Ethacrynate

Synonym :

Ethacrynic acid

Mechanism :

Ethacrynate acts on the ascending limb of the loop of Henle and on the proximal and distal tubules. Urinary output is usually dose dependent and related to the magnitude of fluid accumulation. Water and electrolyte excretion may be increased several times over that observed with thiazide diuretics, since it inhibits reabsorption of a much greater proportion of filtered sodium than most other diuretic agents.

Indication :

It is a loop diuretic used to decrease the edema in nephrotic syndrome or congenital heart disease.

Contraindications :

Contraindicated in anuria. In a few patients this diuretic has produced severe, watery diarrhea. If this occurs, it should be discontinued and not used again. Hypersensitivity to any component of this product.

Dosing :

Orally:

1 mg/kg/dose once every day; can be increased every 2-3 days; Max: 3 mg/kg/day.

Intravenous:

1 mg/kg (limited data).

Adverse Effect :

Hyperglycemia, reversible hyperuricemia, acute gout, deafness, tinnitus, vertigo, blurred vision, anorexia, abdominal discomfort or pain, malaise, nausea, vomiting, dysphagia, diarrhea, headache, apprehension, fatigue, confusion, skin rash, chills, fever, hematuria.

Interaction :

Lithium: Should not be given with diuretics because they reduce its renal clearance and add a high risk of lithium toxicity.
Aminoglycoside and some Cephalosporin Antibiotics: May increase the ototoxic potential of other drugs such as aminoglycoside and some cephalosporin antibiotics. Their concurrent use should be avoided.
Warfarin: Ethacrynic acid to displace warfarin from plasma protein; a reduction in the usual anticoagulant dosage may be required in patients receiving both drugs.
Non-steroidal anti-inflammatory agent can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium- sparing and thiazide diuretics.

Hepatic Dose :

Use with caution in patients with severe cirrhosis of the liver, with other loop diuretics. Diminished natriuretic effect with increased sensitivity to hypokalemia and volume depletion in cirrhosis has been observed.