Ethacrynic Acid
( Ethacrynate ) Pronouncation: (eth-uh-KRIN-ik acid)Class: Loop diuretic
Trade Names:
Edecrin
- Tablets 25 mg
- Tablets 50 mg
Trade Names:
Edecrin Sodium
- Powder for injection 50 mg (as ethacrynate sodium) per vial
Pharmacology
Feedback for Ethacrynic Acid (Ethacrynate)
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Inhibits reabsorption of sodium and chloride in proximal and distal tubules and in loop of Henle.
Pharmacokinetics
Absorption
Approximately 100% bioavailable.
Elimination
The t 1/2 is 60 to 90 min (oral).
Onset
Within 30 min (oral), 5 min (IV).
Peak
2 h (oral), 15 to 30 min (IV).
Duration
6 to 8 h (oral), 30 to 60 min (IV).
Indications and Usage
Treatment of edema associated with CHF, hepatic cirrhosis, or renal disease; treatment of ascites, congenital heart disease, nephrotic syndrome.
Unlabeled Uses
Treatment of glaucoma; treatment of nephrogenic diabetes insipidus, hypercalcemia.
Contraindications
Anuria; infants; increasing azotemia; severe diarrhea; dehydration; electrolyte imbalance; hypotension.
Dosage and Administration
AdultsPO 50 to 200 mg every day. IV 50 mg (0.5 to 1 mg/kg) every day.
ChildrenPO 25 mg every day.
General Advice
- Administer drug PO or IV only. subcutaneous or IM injection causes local pain and irritation.
- To prepare IV solution, add 50 mL of D5W or normal saline. If solution is hazy or opalescent, do not use.
- For IV dose, administer drug slowly. Rotate injection sites to avoid thrombophlebitis.
- Discard reconstituted solution if not used within 24 h.
- Do not administer drug with other drugs or with blood products.
- Give oral medication after meal or with food to prevent GI upset.
Drug Interactions
AminoglycosidesMay increase auditory toxicity.
CisplatinMay cause additive ototoxicity.
Digitalis glycosidesElectrolyte disturbances may predispose to digitalis-induced atrial and ventricular arrhythmias.
LithiumMay increase plasma lithium levels and toxicity.
NSAIDsMay decrease effects of ethacrynic acid.
SalicylatesMay impair diuretic response in patients with cirrhosis and ascites.
Thiazide diureticsSynergistic effects may result in profound diuresis and serious electrolyte abnormalities.
Laboratory Test Interactions
None well documented.
Adverse Reactions
Cardiovascular
Orthostatic hypotension; emboli.
CNS
Apprehension; confusion; fatigue; malaise; vertigo; headache; dysphagia.
Dermatologic
Rash.
EENT
Blurred vision; sense of ear fullness; tinnitus; hearing loss.
GI
Anorexia; nausea; vomiting; diarrhea; pancreatitis; discomfort; pain; sudden watery, profuse diarrhea; bleeding.
Genitourinary
Hematuria.
Hematologic
Neutropenia; thrombocytopenia; agranulocytosis; hyponatremia; hypokalemia; hypomagnesemia; hypocalcemia; hypercalciuria; hypovolemia.
Hepatic
Jaundice; abnormal LFTs.
Metabolic
Acute gout; hyperuricemia; hyperglycemia.
Miscellaneous
Fever; chills; local irritation and pain with parenteral administration.
Precautions
Pregnancy
Category B .
Lactation
Undetermined.
Children
Safety and efficacy not established in infants (see Contraindications) and in children (IV).
Photosensitivity
May occur.
Dehydration
Excessive diuresis may cause dehydration and decreased blood volume with circulatory collapse and possible vascular thrombosis and embolism, especially in elderly.
Electrolyte imbalance
May be more likely in patients receiving large doses with restricted salt intake.
Hepatic cirrhosis and ascites
Sudden alterations of electrolyte balance may precipitate hepatic encephalopathy and coma.
Ototoxicity
Associated with rapid injection, very large doses or concurrent use of other ototoxic drugs.
Systemic lupus erythematosus
May be exacerbated or activated.
Overdosage
Symptoms
Water loss, volume depletion, electrolyte depletion, circulatory collapse, vascular thrombosis and embolism, weakness, dizziness, confusion, anorexia, lethargy, vomiting, cramps.
Patient Information
- Tell patient to take drug with food or milk.
- Instruct patient to take drug in morning.
- Advise patient to avoid exposure to sunlight or UV light and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
- Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
- Instruct patient to report these symptoms to health care provider: confusion or mood changes, increased thirst, dizziness, irregular heart beat, weakness or increased tiredness, diarrhea, blood in urine or stool, muscle weakness or cramps, sudden joint pain or any changes in hearing.
- Advise patients with diabetes mellitus to monitor blood glucose levels closely.
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Fluid Retention, Renal Failure, Pulmonary Edema, Ascites, Nonobstructive Oliguria
