Etacrynic acid


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Oedema Initial: 50 mg/day in the morning. Usual range: 50-200 mg/day. Severe: Up to 400 mg/day. IV Acute pulmonary oedema 0.5-1 mg/kg or 50 mg via slow inj or infusion over 10 min; a 2nd dose may be given, if required, at a new inj site. Max: 100 mg.
Dosage Details
Intravenous
Acute pulmonary oedema
Adult: 0.5-1 mg/kg or 50 mg via slow inj or infusion over 10 min; a 2nd dose may be given, if required, at a new inj site. Max: 100 mg.

Oral
Oedema
Adult: Initially, 50 mg in the morning, increase if necessary, by 25-50 mg increments daily to min effective dose. Usual effective range: 50-200 mg daily. Severe cases: Up to 400 mg daily. Doses >50 mg should be given in divided doses.
Child: >2 yr Initially, 25 mg daily, increase cautiously if necessary, by 25 mg daily.
Reconstitution
Add 50 mL of dextrose 5% or NaCl 0.9% inj to the vial.
Incompatibility
Incompatible w/ soln w/ pH <5.
Contraindications
Anuria, history of severe watery diarrhoea. Infants.
Special Precautions
Patient w/ advanced hepatic cirrhosis, electrolyte imbalance, hepatic encephalopathy, severe myocardial disease and those undergoing surgery. Renal impairment. Childn. Pregnancy and lactation.
Adverse Reactions
Significant: Fluid/electrolyte loss (e.g. hyponatraemia, hypokalaemia, hypochloraemic alkalosis, hypomagnesaemia), nephrotoxicity, ototoxicity, wt loss, orthostatic hypotension, dehydration.
Nervous: Paraesthesia, dizziness, fainting, headache, fatigue, apprehension, malaise, mental confusion, vertigo.
GI: Thirst, anorexia, abdominal discomfort or pain, dysphagia, nausea, vomiting, diarrrhoea/profuse watery diarrhoea, acute pancreatitis.
Hepatic: Jaundice.
Genitourinary: Reversible hyperuricaemia, decreased urinary urate, interstitial nephritis, increased creatinine concentration.
Endocrine: Metabolic alkalosis, hyperglycaemia, dyslipidaemia, gout.
Musculoskeletal: Weakness, muscle cramps.
Otic: Deafness, tinnitus.
Dermatologic: Exfoliative dermatitis, Stevens-Johnson syndrome, bullous eruptions, rash.
Others: Local irritation, pain, thrombophlebitis.
MonitoringParameters
Monitor BP, renal function, serum electrolytes, CO2, BUN, fluid status including input and output, wt, hearing.
Overdosage
Symptoms: Excessive diuresis w/ electrolyte depletion (e.g. hypokalaemia, hypochloraemia, hyponatraemia) and dehydration. Management: Symptomatic and supportive treatment. Induce emesis or perform gastric lavage. For resp depression, administer oxygen or employ artificial respiration, if necessary.
Drug Interactions
May increase the ototoxicity and nephrotoxicity of aminoglycoside antibiotics and some cephalosporins. May increase risk of GI bleeding when used w/ other gastric irritants, corticosteroids, anticoagulants. May cause orthostatic hypotension when used w/ other antihypertensive agents. Displaces warfarin from plasma protein. May increase risk of lithium toxicity. Decreased therapeutic effect w/ NSAIDs. May interfere w/ the hypoglycaemic effect of insulin or other antidiabetic agents. May potentiate kaliuresis and natriuretic effect of acetazolamide, dichlorphenamide, methazolamide.
Food Interaction
Enhanced hypokalaemic effect w/ licorice. Diminished antihypertensive effect w/ yohimbine.
Lab Interference
May cause false-negative aldosterone/renin ratio (ARR). Alters glucose tolerance tests.
Action
Description: Etacrynic acid is a loop diuretic that binds w/ sulfhydryl groups of renal cellular proteins. It inhibits the reabsorption of Na and Cl in the ascending loop of Henle and distal renal tubules, interfering w/ the Cl-binding cotransport system, hence excretion of Na, K, Ca, Mg, and Cl ions are increased and water excretion enhanced.
Onset: Approx 30 min (oral); 5 min (IV).
Duration: 12 hr (oral); 2 hr (IV).
Pharmacokinetics:
Absorption: Rapidly absorbed from the GI tract. Time to peak plasma concentration: 2 hr (oral); 30 min (IV).
Distribution: Plasma protein binding: >90%.
Metabolism: Metabolised in the liver (35-40%) to active cysteine conjugate.
Excretion: Via faeces and urine (30-60% as unchanged drug). Elimination half-life: 2-4 hr.
Chemical Structure

Chemical Structure Image
Etacrynic acid

Source: National Center for Biotechnology Information. PubChem Database. Ethacrynic acid, CID=3278, https://pubchem.ncbi.nlm.nih.gov/compound/Ethacrynic-acid (accessed on Jan. 22, 2020)

Storage
Store at 25°C.
MIMS Class
ATC Classification
C03CC01 - etacrynic acid ; Belongs to the class of high-ceiling aryloxyacetic acid derivative diuretics.
References
Anon. Ethacrynic Acid. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 03/07/2017.

Buckingham R (ed). Etacrynic Acid. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/07/2017.

Ethacrynic Sodium Powder, for Soln (Oceanside Pharmaceuticals). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 03/07/2017.

McEvoy GK, Snow EK, Miller J et al (eds). Ethacrynic Acid, Ethacrynate Sodium. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com/. Accessed 03/07/2017.

Disclaimer: This information is independently developed by MIMS based on Etacrynic acid from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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