other component of the formulation
- History of severe diarrhea due to this product
Warnings and precautions
- 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.
- It is rare, but ethacrynic acids has no crossreactivity with sulfonamides and sulfonylureas.
- 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 is linked to rapid IV delivery, renal dysfunction, and high doses of other ototoxins. Compared to other loop diuretics, this occurs more frequently.
- 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
Risk Factor C (Monitor therapy)
|Alfuzosin||The hypotensive effects of blood pressure-lowering medications may be strengthened.|
|Allopurinol||Loop Diuretics may intensify Allopurinol's harmful or toxic effects. Allopurinol's serum levels may rise in response to loop diuretics.|
|Amikacin (Oral Inhalation)||Loop Diuretics may increase Amikacin's nephrotoxic impact (Oral Inhalation).|
|Aminoglycosides||Aminoglycosides may have a worse or more toxic effect when used with loop diuretics. ototoxicity and nephrotoxicity in particular.|
|Amphetamines||May lessen the effectiveness of antihypertensive agents.|
|Angiotensin-Converting Enzyme Inhibitors||Angiotensin-Converting Enzyme Inhibitors' hypotensive effects may be strengthened by loop diuretics. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by loop diuretics.|
|Antidiabetic Agents||The therapeutic benefit of anti-diabetic agents may be reduced by hyperglycemia-associated agents.|
|Antipsychotic Agents (Second Generation [Atypical])||Antipsychotic drugs' hypotensive effects may be enhanced by blood pressure-lowering medications (Second Generation [Atypical]).|
|Barbiturates||The hypotensive effects of blood pressure-lowering medications may be strengthened.|
|Benperidol||May enhance the hypotensive effect of Blood Pressure Lowering Agents.|
|Beta2-Agonists||May intensify Loop Diuretics' hypokalemic impact.|
|Bilastine||The QTc-prolonging effects of loop diuretics may be enhanced by bilastine.|
|Brigatinib||May lessen the effectiveness of antihypertensive agents. Antihypertensive Agents' bradycardic action may be strengthened by brutinib.|
|Brimonidine (Topical)||May enhance the hypotensive effect of Blood Pressure Lowering Agents.|
|Cardiac Glycosides||Cardiac Glycosides may have a worse or more toxic effect when used with loop diuretics. Particularly, the hypokalemic and hypomagnesemic impact of loop diuretics may worsen cardiac glycoside toxicity.|
|Cefazedone||May intensify Loop Diuretics' nephrotoxic effects.|
|Cefotiam||Loop Diuretics may intensify Ceftiam's nephrotoxic effects.|
|Cefpirome||Loop Diuretics may increase Cefpirome's nephrotoxic effects.|
|Ceftizoxime||Loop Diuretics may increase Ceftizoxime's nephrotoxic effects.|
|Cephalothin||Loop Diuretics may increase Cephalothin's nephrotoxic effects.|
|Cephradine||May intensify Loop Diuretics' nephrotoxic effects.|
|CISplatin||Loop Diuretics might make CISplatin's nephrotoxic effects worse. The ototoxic impact of CISplatin might be increased by loop diuretics.|
|Corticosteroids (Orally Inhaled)||May intensify Loop Diuretics' nephrotoxic effects.|
|Corticosteroids (Systemic)||May intensify Loop Diuretics' nephrotoxic effects.|
|CycloSPORINE (Systemic)||May intensify Loop Diuretics' nephrotoxic effects.|
|Dexmethylphenidate||Can lessen an antihypertensive drug's therapeutic impact.|
|Diacerein||Could make diuretics' therapeutic effects stronger. Particularly, there may be a higher chance of hypokalemia or dehydration.|
|Diazoxide||The hypotensive effects of blood pressure-lowering medications may be strengthened.|
|DULoxetine||Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine.|
|Empagliflozin||May enhance the hypotensive effect of Loop Diuretics.|
|Fosphenytoin||May lessen Loop Diuretics' diuretic effects.|
|Herbs (Hypertensive Properties)||May lessen the effectiveness of antihypertensive agents.|
|Herbs (Hypotensive Properties)||The hypotensive effects of blood pressure-lowering medications may be strengthened.|
|Hypotension-Associated Agents||The hypotensive action of hypotension-associated agents may be strengthened by blood pressure lowering medications.|
|Ipragliflozin||May intensify Loop Diuretics' harmful or hazardous effects. In particular, there may be an elevated risk for intravascular volume depletion.|
|Ivabradine||Ivabradine's ability to induce arrhythmias may be enhanced by loop diuretics.|
|Levodopa-Containing Products||Levodopa-Containing Products' hypotensive effects may be strengthened by blood pressure-lowering medications.|
|Licorice||May intensify Loop Diuretics' hypokalemic impact.|
|Lithium||Loop Diuretics may lower the level of lithium in the blood. Loop Diuretics may raise the level of lithium in the blood.|
|Lormetazepam||The hypotensive effects of blood pressure-lowering medications may be strengthened.|
|Methylphenidate||May lessen the effectiveness of antihypertensive agents.|
|Molsidomine||The hypotensive effects of blood pressure-lowering medications may be strengthened.|
|Naftopidil||The hypotensive effects of blood pressure-lowering medications may be strengthened.|
|Neuromuscular-Blocking Agents||The neuromuscular-blocking effects of neuromuscular-blocking agents may be lessened by loop diuretics. Neuromuscular-Blocking Agents' ability to block neuromuscular activity may be enhanced by loop diuretics.|
|Nicergoline||The hypotensive effects of blood pressure-lowering medications may be strengthened.|
|Nicorandil||The hypotensive effects of blood pressure-lowering medications may be strengthened.|
|Nitroprusside||Nitroprusside's hypotensive impact may be strengthened by blood pressure-lowering medications.|
|Opioid Agonists||Could make diuretics' harmful or toxic effects worse. Opioid antagonists may reduce diuretics' therapeutic benefit|
|Pentoxifylline||The hypotensive effects of blood pressure-lowering medications may be strengthened.|
|Phenytoin||May lessen Loop Diuretics' diuretic effects.|
|Pholcodine||Pholcodine's hypotensive impact may be strengthened by blood pressure lowering medications.|
|Phosphodiesterase 5 Inhibitors||Blood pressure-lowering medicines may strengthen their hypotensive effects.|
|Probenecid||May intensify Loop Diuretics' harmful or hazardous effects. The diuretic action of loop diuretics may be reduced by probenecid. Loop Diuretics' serum levels may rise in response to probenecid. Monitoring for diminished diuretic effects or increased side effects of loop diuretics while probenecid is also being used concurrently. The prescribing advice for bumetanide cautions against using probenecid at the same time.|
|Prostacyclin Analogues||The hypotensive effects of blood pressure-lowering medications may be strengthened.|
|Quinagolide||The hypotensive effects of blood pressure-lowering medications may be strengthened.|
|Quinagolide||.May intensify the effect of loop diuretics on hypokalemia|
|RisperiDONE||Loop Diuretics may intensify RisperiDONE's harmful or hazardous effects.|
|Salicylates||May lessen Loop Diuretics' diuretic effects. The content of salicylates in the serum may rise when using loop diuretics.|
|Tobramycin (Oral Inhalation)||Loop Diuretics may increase Tobramycin's nephrotoxic effects (Oral Inhalation).|
|Topiramate||Loop Diuretics may increase Tobramycin's ototoxic effects (Oral Inhalation).|
|Vitamin K Antagonists (eg, warfarin)||Topiramate's effect on hypokalemia may be enhanced by loop diuretics.
The concentration of vitamin K antagonists in the serum may rise in response to ethacrynic acid.
|Xipamide||May intensify Loop Diuretics' harmful or hazardous effects. Particularly, there may be a higher chance of hypovolemia, electrolyte imbalances, and prerenal azotemia.|
|Yohimbine||May diminish the antihypertensive effect of Antihypertensive Agents.|
Risk Factor D (Consider therapy modification)
|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.|
|Bile Acid Sequestrants||Loop Diuretics' ability to absorb water may be reduced.|
|Canagliflozin||May strengthen Loop Diuretics' hypotensive effects. Management: If canagliflozin is taken with a loop diuretic, watch for signs of hypotension and intravascular volume depletion. The Canadian product labelling advises against taking loop diuretics and canagliflozin together.|
|Dofetilide||Loop Diuretics may increase Dofetilide's ability to extend QTc. Management: When dofetilide is taken with loop diuretics, serum potassium and magnesium levels should be continuously monitored. The need for therapy change may arise.|
|Foscarnet||Loop Diuretics may raise the level of foscarnet in the blood.|
|Methotrexate||May reduce Loop Diuretics' therapeutic efficacy. Loop diuretics may raise the level of methotrexate in the serum. Loop Diuretics' serum levels may be raised by methotrexate. Management involves monitoring for elevated methotrexate and/or loop diuretic levels/toxicity with concurrent use of these drugs as well as for diminished loop diuretic therapeutic effects. It could be essential to reduce the dosage of loop diuretics or methotrexate.|
|Nonsteroidal Anti-Inflammatory Agents||May lessen Loop Diuretics' diuretic effects. Nonsteroidal Anti-Inflammatory Drugs may have a greater nephrotoxic effect when used with loop diuretics. Management: When using an NSAID at the same time as loop diuretics, watch out for signs of kidney damage or diminished therapeutic efficacy. Avoid using concurrently if you have cirrhosis or CHF. Bumetanide and indomethacin should not be used concurrently.|
|Obinutuzumab||The hypotensive effects of blood pressure-lowering medications may be strengthened. Management: Take into account temporarily stopping blood pressure-lowering drugs 12 hours before the start of the obinutuzumab infusion and keeping them off until 1 hour after the infusion is finished.|
|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.|
Risk Factor X (Avoid combination)
|Bromperidol||May diminish the hypotensive effect of Blood Pressure Lowering Agents. The hypotensive impact of bromperidol may be enhanced by blood pressure lowering medications.|
|Desmopressin||Loop Diuretics may enhance the hyponatremic effect of Desmopressin.|
|Furosemide||May enhance the ototoxic effect of Ethacrynic Acid.|
|Levosulpiride||Loop Diuretics may enhance the adverse/toxic effect of Levosulpiride.|
|Promazine||Loop Diuretics may enhance the QTc-prolonging effect of Promazine.|
- Renal function,
- serum electrolytes,
- blood pressure, and fluid status closely, including weight and I & O daily;
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:
- Oral: ~30 minutes;
- IV: 5 minutes
- Oral: 2 hours;
- IV: 30 minutes
- Oral: 12 hours;
- IV: 2 hours
- Oral: Rapid
- More than 90 percent.
- Hepatic (35% to 40%) to active cysteine conjugate
- Normal renal function: 2-4 hours
- Feces and urine (30% to 60% as unchanged drug)
International Brand Names of Ethacrynic acid:
- Sodium Edecrin
- VPI-Ethacrynate Sodium
- Hydromedin i.v. [inj.]
Ethacrynic acid Brand Names in Pakistan:
There is no brand available in Pakistan.