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 (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.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution. Contraindicated in patients with anuria.
There are no dosage adjustments provided in the manufacturer's labeling.
Oral: Initial: 25 to 50 mg/day
(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 (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.
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.
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.
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
Hypersensitivity to ethacrynic acid or any component of the formulation; anuria; history of severe watery diarrhea caused by this product; infants
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]).
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
Yes
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.
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]
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.
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.
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.
Edecrin may be confused with Eulexin, Ecotrin
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.
None known.
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.
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
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
Cephaloridine: Loop Diuretics may enhance the nephrotoxic effect of Cephaloridine. Loop Diuretics may increase the serum concentration of Cephaloridine. Risk X: Avoid combination
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
Iloperidone: May enhance the hypotensive effect of Blood Pressure Lowering 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
Isocarboxazid: May enhance the hypotensive effect of Diuretics. Risk X: Avoid combination
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
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
Adverse events have not been observed in animal reproduction studies.
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.
May cause potassium loss; potassium supplement or dietary changes may be required.
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.
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
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).
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