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( 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

Mechanism of Action

Pharmacology

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

Adults

PO 50 to 200 mg every day. IV 50 mg (0.5 to 1 mg/kg) every day.

Children

PO 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

Aminoglycosides

May increase auditory toxicity.

Cisplatin

May cause additive ototoxicity.

Digitalis glycosides

Electrolyte disturbances may predispose to digitalis-induced atrial and ventricular arrhythmias.

Lithium

May increase plasma lithium levels and toxicity.

NSAIDs

May decrease effects of ethacrynic acid.

Salicylates

May impair diuretic response in patients with cirrhosis and ascites.

Thiazide diuretics

Synergistic 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.