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Ethacrynic acid
From WikEM
Contents
Administration
- Type: Loop diuretic
- Dosage Forms:
- Routes of Administration: PO, IV (ethacrynate sodium)
- Common Trade Names: Edecrin
Adult Dosing
40mg furosemide = 20mg torsemide = 1mg bumetanide = 50 mg ethacrynic acid
- Ethacrynic acid: 50 to 200 PO daily, adjust dose in 25mg increments
- Ethacrynate sodium: 0.5 to 1 mg/kg IV, max 100mg per dose; average dose 50 mg.
Pediatric Dosing
- Contraindicated in infants, safety/efficacy not well established in children
- Ethacrynic acid: 25 mg PO daily initially, titrate in 25mg increments. Max dose 3 mg/kg/day
- Ethacrynate sodium: dose not well established, titrate carefully
Special Populations
- Pregnancy Rating: B
- Lactation risk: Infant risk cannot be ruled out
- Renal dosing: avoid use if GFR <10
- Hepatic dosing: use smallest dose necessary to achieve adequate diuresis
Contraindications
- Allergy to class/drug
- Anuria
- Severe renal disease: if worsening electrolyte imbalance, azotemia, or oliguria develops discontinue and do not reinitiate
- If severe, watery diarrhea occurs, discontinue and do not reinitiate
- Infants
Adverse Reactions
Serious
- Electrolyte imbalances, hypocalcemia, hypokalemia, hyponatremia
- GI bleed, GI perforation, diarrhea, pancreatitis
- Agranulocytosis/neutropenia, thrombocytopenia
- Thromboembolic disorder
- Hepatic coma, jaundice
- Ototoxicity, hearing loss
Common
Pharmacology
- Half-life: 1-4h
- Metabolism: Liver
- Excretion: Mostly renal
Mechanism of Action
- Loop diuretic: inhibits Na+/K+/2Cl symporter in ascending limb of loop of Henle, preventing reabsorption and thereby increasing urinary excretion of sodium, chloride, and potassium
