Indicated for treatment of edema when an agent with greater diuretic potential than those commonly employed is required.

• Treatment of the edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome.

• Short-term management of ascites due to malignancy, idiopathic edema, and lymphedema.

• Short-term management of hospitalized pediatric patients, other than infants, with congenital heart disease or the nephrotic syndrome. 

• Intravenous SODIUM EDECRIN is indicated when a rapid onset of diuresis is desired, e.g., in acute pulmonary edema, or when gastrointestinal absorption is impaired or oral medication is not practicable.

EDECRIN (Ethacrynic Acid) is a potent diuretic which, if given in excessive amounts, may lead to profound diuresis with water and electrolyte depletion. Therefore, careful medical supervision is required, and dose and dose schedule must be adjusted to the individual patient’s needs.

All diuretics, including ethacrynic acid, are contraindicated in anuria. If increasing electrolyte imbalance, azotemia, and/or oliguria occur during treatment of severe, progressive renal disease, the diuretic should be discontinued.

In a few patients this diuretic has produced severe, watery diarrhea. If this occurs, it should be discontinued and not used again.

Until further experience in infants is accumulated, therapy with oral ethacrynic acid is contraindicated.

When excessive diuresis occurs, the drug should be withdrawn until homeostasis is restored. When excessive electrolyte loss occurs, the dosage should be reduced or the drug temporarily withdrawn.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 ethacrynic acid 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.

This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.

Ethacrynic acid 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.

Excessive loss of potassium in patients receiving digitalis glycosides may precipitate digitalis toxicity. Care should also be exercised in patients receiving potassium-depleting steroids.

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 in excess of those recommended.

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.

Loop diuretics have been shown to increase the urinary excretion of magnesium; this may result in hypomagnesemia.

Increases in blood glucose and alterations in glucose tolerance tests have been observed in patients receiving ethacrynic acid.

The safety and efficacy of ethacrynic acid in hypertension have not been established. However, the dosage of co-administered antihypertensive agents may require adjustment.

Ethacrynic acid has little or no effect on glomerular filtration or on 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.

Orthostatic hypotension may occur in patients receiving other antihypertensive agents when given ethacrynic acid.

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.

A number of drugs, including ethacrynic acid, have been shown to displace warfarin from plasma protein; a reduction in the usual anticoagulant dosage may be required in patients receiving both drugs. Ethacrynic acid may increase the risk of gastric hemorrhage associated with corticosteroid treatment.

Lithium generally should not be given with diuretics.

Ethacrynic acid may increase the ototoxic potential of other drugs such as aminoglycoside and some cephalosporin antibiotics. Their concurrent use should be avoided.

A number of drugs, including ethacrynic acid, have 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. Therefore, when ethacrynic acid 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.

There are no adequate and well-controlled studies in pregnant women. Animal studies: reduced body weight.

It is 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 from ethacrynic acid, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

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• Use in patients under the age of 2. GoToSource

• Adjunctive treatment for multiple myeloma. GoToSource

• Adjunctive treatment for renal cancer. GoToSource

• Malignant pleural mesothelioma. GoToSource

• Glaucoma. GoToSource

• Hypercalcemia. GoToSource 

• A radiation enhancer in human carcinoma cells. GoToSource 

• Elevated intracranial pressure. GoToSource 

• Hypertension, diabetes and hypercalciuria. GoToSource 

• Reducing chemotherapy resistance in cancer chemotherapeutics. GoToSource

Metabolic alkalosis and hearing loss. GoToSource

Pancreatitis (inflammation of pancreas). GoToSource 

Hypokalemia (low blood potassium level), hyponatremia (low blood sodium level) and hyperuricemia (high level of uric acid). GoToSource

Anorexia (loss of appetite), vertigo, tinnitus (ringing or buzzing in ears), thrombocytopenia (low blood platelet count), bone marrow depression, steven-johnson syndrome (severe drug reaction), postural hypotension (fall in blood pressure when an upright position is assumed), urticaria (hives) and anaphylaxis (potentially life-threatening allergic reaction). GoToSource

Magnesium deficiency. GoToSource

Gastrointestinal bleeding. GoToSource

Hyperglycemia (high blood sugar). GoToSource

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