Dosing and uses of Edecrin (ethacrynic acid)
Adult dosage forms and strengths
powder for injection
- 50mg
tablet
- 25mg
Edema
0.5-1 mg/kg up to 100 mg/dose slow IVP, Or
25-100 mg PO qDay or q12hr
May take with food
Renal Impairment
Not necessary to supplement dose; not removed by hemo- or peritoneal dialysis
CrCl <10 mL/minute: Not recommended
Overdose Management
May use normal saline for volume replacement
May use dopamine or norepinephrine to treat hypotension
If dysrhythmia due to decreased K+ or Mg+ suspected replace aggressively
Discontinue treatment if no symptoms after 6hr
Other Indications & Uses
Edema-associated with CHF, hepatic cirrhosis, renal dysfunction, malignancy, & pulmonary edema
Short-term use in children (other than infants) with congenital heart disease or nephrotic syndrome
Use when fluid retention refractory to thiazides, or with impaired renal function
Pediatric dosage forms and strengths
powder for injection
- 50mg
tablet
- 25mg
Congenital Heart Disease, Nephrotic Syndrome
PO: 1 mg/kg/dose qDay; may increase q2-3days to maximum of 3 mg/kg/day
IV: Data limited; 1 mg/kg IV
Geriatric dosage forms and strengths
May cause hypertension and fluid imblances in the elderly; use alternatives if available
Edema
0.5-1 mg/kg up to 100 mg/dose slow IVP, Or
25-50 mg PO qDay or q12hr
May take with food
Edecrin (ethacrynic acid) adverse (side) effects
Frequency not defined
Injection site reaction
Hyperuricemia
Gout
Hypotension
Hypokalemia
Electrolyte abnormalities
Hyperglycemia/hypoglycemia
Hyperlipidemia
Ototoxicity
Tinnitus
Photosensitivity
Muscle cramps
Dizziness
Confusion
Headache
Nausea/vomiting
Anorexia
Dysphagia
Diarrhea
Pancreatitis
Agranulocytosis
Neutropenia
Thrombocytopenia
Hematuria
Warnings
Contraindications
Hypersensitivity to ethacrynic acid
Anuria, severe, watery diarrhea
Use in infants
Cautions
Avoid concurrent use with lithium or furosemide
Diabetes mellitus, geriatrics, liver disease, renal impairment
Risk of fluid or electrolyte imbalance, hyperglycemia, hyperuricemia, hypotension, metabolic alkalosis
Risk of ototoxicity (tinnitus, reversible/irreversible hearing impairment)
Discontinue use if severe, watery diarrhea occurs
Pregnancy and lactation
Pregnancy category: B
Lactation: excretion in milk unknown/not recommended
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Edecrin (ethacrynic acid)
Mechanism of action
Loop diuretic acting at Na/2Cl reabsorptive pump at ascending loop of Henle and distal renal tubule. Intereference with the chloride-binding cotransport system, causes increased excretion of water, sodium, chlorine, magnesium, and calcium.
Pharmacokinetics
Half-Life: 2-4 hr
Onset
- Initial effect: IV: 5-15 min, PO: 30-60 min
- Max effect: IV: 15 min-3 hr, PO: 2 hr
Other Information
Duration: IV: 2-7 hr, PO: 4-8 hr
Bioavailability: 100%
Protein Bound: 90%
Metabolism: conjugation w/ compounds containing sulfhydryl groups, such as cysteine & N-acetylcysteine in liver
Excretion: urine 66%
Administration
IV Incompatibilities
Whole blood or its derivatives
Additive: hydralazine, procainamide, ranitidine, tolazoline, triflupromazine
IV Compatibilities
Additive: chlorpromazine, cimetidine, prochlorperazine, promazine
Y-site: heparin & hydrocortisone Na-succinate, KCl, vit B/C
IV Administration
Do not give SC or IM due to local pain & irritation
Single doses should not exceed 100 mg
Administer IVP at 10 mg/min
If second dose needed, a new injection site is recommended to avoid possible thrombophlebitis
