Edema (diuresis): Note: Ethacrynic acid is a potent diuretic and should be used for clinical conditions refractory to other diuretics, or requiring rapid onset in diuretic response. Very limited data available: IV: 1 mg/kg/dose once daily (Ref)
Note: Dose equivalency for adult patients with normal renal function (approximate): Bumetanide 1 mg = furosemide 40 mg = torsemide 20 mg = ethacrynic acid 50 mg
Edema (diuresis): Note: Ethacrynic acid is a potent diuretic and should be used for clinical conditions refractory to other diuretics, or requiring rapid onset in diuretic response.
Oral: Infants (limited data available), Children, and Adolescents: Initial: 1 mg/kg/dose once daily; maximum initial dose should generally not exceed 25 to 50 mg/dose based on experience in adult patients; increase at intervals of 2 to 3 days to a maximum of 3 mg/kg/day in divided doses 1 to 3 times daily not to exceed a maximum daily dose: 400 mg/24 hours (Ref)
Parenteral: Limited data available: Infants, Children, and Adolescents:
Intermittent IV: 0.5 to 1 mg/kg/dose every 8 to 24 hours; maximum dose: 50 mg/dose (Ref)
Continuous IV infusion: Usual reported initial rate: 0.1 mg/kg/hour, titrate to effect; maximum reported infusion rate: 0.5 mg/kg/hour, although in trials, most patients responded to a lower dose. Dosing based on a prospective study of 36 pediatric post-operative cardiac surgery patients (mean age: 135 ± 181 days; mean weight: 4.2 ± 3.1 kg) which reported a mean effective dose of 0.22 ± 0.13 mg/kg/hour (Ref); a pilot retrospective report of 9 patients reported a mean initial dose 0.13 ± 0.07 mg/kg/hour and a mean maximum rate of 0.17 ± 0.08 mg/kg/hour (Ref). Note: Monitor serum electrolytes closely; in trials, hypokalemia and metabolic alkalosis was frequently observed.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution; contraindicated in patients with anuria. Based on experience with other loop diuretics (ie, furosemide) in adults, very high doses may be necessary to initiate diuretic effect.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution in patients with severe cirrhosis of the liver; with other loop diuretics (ie, furosemide), diminished natriuretic effect with increased sensitivity to hypokalemia and volume depletion in cirrhosis has been observed; monitor effects, particularly with high doses.
(For additional information see "Ethacrynic acid: Drug information")
Note: Loop diuretic approximate oral dose equivalency for patients with normal renal function: Ethacrynic acid 50 mg = bumetanide 1 mg = torsemide 10 to 20 mg = furosemide 40 mg (Ref).
Edema or volume overload (alternative agent):
Note: Reserve use for patients who develop a hypersensitivity reaction to sulfonamide-based loop diuretics (eg, furosemide, bumetanide, torsemide). Ototoxicity is more common when administered at high doses compared with other loop diuretics (Ref). When used as a replacement for another loop diuretic, refer to the equivalencies above.
Naive to loop diuretics:
Oral: 25 to 50 mg once daily; increase dose by 25 to 50 mg/day based on response and tolerability; usual effective dose: 50 to 200 mg/day in 1 to 2 divided doses; for severe, refractory edema, may administer up to 400 mg/day in 2 divided doses (Ref).
IV: 50 mg or 0.5 to 1 mg/kg/dose (maximum single dose: 100 mg); usually one dose is sufficient; if needed, a repeat dose can be administered 12 hours later; doses up to 200 mg/day in 2 divided doses for 2 to 5 days have been reported (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution. Contraindicated in patients with anuria.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions are derived from product labeling unless otherwise specified.
Frequency not defined:
Dermatologic: Skin rash
Gastrointestinal: Abdominal distress, abdominal pain, anorexia, diarrhea, dysphagia, gastrointestinal hemorrhage, nausea, vomiting
Genitourinary: Hematuria
Local: Infusion-site irritation, infusion-site pain
Nervous system: Apprehension, chills, confusion, fatigue, headache, malaise, vertigo
Ophthalmic: Blurred vision
Otic: Deafness (temporary or permanent), tinnitus
Miscellaneous: Fever
Postmarketing:
Endocrine & metabolic: Hyperglycemia, hyperuricemia (reversible)
Gastrointestinal: Acute pancreatitis
Hematologic & oncologic: Thrombocytopenia
Neuromuscular & skeletal: Gout
Hypersensitivity to ethacrynic acid or any component of the formulation; anuria; history of severe watery diarrhea caused by this product; infants
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: Rarely occurs. Ethacrynic acid has no cross-reactivity to sulfonamides or sulfonylureas (Wall 2003).
• 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:
• Bariatric surgery: Dehydration: Avoid diuretics in the immediate postoperative period after bariatric surgery; electrolyte disturbances and dehydration may occur. Diuretics may be resumed, if indicated, once oral fluid intake goals are met (Ziegler 2009).
• Hepatic impairment: Use caution in patients with cirrhosis; initiate ethacrynic acid therapy with conservative dosing and close monitoring of electrolytes; avoid sudden changes in fluid and electrolyte balance and acid/base status, which may lead to hepatic encephalopathy.
Special populations:
• Surgical patients: If administered in the morning prior to 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 high doses of loop diuretic, an adequate diuretic response cannot be attained. Diuretic resistance may be overcome by IV rather than oral administration or the use of two diuretics together (eg, a loop diuretic in combination with a thiazide diuretic). When such combinations are used, serum electrolytes need to be monitored even more closely (ACC [Hollenberg 2019]).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution Reconstituted, Intravenous, as ethacrynate sodium:
Sodium Edecrin: 50 mg (1 ea [DSC])
Generic: 50 mg (1 ea)
Solution Reconstituted, Intravenous, as ethacrynate sodium [preservative free]:
Generic: 50 mg (1 ea)
Tablet, Oral:
Edecrin: 25 mg [scored]
Generic: 25 mg
Yes
Solution (reconstituted) (Ethacrynate Sodium Intravenous)
50 mg (per each): $4,560.00
Tablets (Edecrin Oral)
25 mg (per each): $29.33
Tablets (Ethacrynic Acid Oral)
25 mg (per each): $2.70 - $24.19
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution Reconstituted, Intravenous, as ethacrynate sodium:
Sodium Edecrin: 50 mg ([DSC])
Generic: 50 mg (1 ea)
Tablet, Oral:
Edecrin: 25 mg [contains corn starch]
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.
Oral: Administer with food or milk
Parenteral: IV: May be infused without further dilution over a period of several minutes or infused slowly through the tubing of a running infusion; if a second dose is needed, it is recommended to use a new injection site to avoid possible thrombophlebitis. Should not be administered IM or SubQ due to local pain and irritation.
IV: For IV use only; do not administer SUBQ or IM due to local pain and irritation. Administer slowly through the tubing of a running infusion or by direct IV injection over ~5 to 20 minutes; rapid administration increases the risk of ototoxicity due to the high concentrations achieved in a short period of time. If a second or repeat doses are needed, rotate the injection site to avoid possible thrombophlebitis (Ref).
Oral: Administer after a meal.
Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Discard unused reconstituted injection solution after 24 hours.
Oral: Short-term management of hospitalized patients with congenital heart disease or nephrotic syndrome (FDA approved in children, adolescents, and adults); management of edema associated with congestive heart failure, hepatic cirrhosis, or renal disease (FDA approved in adults); short-term management of ascites due to malignancy, idiopathic edema, and lymphedema (FDA approved in adults)
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) (FDA approved in adults)
Edecrin may be confused with Eulexin, Ecotrin
Beers Criteria: Diuretics are identified in the Beers Criteria as potentially inappropriate medications to be used with caution in patients 65 years and older due to the potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium concentration closely when initiating or adjusting the dose in older adults (Beers Criteria [AGS 2023]). Note: Updates for the American Geriatrics Society 2023 AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults are in process.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Allopurinol: Loop Diuretics may increase adverse/toxic effects of Allopurinol. Loop Diuretics may increase serum concentration of Allopurinol. Specifically, Loop Diuretics may increase the concentration of Oxypurinol, an active metabolite of Allopurinol. Risk C: Monitor
Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification
Amikacin Liposome (Oral Inhalation): Loop Diuretics may increase nephrotoxic effects of Amikacin Liposome (Oral Inhalation). Loop Diuretics may increase ototoxic effects of Amikacin Liposome (Oral Inhalation). Risk C: Monitor
Aminoglycosides: Loop Diuretics may increase adverse/toxic effects of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Risk C: Monitor
Aminolevulinic Acid (Systemic): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Systemic). Risk X: Avoid
Aminolevulinic Acid (Topical): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Topical). Risk C: Monitor
Amphetamines: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor
Angiotensin II Receptor Blockers: Loop Diuretics may increase hypotensive effects of Angiotensin II Receptor Blockers. Loop Diuretics may increase nephrotoxic effects of Angiotensin II Receptor Blockers. Risk C: Monitor
Angiotensin-Converting Enzyme Inhibitors: Loop Diuretics may increase hypotensive effects of Angiotensin-Converting Enzyme Inhibitors. Loop Diuretics may increase nephrotoxic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor
Antidiabetic Agents: Hyperglycemia-Associated Agents may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor
Antihypertensive Agents: Loop Diuretics may increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor
Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Arsenic Trioxide: Loop Diuretics may increase QTc-prolonging effects of Arsenic Trioxide. Loop Diuretics may increase hypotensive effects of Arsenic Trioxide. Management: When possible, avoid concurrent use of arsenic trioxide with drugs that can cause electrolyte abnormalities, such as the loop diuretics. Risk D: Consider Therapy Modification
Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Beta2-Agonists: May increase hypokalemic effects of Loop Diuretics. Risk C: Monitor
Bilastine: Loop Diuretics may increase QTc-prolonging effects of Bilastine. Risk C: Monitor
Bile Acid Sequestrants: May decrease absorption of Loop Diuretics. Risk C: Monitor
Brigatinib: May decrease antihypertensive effects of Antihypertensive Agents. Brigatinib may increase bradycardic effects of Antihypertensive Agents. Risk C: Monitor
Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid
Canagliflozin: May increase hypotensive effects of Loop Diuretics. Risk C: Monitor
Cardiac Glycosides: Loop Diuretics may increase adverse/toxic effects of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of loop diuretics. Risk C: Monitor
Cefazedone: May increase nephrotoxic effects of Loop Diuretics. Risk C: Monitor
Cefotiam: Loop Diuretics may increase nephrotoxic effects of Cefotiam. Risk C: Monitor
Cefpirome: Loop Diuretics may increase nephrotoxic effects of Cefpirome. Risk C: Monitor
Ceftizoxime: Loop Diuretics may increase nephrotoxic effects of Ceftizoxime. Risk C: Monitor
Cephaloridine: Loop Diuretics may increase nephrotoxic effects of Cephaloridine. Loop Diuretics may increase serum concentration of Cephaloridine. Risk X: Avoid
Cephalothin: Loop Diuretics may increase nephrotoxic effects of Cephalothin. Risk C: Monitor
Cephradine: May increase nephrotoxic effects of Loop Diuretics. Risk C: Monitor
Certoparin: Ethacrynic Acid may increase anticoagulant effects of Certoparin. Risk C: Monitor
CISplatin: Loop Diuretics may increase ototoxic effects of CISplatin. Loop Diuretics may increase nephrotoxic effects of CISplatin. Risk C: Monitor
Corticosteroids (Systemic): May increase hypokalemic effects of Loop Diuretics. Risk C: Monitor
CycloSPORINE (Systemic): May increase adverse/toxic effects of Loop Diuretics. Specifically, the risk for hyperuricemia and gout may be increased. Risk C: Monitor
Desmopressin: May increase hyponatremic effects of Loop Diuretics. Risk X: Avoid
Dexmethylphenidate: May decrease therapeutic effects of Antihypertensive Agents. Risk C: Monitor
Diacerein: May increase therapeutic effects of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Risk C: Monitor
Diazoxide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Dichlorphenamide: Loop Diuretics may increase hypokalemic effects of Dichlorphenamide. Risk C: Monitor
Dofetilide: Loop Diuretics may increase QTc-prolonging effects of Dofetilide. Management: Monitor serum potassium and magnesium more closely when dofetilide is combined with loop diuretics. Electrolyte replacements will likely be required to maintain potassium and magnesium serum concentrations. Risk D: Consider Therapy Modification
DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor
Empagliflozin: May increase hypotensive effects of Loop Diuretics. Risk C: Monitor
EPINEPHrine (Systemic): Diuretics may increase arrhythmogenic effects of EPINEPHrine (Systemic). Diuretics may decrease vasopressor effects of EPINEPHrine (Systemic). Risk C: Monitor
Flunarizine: May increase therapeutic effects of Antihypertensive Agents. Risk C: Monitor
Foscarnet: Loop Diuretics may increase serum concentration of Foscarnet. Management: When diuretics are indicated during foscarnet treatment, thiazides are recommended over loop diuretics. If patients receive loop diuretics during foscarnet treatment, monitor closely for evidence of foscarnet toxicity. Risk D: Consider Therapy Modification
Furosemide: May increase ototoxic effects of Ethacrynic Acid. Risk X: Avoid
Herbal Products with Blood Pressure Increasing Effects: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor
Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor
Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Immune Globulin: Loop Diuretics may increase thrombogenic effects of Immune Globulin. Risk C: Monitor
Indoramin: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor
Iodinated Contrast Agents: Loop Diuretics may increase nephrotoxic effects of Iodinated Contrast Agents. Risk C: Monitor
Ipragliflozin: May increase adverse/toxic effects of Loop Diuretics. Specifically, the risk for intravascular volume depletion may be increased. Risk C: Monitor
Isocarboxazid: May increase hypotensive effects of Diuretics. Risk X: Avoid
Ivabradine: Loop Diuretics may increase arrhythmogenic effects of Ivabradine. Risk C: Monitor
Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor
Levosulpiride: Loop Diuretics may increase adverse/toxic effects of Levosulpiride. Risk X: Avoid
Licorice: May increase hypokalemic effects of Loop Diuretics. Risk C: Monitor
Lithium: Loop Diuretics may decrease serum concentration of Lithium. Loop Diuretics may increase serum concentration of Lithium. Risk C: Monitor
Loop Diuretics: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor
Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor
Methotrexate: May decrease therapeutic effects of Loop Diuretics. Loop Diuretics may increase serum concentration of Methotrexate. Methotrexate may increase serum concentration of Loop Diuretics. Risk C: Monitor
Methoxsalen (Systemic): Photosensitizing Agents may increase photosensitizing effects of Methoxsalen (Systemic). Risk C: Monitor
Methylphenidate: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor
Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Netilmicin (Ophthalmic): Loop Diuretics may increase nephrotoxic effects of Netilmicin (Ophthalmic). Risk X: Avoid
Neuromuscular-Blocking Agents: Loop Diuretics may decrease neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Loop Diuretics may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents. Risk C: Monitor
Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor
Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Loop Diuretics. Risk C: Monitor
Nonsteroidal Anti-Inflammatory Agents: May decrease diuretic effects of Loop Diuretics. Loop Diuretics may increase nephrotoxic effects 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. Risk D: Consider Therapy Modification
Obinutuzumab: May increase hypotensive effects 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. Risk D: Consider Therapy Modification
Opioid Agonists: May increase adverse/toxic effects of Diuretics. Opioid Agonists may decrease therapeutic effects of Diuretics. Risk C: Monitor
Palopegteriparatide: Loop Diuretics may decrease therapeutic effects of Palopegteriparatide. Loop Diuretics may increase therapeutic effects of Palopegteriparatide. Risk C: Monitor
Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Perazine: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor
Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor
Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Piperacillin: May increase hypokalemic effects of Diuretics. Risk C: Monitor
Polyethylene Glycol-Electrolyte Solution: Diuretics may increase nephrotoxic effects of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor
Porfimer: Photosensitizing Agents may increase photosensitizing effects of Porfimer. Risk X: Avoid
Prazosin: Antihypertensive Agents may increase hypotensive effects of Prazosin. Risk C: Monitor
Probenecid: May decrease diuretic effects of Loop Diuretics. Probenecid may increase serum concentration of Loop Diuretics. Risk C: Monitor
Promazine: Loop Diuretics may increase QTc-prolonging effects of Promazine. Risk X: Avoid
Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Reboxetine: May increase hypokalemic effects of Loop Diuretics. Risk C: Monitor
Salicylates: May decrease therapeutic effects of Loop Diuretics. Loop Diuretics may increase serum concentration of Salicylates. Risk C: Monitor
Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor
Sodium Phosphates: Diuretics may increase nephrotoxic effects of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor
Terazosin: Antihypertensive Agents may increase hypotensive effects of Terazosin. Risk C: Monitor
Tobramycin (Oral Inhalation): Loop Diuretics may increase ototoxic effects of Tobramycin (Oral Inhalation). Loop Diuretics may increase nephrotoxic effects of Tobramycin (Oral Inhalation). Risk C: Monitor
Topiramate: Loop Diuretics may increase hypokalemic effects of Topiramate. Risk C: Monitor
Urapidil: Antihypertensive Agents may increase hypotensive effects of Urapidil. Risk C: Monitor
Vancomycin: Loop Diuretics may increase nephrotoxic effects of Vancomycin. Risk C: Monitor
Verteporfin: Photosensitizing Agents may increase photosensitizing effects of Verteporfin. Risk C: Monitor
Vitamin K Antagonists: Ethacrynic Acid may increase anticoagulant effects of Vitamin K Antagonists. Risk C: Monitor
Xipamide: May increase adverse/toxic effects of Loop Diuretics. Specifically, the risk of hypovolemia, electrolyte disturbances, and prerenal azotemia may be increased. Risk C: Monitor
Zoledronic Acid: Loop Diuretics may increase hypocalcemic effects of Zoledronic Acid. Risk C: Monitor
May cause potassium loss; potassium supplement or dietary changes may be required.
Adverse events have not been observed in animal reproduction studies.
Serum electrolytes including calcium and magnesium (baseline and frequently during therapy); blood pressure; renal function parameters (baseline and frequently during therapy); fluid balance (bodyweight; neonatal and young pediatric patients may require more frequent monitoring than older patients); hearing (with high doses or extended duration), blood glucose
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
Onset of action: Diuresis: Oral: ~30 minutes; IV: 5 minutes.
Peak effect: Oral: 2 hours; IV: 30 minutes.
Duration: Oral: 12 hours; IV: 2 to 4 hours (Molnar 2009).
Absorption: Oral: Rapid.
Bioavailability: ~100% (Molnar 2009).
Protein binding: >90%.
Metabolism: Hepatic (35% to 40%) to active cysteine conjugate.
Half-life elimination: Normal renal function: 2 to 4 hours.
Excretion: Feces and urine (30% to 60% as unchanged drug).