ethacrynic acid (Edecrin)

Introduction

Tradename: Edecrin.

Indications

• treatment of hypertension & edema
• IV form has been used to increase Ca+2 excretion in patients with hypercalcemia
• used in combination with mannitol in the management of ethylene glycol toxicity
• nephrogenic diabetes insipidus unresponsive to vasopressin or chlorpropamide
• the ONLY diuretic which can be used in severe sulfa allergic patients

Dosage

• 0.5-1.0 mg/kg up to 50 mg IV.
• 25-100 mg PO QD/BID.

Tabs: 25, 50 mg.

Injection: 50 mg.

Pharmacokinetics

• absorbed rapidly from GI tract
• diuretic effect occurs within:
  • 30 minutes following oral administration
  • 5 minutes following IV administration
• peak effect: 2 hours after PO, 30 min after IV administration
• metabolized by conjugation with cysteine

elimination via kidney

Adverse effects

• common (> 10%)
  • diarrhea
• less common (1-10%)
  • dilutional hyponatremia, hypochloremic alkalosis, hypokalemia with total body K+ depletion, ototoxicity more common than with other loop diuretics, blurred vision, headache, loss of appetite, orthostatic hypotension
• uncommon (< 1%)
  • skin rash, hematuria, gastrointestinal bleeding, hyperuricemia, hepatic dysfunction, leukopenia, agranulocytosis, thrombocytopenia, pancreatitis, local irritation, nervousness, stomach cramps
• other
  • hypocalcemia
  • hyperglycemia
  • glucosuria
  • vasculitis
  • hypercholesterolemia (mild, LDL & total cholesterol)
  • photosensitivity

• drug adverse effects of loop diuretics
• drug adverse effects of diuretics
• drug adverse effects of antihypertensive agents

Drug interactions

• drugs that cause K+ depletion - beta 2 agonists
• ethacyrnic acid decreases lithium clearance
• ethacryic acid increases requirement for insulin or sulfonylureas
• probenecid
• ethacrynic acid increases risk of NSAID-induced renal failure

• drug interaction(s) SGLT2 inhibitors (flozins) with diuretics
• drug interaction(s) of diuretics in combination with Zn+2
• drug interaction(s) of antiarrhythmic agents in combination with diuretics
• drug interaction(s) of beta-2 adrenergic receptor agonists with loop diuretics
• drug interaction(s) of calcium channel blockers with diuretics
• drug interaction(s) of lithium carbonate with loopt diuretics
• drug interaction(s) of beta-adrenergic receptor antagonists with loop diuretics
• drug interaction(s) of diuretics with angiotensin II receptor antagonists
• drug interaction(s) of diuretics with ACE inhibitors
• drug interaction(s) of loop diuretics with alpha-1 adrenergic receptor antagonist
• drug interaction(s) of NSAIDs, diuretics & angiotensin II receptor antagonists
• drug interaction(s) of NSAIDs, diuretics & ACE inhibitors
• drug interaction(s) of NSAIDs & antihypertensives
• drug interaction(s) of NSAIDs & loop diuretics

Mechanism of action

• loop diuretic
• site of action: loop of Henle

More general terms

• loop diuretic

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=3278
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=445898
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=222525
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=23003