Ethacrynate sodium
Ethacrynate sodium (Sodium Edecrin)
Ethacrynate
(eth-ah- KRIH-nayt)
Pregnancy Category: B Sodium Edecrin (Rx)
Ethacrynic acid
Ethacrynic acid (Edecrin)
Ethacrynic acid
(eth-ah- KRIH-nik AH-sid)
Pregnancy Category: B Edecrin (Rx)

Classification: Diuretics, loop

See Also: See also Diuretics, Loop.

Action/Kinetics: Inhibits the reabsorption of sodium and chloride in the loop of Henle; it also decreases reabsorption of sodium and chloride and increases potassium excretion in the distal tubule. Also acts directly on the proximal tubule to enhance excretion of electrolytes. Large quantities of sodium and chloride and smaller amounts of potassium and bicarbonate ion are excreted during diuresis. Onset: PO, 30 min; IV, Within 5 min. Peak: PO, 2 hr; IV, 15-30 min. Duration: PO, 6-8 hr. IV, 2 hr. t 1/2, after PO: 60 min. Metabolites are excreted through the urine. Diuresis and electrolyte loss are more pronounced with ethacrynic acid than with thiazide diuretics. Is often effective in clients refractory to other diuretics. Careful monitoring of the diuretic effects is necessary.

Uses: Of value with resistance to less potent diuretics. CHF, acute pulmonary edema, edema associated with nephrotic syndrome, ascites due to idiopathic edema, lymphedema, malignancy. Short-term use for ascites as a result of malignancy, lymphedema, or idiopathic edema; also, for short-term use in pediatric clients (except infants) with congenital heart disease. Investigational. Ethacrynic acid: Single injection into the eye to treat glaucoma (effective for a week or more). Ethacrynate sodium: Hypercalcemia, bromide intoxication, and with mannitol in ethylene glycol poisoning.

Contraindications: Pregnancy (usually), lactation, use in neonates. Anuria and severe renal damage.

Special Concerns: Geriatric clients may be more sensitive to the usual adult dose. Use with caution in diabetics and in those with hepatic cirrhosis (who are particularly susceptible to electrolyte imbalance). Monitor gout clients carefully. Safety and efficacy of oral use in infants and IV use in children have not been established.

Side Effects: Electrolyte imbalance: Hypokalemia, hyponatremia, hypochloremic alkalosis, hypomagnesemia, hypocalcemia. GI: Anorexia, nausea, vomiting, diarrhea (may be sudden watery, profuse diarrhea), acute pancreatitis, abdominal discomfort or pain, jaundice, GI bleeding or hemorrhage dysphagia. Hematologic: Severe neutropenia, thrombocytopenia, agranulocytosis rarely Henoch-Schoenlein purpura in clients with rheumatic heart disease. CNS: Apprehension, confusion, vertigo, headache. Body as a whole: Fever, chills, fatigue, malaise. Otic: Sense of fullness in the ears, tinnitus, irreversible hearing loss. Miscellaneous: Hematuria, acute gout, abnormal liver function tests in seriously ill clients on multiple drug therapy including ethacrynic acid, blurred vision, rash, local irritation and pain following parenteral use, hyperuricemia, hyperglycemia.
Ethacrynic acid may cause death in critically ill clients refractory to other diuretics. These include (a) clients with severe myocardial disease who also received digitalis and who developed acute hypokalemia with fatal arrhythmias and (b) those with severely decompensated hepatic cirrhosis with ascites, with or without encephalopathy, who had electrolyte imbalances with death due to intensification of the electrolyte effect.

Overdose Management: Symptoms: Profound water loss, electrolyte depletion (causes dizziness, weakness, mental confusion, vomiting, anorexia, lethargy, cramps), dehydration, reduction of blood volume, circulatory collapse (possibility of vascular thrombosis and embolism). Treatment: Replace electrolytes and fluid and monitor urine output and serum electrolyte levels. Induce emesis or perform gastric lavage. Artificial respiration and oxygen may be needed. Treat other symptoms.

How Supplied: Ethacrynate Sodium: Powder for injection: 50 mg. Ethacrynic Acid: Tablet: 25 mg, 50 mg

Dosage
Ethacrynate sodium ?IV
Adults: 50 mg (base) (or 0.5-1 mg/kg); may be repeated in 2-4 hr, although only one dose is usually needed. A single 100-mg dose IV has also been used.
Ethacrynic acid ?Tablets
Adults, initial: 50-200 mg/day in single or divided doses to produce a gradual weight loss of 2.2-4.4 kg/day (1-2 lb/day). The dose can be increased by 25-50 mg/day if needed. Maintenance: Usually 50-200 mg (up to a maximum of 400 mg) daily may be required in severe, refractory edema. If used with other diuretics, the initial dose should be 25 mg with increments of 25 mg. Pediatric, initial: 25 mg/day; can increase by 25 mg/day if needed. Maintenance: Adjust dose to needs of client. Dosage for infants has not been determined.