Ethacrynic Acid

Ethacrynic Acid is a prescription medication used to treat the symptoms of Swelling or Fluid Retention (Edema)

• Ethacrynic Acid is available under the following different brand names: Edecrin

Common side effects of Ethacrynic Acid include:

• Nausea,
• Vomiting,
• Diarrhea,
• Stomach discomfort,
• Trouble swallowing,
• Loss of appetite,
• Blurred vision,
• Fever,
• Chills,
• Headache, and
• Feeling tired

Serious side effects of Ethacrynic Acid include:

• Hives,
• Difficulty breathing,
• Swelling of the face, lips, tongue, or throat,
• Weight loss,
• Severe or watery diarrhea,
• Hearing problems,
• Feeling of fullness in the ear,
• Severe weakness,
• Muscle cramps,
• Numbness,
• Tingling,
• Lightheadedness,
• Problems with speech,
• Chest pain,
• Coughing up blood,
• Leg cramps,
• Constipation,
• Irregular heartbeats,
• Fluttering in the chest,
• Increased thirst or urination,
• Muscle weakness,
• Limp feeling,
• Headache,
• Confusion,
• Slurred speech,
• Severe weakness,
• Loss of coordination, and
• Feeling unsteady

Rare side effects of Ethacrynic Acid include:

• None 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out. 

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult and pediatric dosage

Powder for injection

• 50 mg

Tablet

• 25 mg

Edema

Adult and geriatric dosage

• 0.5-1 mg/kg up to 100 mg/dose slow IVP, OR  
• 25-100 mg orally once a day or every 12 hours
• May take it with food
• Congenital Heart Disease, Nephrotic Syndrome

Pediatric dosage

• Orally: 1 mg/kg/dose once a day; may increase every 2-3 days to a maximum of 3 mg/kg/day
• Intravenous: Data limited; 1 mg/kg Intravenous

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Ethacrynic Acid has severe interactions with no other drugs.
• Ethacrynic Acid has serious interactions with the following drugs
  • Amikacin
  • Baricitinib
  • Furosemide
  • Gentamicin
  • Lofexidine
  • Neomycin po
  • Paromomycin
  • Squill
  • Streptomycin
  • Tobramycin
• Ethacrynic Acid has moderate interactions with at least 148 other drugs.
• Ethacrynic Acid has minor interactions with at least 71 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Hypersensitivity to ethacrynic Acid
• Anuria, severe, watery diarrhea
• Use in infants

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Ethacrynic Acid?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Ethacrynic Acid?”

Cautions

• Effects on electrolytes are related to their renal pharmacologic activity and are dose-dependent; the possibility of profound electrolyte and water loss may be avoided by weighing the patient throughout the treatment period, by careful adjustment of dosage, by initiating treatment with small doses, and by using the drug on an intermittent schedule when possible
• When excessive diuresis occurs, the drug should be withdrawn until homeostasis is restored; when excessive electrolyte loss occurs, the dosage should be reduced, or the drug temporarily withdrawn
• Initiation of diuretic therapy with this drug in the cirrhotic patient with ascites is best carried out in the hospital; when maintenance therapy has been established, the individual can be satisfactorily followed as an outpatient
• The drug should be given with caution to patients with advanced cirrhosis of the liver, particularly those with a history of previous episodes of electrolyte imbalance or hepatic encephalopathy; like other diuretics, it may precipitate hepatic coma and death
• Too vigorous a diuresis, as evidenced by rapid and excessive weight loss, may induce an acute hypotensive episode; in elderly cardiac patients, rapid contraction of plasma volume and the resultant hemoconcentration should be avoided to prevent the development of thromboembolic episodes, such as cerebral vascular thromboses and pulmonary emboli which may be fatal
• Excessive loss of potassium in patients receiving digitalis glycosides may precipitate digitalis toxicity; care should be exercised in patients receiving potassium-depleting steroid
• Several possibly drug-related deaths have occurred in critically ill patients refractory to other diuretics; these generally have fallen into two categories: patients with severe myocardial disease who have been receiving digitalis and presumably developed acute hypokalemia with fatal arrhythmia and patients with severely decompensated hepatic cirrhosis with ascites, with or without accompanying encephalopathy, who were in electrolyte imbalance and died because of intensification of electrolyte defect
• Deafness, tinnitus, and vertigo with a sense of fullness in the ears have occurred, most frequently in patients with severe impairment of renal function; these symptoms have been associated most often with intravenous administration and with doses over those recommended; the deafness has usually been reversible and of short duration (one to 24 hours); however, in some patients, the hearing loss has been permanent
• A number of these patients were also receiving drugs known to be ototoxic; this drug may increase the ototoxic potential of other drugs
• Weakness, muscle cramps, paresthesias, thirst, anorexia, and signs of hyponatremia, hypokalemia, and/or hypochloremic alkalosis may occur following vigorous or excessive diuresis and these may be accentuated by rigid salt restriction; rarely, tetany has been reported following vigorous diuresis; during therapy with ethacrynic Acid, liberalization of salt intake and supplementary potassium chloride are often necessary
• When metabolic alkalosis may be anticipated, g, in cirrhosis with ascites, the use of potassium chloride or a potassium-sparing agent before and during therapy may mitigate or prevent hypokalemia
• Loop diuretics have been shown to increase urinary excretion of magnesium; this may result in hypomagnesemia
• The safety and efficacy of this drug in hypertension have not been established; however, the dosage of coadministered antihypertensive agents may require adjustment
• Orthostatic hypotension may occur in patients receiving other antihypertensive agents when given this drug has little or no effect on glomerular filtration or renal blood flow, except following pronounced reductions in plasma volume when associated with rapid diuresis; a transient increase in serum urea nitrogen may occur; usually, this is readily reversible when the drug is discontinued
• As with other diuretics used in the treatment of renal edema, hypoproteinemia may reduce responsiveness to ethacrynic Acid and the use of salt-poor albumin should be considered
• Drug interaction overview
  • Lithium generally should not be given with diuretics because they reduce renal clearance and add a high risk of lithium toxicity
  • May increase the ototoxic potential of other drugs such as aminoglycoside and some cephalosporin antibiotics; avoid their concurrent use
  • Therapy may increase the risk of gastric hemorrhage associated with corticosteroid treatment
  • This drug has been shown to displace warfarin from plasma protein; a reduction in the usual anticoagulant dosage may be required in patients receiving both drugs
  • In some patients, the administration of a non-steroidal anti-inflammatory agent can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing, and thiazide diuretics; when this drug and non-steroidal anti-inflammatory agents are used concomitantly, the patient should be observed closely to determine if the desired effect of the diuretic is obtained

Pregnancy and Lactation

• There are no adequate and well-controlled studies in pregnant women; since animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if needed
• Lactation
  • Not known whether this drug is excreted in human milk; because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, considering the importance of the drug to the mother