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Ethacrynic acid: Drug information

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

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Edecrin;
  • Sodium Edecrin
Brand Names: Canada
  • Edecrin;
  • Sodium Edecrin [DSC];
  • VPI-Ethacrynate Sodium
Pharmacologic Category
  • Diuretic, Loop
Dosing: Adult

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: Hepatic Impairment: Adult

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

Dosing: Older Adult

Oral: Initial: 25 to 50 mg/day

Dosing: Pediatric

(For additional information see "Ethacrynic acid: Pediatric drug information")

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: Hepatic 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.

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.

Solution Reconstituted, Intravenous, as ethacrynate sodium:

Sodium Edecrin: 50 mg (1 ea)

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

Solution (reconstituted) (Sodium Edecrin Intravenous)

50 mg (per each): $6,017.59

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]

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.

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.

Use: Labeled Indications

Edema or volume overload: Management of edema associated with congestive heart failure; pulmonary edema; hepatic cirrhosis or renal disease; short-term management of ascites due to malignancy, idiopathic edema, and lymphedema; short-term management of hospitalized pediatric patients, other than infants, with congenital heart disease or the nephrotic syndrome.

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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Allopurinol: Loop Diuretics may enhance the adverse/toxic effect of Allopurinol. Loop Diuretics may increase the serum concentration of Allopurinol. Specifically, Loop Diuretics may increase the concentration of Oxypurinol, an active metabolite of Allopurinol. Risk C: Monitor therapy

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect 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 enhance the nephrotoxic effect of Amikacin Liposome (Oral Inhalation). Loop Diuretics may enhance the ototoxic effect of Amikacin Liposome (Oral Inhalation). Risk C: Monitor therapy

Aminoglycosides: Loop Diuretics may enhance the adverse/toxic effect of Aminoglycosides. Specifically, nephrotoxicity and ototoxicity. Risk C: Monitor therapy

Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Risk X: Avoid combination

Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Risk C: Monitor therapy

Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Angiotensin II Receptor Blockers: Loop Diuretics may enhance the hypotensive effect of Angiotensin II Receptor Blockers. Loop Diuretics may enhance the nephrotoxic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Loop Diuretics may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Loop Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Antihypertensive Agents: Loop Diuretics may enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy

Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Arsenic Trioxide: Loop Diuretics may enhance the hypotensive effect of Arsenic Trioxide. Loop Diuretics may enhance the QTc-prolonging effect 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 enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Beta2-Agonists: May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy

Bilastine: Loop Diuretics may enhance the QTc-prolonging effect of Bilastine. Risk C: Monitor therapy

Bile Acid Sequestrants: May decrease the absorption of Loop Diuretics. Risk C: Monitor therapy

Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination

Canagliflozin: May enhance the hypotensive effect of Loop Diuretics. Risk C: Monitor therapy

Cardiac Glycosides: Loop Diuretics may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of loop diuretics. Risk C: Monitor therapy

Cefaloridine [Cephaloridine]: Loop Diuretics may enhance the nephrotoxic effect of Cefaloridine [Cephaloridine]. Loop Diuretics may increase the serum concentration of Cefaloridine [Cephaloridine]. Risk X: Avoid combination

Cefazedone: May enhance the nephrotoxic effect of Loop Diuretics. Risk C: Monitor therapy

Cefotiam: Loop Diuretics may enhance the nephrotoxic effect of Cefotiam. Risk C: Monitor therapy

Cefpirome: Loop Diuretics may enhance the nephrotoxic effect of Cefpirome. Risk C: Monitor therapy

Ceftizoxime: Loop Diuretics may enhance the nephrotoxic effect of Ceftizoxime. Risk C: Monitor therapy

Cephalothin: Loop Diuretics may enhance the nephrotoxic effect of Cephalothin. Risk C: Monitor therapy

Cephradine: May enhance the nephrotoxic effect of Loop Diuretics. Risk C: Monitor therapy

CISplatin: Loop Diuretics may enhance the nephrotoxic effect of CISplatin. Loop Diuretics may enhance the ototoxic effect of CISplatin. Risk C: Monitor therapy

Corticosteroids (Systemic): May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy

CycloSPORINE (Systemic): May enhance the adverse/toxic effect of Loop Diuretics. Specifically, the risk for hyperuricemia and gout may be increased. Risk C: Monitor therapy

Desmopressin: May enhance the hyponatremic effect of Loop Diuretics. Risk X: Avoid combination

Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Diacerein: May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Risk C: Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Dichlorphenamide: Loop Diuretics may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy

Dofetilide: Loop Diuretics may enhance the QTc-prolonging effect 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 enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy

Empagliflozin: May enhance the hypotensive effect of Loop Diuretics. Risk C: Monitor therapy

Flunarizine: May enhance the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy

Foscarnet: Loop Diuretics may increase the 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 enhance the ototoxic effect of Ethacrynic Acid. Risk X: Avoid combination

Herbal Products with Blood Pressure Increasing Effects: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Indoramin: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Iodinated Contrast Agents: Loop Diuretics may enhance the nephrotoxic effect of Iodinated Contrast Agents. Risk C: Monitor therapy

Ipragliflozin: May enhance the adverse/toxic effect of Loop Diuretics. Specifically, the risk for intravascular volume depletion may be increased. Risk C: Monitor therapy

Ivabradine: Loop Diuretics may enhance the arrhythmogenic effect of Ivabradine. Risk C: Monitor therapy

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy

Levosulpiride: Loop Diuretics may enhance the adverse/toxic effect of Levosulpiride. Risk X: Avoid combination

Licorice: May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy

Lithium: Loop Diuretics may decrease the serum concentration of Lithium. Loop Diuretics may increase the serum concentration of Lithium. Risk C: Monitor therapy

Loop Diuretics: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Methotrexate: May diminish the therapeutic effect of Loop Diuretics. Loop Diuretics may increase the serum concentration of Methotrexate. Methotrexate may increase the serum concentration of Loop Diuretics. Risk C: Monitor therapy

Methoxsalen (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Methoxsalen (Systemic). Risk C: Monitor therapy

Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Netilmicin (Ophthalmic): Loop Diuretics may enhance the nephrotoxic effect of Netilmicin (Ophthalmic). Risk X: Avoid combination

Neuromuscular-Blocking Agents: Loop Diuretics may diminish the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Loop Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect 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

Nonsteroidal Anti-Inflammatory Agents (Topical): May diminish the therapeutic effect of Loop Diuretics. Risk C: Monitor therapy

Obinutuzumab: May enhance the hypotensive effect 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 enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. Risk C: Monitor therapy

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Polyethylene Glycol-Electrolyte Solution: Diuretics may enhance the nephrotoxic effect of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor therapy

Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy

Prazosin: Antihypertensive Agents may enhance the hypotensive effect of Prazosin. Risk C: Monitor therapy

Probenecid: May diminish the diuretic effect of Loop Diuretics. Probenecid may increase the serum concentration of Loop Diuretics. Risk C: Monitor therapy

Promazine: Loop Diuretics may enhance the QTc-prolonging effect of Promazine. Risk X: Avoid combination

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Reboxetine: May enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy

RisperiDONE: Loop Diuretics may enhance the adverse/toxic effect of RisperiDONE. Risk C: Monitor therapy

Salicylates: May diminish the therapeutic effect of Loop Diuretics. Loop Diuretics may increase the serum concentration of Salicylates. Risk C: Monitor therapy

Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Sodium Phosphates: Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor therapy

Terazosin: Antihypertensive Agents may enhance the hypotensive effect of Terazosin. Risk C: Monitor therapy

Tobramycin (Oral Inhalation): Loop Diuretics may enhance the nephrotoxic effect of Tobramycin (Oral Inhalation). Loop Diuretics may enhance the ototoxic effect of Tobramycin (Oral Inhalation). Risk C: Monitor therapy

Topiramate: Loop Diuretics may enhance the hypokalemic effect of Topiramate. Risk C: Monitor therapy

Urapidil: Antihypertensive Agents may enhance the hypotensive effect of Urapidil. Risk C: Monitor therapy

Vancomycin: Loop Diuretics may enhance the nephrotoxic effect of Vancomycin. Risk C: Monitor therapy

Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Risk C: Monitor therapy

Vitamin K Antagonists (eg, warfarin): Ethacrynic Acid may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Xipamide: May enhance the adverse/toxic effect of Loop Diuretics. Specifically, the risk of hypovolemia, electrolyte disturbances, and prerenal azotemia may be increased. Risk C: Monitor therapy

Zoledronic Acid: Loop Diuretics may enhance the hypocalcemic effect of Zoledronic Acid. Risk C: Monitor therapy

Pregnancy Considerations

Adverse events have not been observed in animal reproduction studies.

Breastfeeding Considerations

It is not known if ethacrynic acid is excreted in breast milk. Due to the potential for serious adverse reactions in the nursing infant, the manufacturer recommends a decision be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of treatment to the mother.

Dietary Considerations

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

Monitoring Parameters

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; BP and orthostasis; monitor fluid intake and output (inpatient setting) and weight daily; serum electrolytes (especially during rapid diuresis; therapy should not be initiated unless serum electrolytes, especially potassium, are normalized), renal function; monitor hearing with high doses or rapid IV administration.

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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