Ethacrynic acid (tablet): Difference between revisions

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::* Day 3 — 100 mg in the morning and 50 to 100 mg following the afternoon or evening meal, depending upon response to the morning dose.
::* Day 3 — 100 mg in the morning and 50 to 100 mg following the afternoon or evening meal, depending upon response to the morning dose.
:* A few patients may require initial and maintenance doses as high as '''200 mg twice daily'''. These higher doses, which should be achieved gradually, are most often required in patients with severe, refractory [[edema]].
:* A few patients may require initial and maintenance doses as high as '''200 mg twice daily'''. These higher doses, which should be achieved gradually, are most often required in patients with severe, refractory [[edema]].
: '''''
:* Maintenance Dose'''''
:* Ethacrynic acid may be given intermittently after an effective [[diuresis]] is obtained with the regimen outlined above.
:* Dosage may be on an alternate daily schedule or more prolonged periods of diuretic therapy may be interspersed with rest periods. Such an intermittent dosage schedule allows time for correction of any electrolyte imbalance and may provide a more efficient diuretic response.
:* The chloruretic effect of this agent may give rise to retention of [[bicarbonate]] and a [[metabolic alkalosis]]. This may be corrected by giving [[chloride]] ([[ammonium]] [[chloride]] or [[arginine]] [[chloride]]). [[Ammonium]] [[chloride]] should not be given to [[cirrhosis|cirrhotic]] patients.
:* Ethacrynic acid has additive effects when used with other [[diuretics]]. For example, a patient who is on maintenance dosage of an oral [[diuretic]] may require additional intermittent diuretic therapy, such as an organomercurial, for the maintenance of basal weight. The intermittent use of ethacrynic aicd orally may eliminate the need for injections of organomercurials. Small doses of ethacrynic acid may be added to existing [[diuretic]] regimens to maintain basal weight.
:* This drug may potentiate the action of [[carbonic anhydrase]] inhibitors, with augmentation of [[natriuresis]] and [[kaliuresis]]. Therefore, when adding ethacrynic acid the initial dose and changes of dose should be in 25 mg increments, to avoid [[electrolyte]] depletion.
:* While many patients do not require supplemental [[potassium]], the use of [[potassium chloride]] or [[potassium]]-sparing agents, or both, during treatment with ethacrynic acid is advisable, especially in [[cirrhosis|cirrhotic]] or nephrotic patients and in patients receiving [[digitalis]].
:* Salt liberalization usually prevents the development of [[hyponatremia]] and [[hypochloremia]]. During treatment with ethacrynic acid, salt may be liberalized to a greater extent than with other [[diuretics]]. [[cirrhosis|Cirrhotic]] patients, however, usually require at least moderate salt restriction concomitant with [[diuretic]] therapy.


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Revision as of 00:56, 2 July 2014

Ethacrynic acid (tablet)
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gerald Chi

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Overview

Ethacrynic acid (tablet) is a loop diuretic that is FDA approved for the {{{indicationType}}} of edema associated with congestive heart failure, cirrhosis, and renal disease. It is also indicated for short-term management of ascites due to malignancy, idiopathic edema, and lymphedema. Common adverse reactions include electrolyte imbalance, anorexia, malaise, abdominal discomfort, dysphagia, nausea, vomiting, diarrhea, agranulocytosis, neutropenia, deafness, tinnitus, and vertigo.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

  • Ethacrynic acid is indicated for treatment of edema when an agent with greater diuretic potential than those commonly employed is required.
Edema
  • Dosage must be regulated carefully to prevent a more rapid or substantial loss of fluid or electrolyte than is indicated or necessary.
  • The magnitude of diuresis and natriuresis is largely dependent on the degree of fluid accumulation present in the patient. Similarly, the extent of potassium excretion is determined in large measure by the presence and magnitude of aldosteronism.
  • Dosing Information
Initial Dose
  • The smallest dose required to produce gradual weight loss (about 1 to 2 pounds per day) is recommended.
  • Onset of diuresis usually occurs at 50 to 100 mg for adults. After diuresis has been achieved, the minimally effective dose (usually from 50 to 200 mg daily) may be given on a continuous or intermittent dosage schedule.
  • Dosage adjustments are usually in 25 to 50 mg increments to avoid derangement of water and electrolyte excretion.
  • The patient should be weighed under standard conditions before and during the institution of diuretic therapy with this compound. Small alterations in dose should effectively prevent a massive diuretic response.
  • The following schedule may be helpful in determining the smallest effective dose.
  • Day 1 — 50 mg once daily after a meal
  • Day 2 — 50 mg twice daily after meals, if necessary
  • Day 3 — 100 mg in the morning and 50 to 100 mg following the afternoon or evening meal, depending upon response to the morning dose.
  • A few patients may require initial and maintenance doses as high as 200 mg twice daily. These higher doses, which should be achieved gradually, are most often required in patients with severe, refractory edema.
  • Maintenance Dose
  • Ethacrynic acid may be given intermittently after an effective diuresis is obtained with the regimen outlined above.
  • Dosage may be on an alternate daily schedule or more prolonged periods of diuretic therapy may be interspersed with rest periods. Such an intermittent dosage schedule allows time for correction of any electrolyte imbalance and may provide a more efficient diuretic response.
  • The chloruretic effect of this agent may give rise to retention of bicarbonate and a metabolic alkalosis. This may be corrected by giving chloride (ammonium chloride or arginine chloride). Ammonium chloride should not be given to cirrhotic patients.
  • Ethacrynic acid has additive effects when used with other diuretics. For example, a patient who is on maintenance dosage of an oral diuretic may require additional intermittent diuretic therapy, such as an organomercurial, for the maintenance of basal weight. The intermittent use of ethacrynic aicd orally may eliminate the need for injections of organomercurials. Small doses of ethacrynic acid may be added to existing diuretic regimens to maintain basal weight.
  • This drug may potentiate the action of carbonic anhydrase inhibitors, with augmentation of natriuresis and kaliuresis. Therefore, when adding ethacrynic acid the initial dose and changes of dose should be in 25 mg increments, to avoid electrolyte depletion.
  • While many patients do not require supplemental potassium, the use of potassium chloride or potassium-sparing agents, or both, during treatment with ethacrynic acid is advisable, especially in cirrhotic or nephrotic patients and in patients receiving digitalis.
  • Salt liberalization usually prevents the development of hyponatremia and hypochloremia. During treatment with ethacrynic acid, salt may be liberalized to a greater extent than with other diuretics. Cirrhotic patients, however, usually require at least moderate salt restriction concomitant with diuretic therapy.
Condition2
  • Dosing Information
  • Dosage
Condition3
  • Dosing Information
  • Dosage
Condition4
  • Dosing Information
  • Dosage

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Ethacrynic acid (tablet) in adult patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Ethacrynic acid (tablet) in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Edema
  • Dosing Information
Initial Dose
  • The initial dose should be 25 mg. Careful stepwise increments in dosage of 25 mg should be made to achieve effective maintenance.
Condition2

There is limited information regarding FDA-Labeled Use of Ethacrynic acid (tablet) in pediatric patients.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Ethacrynic acid (tablet) in pediatric patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Ethacrynic acid (tablet) in pediatric patients.

Contraindications

  • Condition1

Warnings

Description

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Clinical Trial Experience of Ethacrynic acid (tablet) in the drug label.

Central Nervous System
Cardiovascular
Respiratory
Gastrointestinal
Hypersensitivity
Miscellaneous

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Ethacrynic acid (tablet) in the drug label.

Central Nervous System
Cardiovascular
Respiratory
Gastrointestinal
Hypersensitivity
Miscellaneous

Drug Interactions

  • Drug
  • Description

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA):

  • Pregnancy Category


Pregnancy Category (AUS):

  • Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Ethacrynic acid (tablet) in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Ethacrynic acid (tablet) during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Ethacrynic acid (tablet) with respect to nursing mothers.

Pediatric Use

There is no FDA guidance on the use of Ethacrynic acid (tablet) with respect to pediatric patients.

Geriatic Use

There is no FDA guidance on the use of Ethacrynic acid (tablet) with respect to geriatric patients.

Gender

There is no FDA guidance on the use of Ethacrynic acid (tablet) with respect to specific gender populations.

Race

There is no FDA guidance on the use of Ethacrynic acid (tablet) with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Ethacrynic acid (tablet) in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Ethacrynic acid (tablet) in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Ethacrynic acid (tablet) in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Ethacrynic acid (tablet) in patients who are immunocompromised.

Administration and Monitoring

Administration

Oral

Intravenous

Monitoring

There is limited information regarding Monitoring of Ethacrynic acid (tablet) in the drug label.

Condition1

Description

IV Compatibility

There is limited information regarding IV Compatibility of Ethacrynic acid (tablet) in the drug label.

Overdosage

Acute Overdose

Signs and Symptoms

Description

Management

Description

Chronic Overdose

There is limited information regarding Chronic Overdose of Ethacrynic acid (tablet) in the drug label.

Pharmacology

There is limited information regarding Ethacrynic acid (tablet) Pharmacology in the drug label.

Mechanism of Action

There is limited information regarding Ethacrynic acid (tablet) Mechanism of Action in the drug label.

Structure

There is limited information regarding Structure of Ethacrynic acid (tablet) in the drug label.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Ethacrynic acid (tablet) in the drug label.

Pharmacokinetics

There is limited information regarding Pharmacokinetics of Ethacrynic acid (tablet) in the drug label.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Ethacrynic acid (tablet) in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Ethacrynic acid (tablet) in the drug label.

Condition1

Description

How Supplied

There is limited information regarding Ethacrynic acid (tablet) How Supplied in the drug label.

Storage

There is limited information regarding Ethacrynic acid (tablet) Storage in the drug label.

Images

Drug Images

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Package and Label Display Panel

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Patient Counseling Information

There is limited information regarding Patient Counseling Information of Ethacrynic acid (tablet) in the drug label.

Precautions with Alcohol

Alcohol-Ethacrynic acid (tablet) interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.[1]

Brand Names

Edecrin®

Look-Alike Drug Names

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. ↑ "EDECRIN (ethacrynic acid) tablet".
  2. ↑ "http://www.ismp.org". External link in |title= (help)


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