Home > Medical Reference > Encyclopedia (English)

Please install flash player to see this video.

Hospital Virtual Tour

Related Content

Pronunciation:

(eth a KRIN ik AS id)

U.S. Brand Names:

Edecrin®

Synonyms:

Ethacrynate Sodium

Generic Available:

Canadian Brand Names:

Edecrin®

Use:

Management of edema associated with congestive heart failure; hepatic cirrhosis or renal disease; short-term management of ascites due to malignancy, idiopathic edema, and lymphedema

Pregnancy Risk Factor:

Pregnancy Implications:

No data available. Generally, use of diuretics during pregnancy is avoided due to risk of decreased placental perfusion.

Lactation:

Contraindicated

Contraindications:

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

Warnings/Precautions:

Adjust dose to avoid dehydration. In cirrhosis, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy. Ototoxicity is associated with rapid I.V. administration, renal impairment, excessive doses, and concurrent use of other ototoxins. Has been associated with a higher incidence of ototoxicity than other loop diuretics. Hypersensitivity reactions can rarely occur, however, ethacrynic acid has no cross-reactivity to sulfonamides or sulfonylureas. 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. Watch for and correct electrolyte disturbances. Coadministration of antihypertensives may increase the risk of hypotension. Increased risk of gastric hemorrhage associated with corticosteroid therapy.

Adverse Reactions:

Frequency not defined.

Central nervous system: Headache, fatigue, apprehension, confusion, fever, chills, encephalopathy (patients with pre-existing liver disease); vertigo

Dermatologic: Skin rash, Henoch-Schönlein purpura (in patient with rheumatic heart disease)

Endocrine & metabolic: Hyponatremia, hyperglycemia, variations in phosphorus, CO2 content, bicarbonate, and calcium; reversible hyperuricemia, gout, hyperglycemia, hypoglycemia (occurred in two uremic patients who received doses above those recommended)

Gastrointestinal: Anorexia, malaise, abdominal discomfort or pain, dysphagia, nausea, vomiting, and diarrhea, gastrointestinal bleeding, acute pancreatitis (rare)

Genitourinary: Hematuria

Hepatic: Jaundice, abnormal liver function tests

Hematology: Agranulocytosis, severe neutropenia, thrombocytopenia

Local: Thrombophlebitis (with intravenous use), local irritation and pain,

Ocular: Blurred vision

Otic: Tinnitus, temporary or permanent deafness

Renal: Increased serum creatinine

Overdosage/Toxicology:

Symptoms of overdose include electrolyte depletion, volume depletion, dehydration, and circulatory collapse. Treatment is supportive.

Drug Interactions:

ACE inhibitors: Hypotensive effects and/or renal effects are potentiated by hypovolemia.

Antidiabetic agents: Glucose tolerance may be decreased.

Antihypertensive agents: Hypotensive effects may be enhanced.

Cephaloridine or cephalexin: Nephrotoxicity may occur.

Cholestyramine or colestipol may reduce bioavailability of ethacrynic acid.

Clofibrate: Protein binding may be altered in hypoalbuminemic patients receiving ethacrynic acid, potentially increasing toxicity.

Digoxin: Ethacrynic acid-induced hypokalemia may predispose to digoxin toxicity; monitor potassium.

Indomethacin (and other NSAIDs) may reduce natriuretic and hypotensive effects of diuretics.

Lithium: Renal clearance may be reduced. Isolated reports of lithium toxicity have occurred; monitor lithium levels.

NSAIDs: Risk of renal impairment may increase when used in conjunction with diuretics.

Ototoxic drugs (aminoglycosides, cis-platinum): Concomitant use of ethacrynic acid may increase risk of ototoxicity, especially in patients with renal dysfunction.

Peripheral adrenergic-blocking drugs or ganglionic blockers: Effects may be increased.

Salicylates (high-dose) with diuretics may predispose patients to salicylate toxicity due to reduced renal excretion or alter renal function.

Thiazides: Synergistic diuretic effects occur.

Compatibility:

Stable in D5NS, D5W, LR, NS; do not mix with whole blood or its derivatives

Y-site administration: Compatible: Heparin with hydrocortisone sodium succinate, potassium chloride, vitamin B complex with C

Compatibility when admixed: Compatible: Chlorpromazine, cimetidine, prochlorperazine, promazine. Incompatible: Hydralazine, procainamide, ranitidine, tolazoline, triflupromazine

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

Pharmacodynamics/Kinetics:

Onset of action: Diuresis: Oral: ~30 minutes; I.V.: 5 minutes

Peak effect: Oral: 2 hours; I.V.: 30 minutes

Duration: Oral: 12 hours; I.V.: 2 hours

Absorption: Oral: Rapid

Protein binding: >90%

Metabolism: Hepatic (35% to 40%) to active cysteine conjugate

Half-life elimination: Normal renal function: 2-4 hours

Excretion: Feces and urine (30% to 60% as unchanged drug)

Dosage:

I.V. formulation should be diluted in D5W or NS (1 mg/mL) and infused over several minutes.

Children: Oral: 1 mg/kg/dose once daily; increase at intervals of 2-3 days as needed, to a maximum of 3 mg/kg/day.

Adults:

Oral: 50-200 mg/day in 1-2 divided doses; may increase in increments of 25-50 mg at intervals of several days; doses up to 200 mg twice daily may be required with severe, refractory edema.

I.V.: 0.5-1 mg/kg/dose (maximum: 100 mg/dose); repeat doses not routinely recommended; however, if indicated, repeat doses every 8-12 hours.

Dosing adjustment/comments in renal impairment: Clcr<10 mL/minute: Avoid use.

Dialysis: Not removed by hemo- or peritoneal dialysis; supplemental dose is not necessary.

Administration:

Injection should not be given SubQ or I.M. due to local pain and irritation; single I.V. doses should not exceed 100 mg; if a second dose is needed, use a new injection site to avoid possible thrombophlebitis

Monitoring Parameters:

Blood pressure, renal function, serum electrolytes, and fluid status closely, including weight and I & O daily; hearing

Dietary Considerations:

This product may cause a potassium loss. Your healthcare provider may prescribe a potassium supplement, another medication to help prevent the potassium loss, or recommend that you eat foods high in potassium, especially citrus fruits. Do not change your diet on your own while taking this medication, especially if you are taking potassium supplements or medications to reduce potassium loss. Too much potassium can be as harmful as too little.

Patient Education:

Inform prescriber of all prescriptions, OTC medications, or herbal products you are taking, and any allergies you have. Do not take any new medication during therapy without consulting prescriber. Take prescribed dose with food early in day. Include orange juice or bananas (or other potassium-rich foods) in your diet, but do not take potassium supplements without consulting prescriber. If you have diabetes, monitor serum glucose closely (this medication may alter glucose levels). May cause postural hypotension (use caution when rising from lying or sitting position, when climbing stairs, or when driving); lightheadedness, dizziness, or drowsiness (use caution driving or when engaging in hazardous activities); diarrhea (buttermilk, boiled milk, or yogurt may help); or decreased accommodation to heat (avoid excessive exercise in hot weather). Report hearing changes (ringing in ears); persistent headache; unusual confusion or nervousness; abdominal pain or blood stool (black stool); palpitations, chest pain, rapid heartbeat; flu-like symptoms; skin rash or itching; blurred vision; swelling of ankles or feet; weight changes of more than 3 lb/day; increased fatigue; or joint/muscle swelling, pain, cramping, or trembling. Breast-feeding precaution: Do not breast-feed.

Nursing Implications:

Tissue irritant; not to be administered I.M. or SubQ; dilute injection with 50 mL dextrose 5% or normal saline (1 mg/mL concentration resulting); may be injected without further dilution over a period of several minutes or infused over 20-30 minutes

Monitor blood pressure, serum electrolytes, renal function, hearing

Anesthesia and Critical Care Concerns/Other Considerations:

Ethacrynic acid has limited use over other loop diuretics because of increased risk of ototoxicity. If given the morning of surgery, it may render the patient volume depleted and blood pressure may be labile during general anesthesia.

Cardiovascular Considerations:

Limited use over other loop diuretics because of increased risk of ototoxicity. Hypotensive effect of ethacrynic acid may be more pronounced in patients previously on a diuretic therapy or who have volume depletion.

Dental Health: Effects on Dental Treatment:

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

May cause dizziness; may rarely cause drowsiness, nervousness, or confusion

Mental Health: Effects on Psychiatric Treatment:

Rare reports of agranulocytosis; use caution with clozapine and carbamazepine; may increase serum lithium levels, however, more likely with thiazide diuretic

Dosage Forms:

Injection, powder for reconstitution, as ethacrynate sodium: 50 mg

Tablet: 25 mg

Extemporaneously Prepared:

To make a 1 mg/mL suspension: 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 50% sorbitol solution to make a final volume of 120 mL. (Methylparaben 6 mg and propylparaben 2.4 mg are added as preservatives.) Stable 220 days at room temperature.

Handbook on Extemporaneous Formulations, Bethesda, MD: American Society of Hospital Pharmacists, 1987.

International Brand Names:

Edecril® (AU, NZ); Edecrina® (SE); Edecrin® (AT, CA, HK, NL); Hydromedin i.v.® [inj.] (DE); Reomax® (IT); Uregyt® (CZ, HU, RU); Uregyt® [inj.] (HU)

References

Cowley AJ and Elkeles RS, "Diabetes and Therapy With Potent Diuretics,"Lancet, 1978, 1(8056):154.

Gomolin IH and Garschick E, "Ethacrynic Acid-Induced Deafness Accompanied by Nystagmus,"N Engl J Med, 1980, 303(12):702.

Lant A, "Diuretics: Clinical Pharmacology and Therapeutic Use,"Drugs, 1985, 29(1):57-87.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.