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Ethacrynic acid: Pediatric drug information

Ethacrynic acid: Pediatric drug information
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For additional information see "Ethacrynic acid: Drug information" and "Ethacrynic acid: Patient drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Edecrin;
  • Sodium Edecrin [DSC]
Brand Names: Canada
  • Edecrin;
  • Sodium Edecrin [DSC]
Therapeutic Category
  • Antihypertensive Agent;
  • Diuretic, Loop
Dosing: Neonatal
Edema

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)

Dosing: Pediatric

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

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.

Dosing: Kidney Impairment: Pediatric

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.

Dosing: Liver Impairment: Pediatric

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.

Dosing: Adult

(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

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.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; use with caution. Contraindicated in patients with anuria.

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

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

Contraindications

Hypersensitivity to ethacrynic acid or any component of the formulation; anuria; history of severe watery diarrhea caused by this product; infants

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: 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]).

Dosage Forms: US

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

Generic Equivalent Available: US

Yes

Pricing: US

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.

Dosage Forms: Canada

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]

Extemporaneous Preparations

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: Pediatric

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.

Administration: Adult

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.

Storage/Stability

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.

Use

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)

Medication Safety Issues
Sound-alike/look-alike issues:

Edecrin may be confused with Eulexin, Ecotrin

Older Adult: High-Risk Medication:

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.

Metabolism/Transport Effects

None known.

Drug Interactions

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

Dietary Considerations

May cause potassium loss; potassium supplement or dietary changes may be required.

Pregnancy Considerations

Adverse events have not been observed in animal reproduction studies.

Monitoring Parameters

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

Mechanism of Action

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

Pharmacokinetics (Adult Data Unless Noted)

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).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Edecrin;
  • (AT) Austria: Edecrin;
  • (AU) Australia: Edecril | Edecrin;
  • (CH) Switzerland: Edecrin;
  • (CZ) Czech Republic: Uregyt;
  • (DE) Germany: Hydromedin;
  • (EE) Estonia: Uregyt;
  • (HK) Hong Kong: Edecrin;
  • (HU) Hungary: Uregyt | Uregyt egis;
  • (IT) Italy: Reomax;
  • (JP) Japan: Edecril;
  • (LT) Lithuania: Uregyt;
  • (LV) Latvia: Uregyt;
  • (NZ) New Zealand: Edecrin;
  • (PL) Poland: Hydromedin | Uregyt;
  • (PR) Puerto Rico: Edecrin | Ethacrynic acid;
  • (RU) Russian Federation: Uregyt;
  • (SE) Sweden: Edecrina;
  • (SK) Slovakia: Uregyt;
  • (TW) Taiwan: Edecrin;
  • (UA) Ukraine: Uregyt
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