Ethacrynic Acid

About Ethacrynic Acid

Ethacrynic acid is a loop diuretic: it blocks the reabsorption of salt and water in the loop of Henle in the kidney, so more urine is passed and excess fluid leaves the body. The label approves it for edema that needs a diuretic stronger than the usual ones, when the cause is congestive heart failure, cirrhosis of the liver or kidney disease, including nephrotic syndrome; for short-term management of ascites due to malignancy, idiopathic edema or lymphedema; and for short-term management of hospitalized children, other than infants, with congenital heart disease or nephrotic syndrome. Treatment starts with the smallest dose that produces gradual weight loss, usually 50 mg after a meal on the first day, and diuresis usually begins at 50 to 100 mg; the maintenance dose is typically 50 to 200 mg a day, adjusted in 25 to 50 mg steps, and the label allows an alternate-day schedule, which gives time for electrolytes to recover. Children start at 25 mg with 25 mg steps. An intravenous form (Sodium Edecrin) is given in hospitals and is not covered here.

There is no boxed warning. Ethacrynic acid must not be used by anyone who passes no urine (anuria), by anyone allergic to it, or in infants, and it is stopped and never restarted if severe, watery diarrhea develops. Its most serious hazard is ototoxicity: deafness, ringing in the ears and vertigo have occurred, mostly in people with severe kidney impairment, with intravenous use or with doses above the recommended range; the hearing loss is usually reversible but can be permanent, and it adds to the ear-damaging effect of aminoglycoside and some cephalosporin antibiotics, so those combinations are avoided. Excessive diuresis can cause serious water and electrolyte depletion, so weight is checked regularly and the drug is held if losses become too great; low potassium can trigger digitalis toxicity, and people with cirrhosis can slip into hepatic coma. Common side effects are loss of appetite, nausea, vomiting, diarrhea and stomach discomfort, raised uric acid and gout, raised blood sugar, headache, tiredness and rash.

What is distinctive is how carefully the dose is handled. The label advises potassium chloride or a potassium-sparing diuretic, or both, during treatment, especially in cirrhosis, nephrotic syndrome and anyone on digoxin, and favors an intermittent schedule when possible. Lithium generally should not be given with diuretics because they reduce its clearance from the kidney and raise the risk of toxicity; ethacrynic acid displaces warfarin from plasma proteins, so a lower anticoagulant dose may be needed; nonsteroidal anti-inflammatory drugs can blunt its diuretic effect; and blood pressure medicines may need their doses adjusted. The label says to use it in pregnancy only if clearly needed and that it is not known whether it passes into breast milk. MedlinePlus notes that for adults 65 and older other medicines are usually considered safer for the same purpose. Ethacrynic acid is not a controlled substance.

Taking Ethacrynic Acid

How to take it

Take it by mouth after a meal, once or twice a day or on alternate days exactly as the prescriber directs, at about the same time each day. Weigh yourself as often as the prescriber asks and report rapid weight loss, dizziness, thirst or muscle cramps.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose. Do not take a double dose.

Storage

In the original tightly closed container at room temperature (25 degrees C, 77 degrees F), away from heat and moisture (not in the bathroom), out of reach of children.

Interactions to know about

Aminoglycoside and some cephalosporin antibiotics add to the risk of hearing damage and are avoided; lithium levels can rise to toxic levels; warfarin may need a lower dose; NSAIDs such as ibuprofen and naproxen can blunt the diuretic effect; digoxin becomes more toxic when potassium is low; and blood pressure medicines may need adjusting. Tell the pharmacist about every medicine and supplement you take.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Ethacrynic Acid differs from pharmacy to pharmacy

Ethacrynic acid is a much less common loop diuretic than furosemide, and generics arrived only in recent years, so fewer makers supply it and fewer pharmacies keep it on the shelf; quotes depend on which maker a pharmacy can buy from and whether it must order the drug in. A prescription for the Edecrin brand without substitution is priced as a brand and costs far more than the generics.

Only one strength exists, so the daily dose sets the tablet count: a maintenance dose of 100 mg a day uses four tablets, and an alternate-day schedule halves the count for the same month. Quotes therefore vary with the dose and quantity written, and the dispensing fee is a larger share of a small alternate-day fill.

Ways to pay less for Ethacrynic Acid without insurance

• Ask the prescriber to write ethacrynic acid generically and allow substitution.
• Compare more than one pharmacy and ask whether the pharmacy stocks ethacrynic acid or has to order it, since stocking varies for this less common diuretic.
• Once the dose is stable, ask the prescriber whether a ninety-day supply suits you, so you pay fewer dispensing fees.
• If the quote is high, ask the prescriber whether a more widely stocked loop diuretic would suit you; do not switch or change your dose on your own.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Ethacrynic Acid

1. 1.Should I take my tablets after a meal, and at what time of day so I am not up all night?
2. 2.Do I need a potassium supplement with my ethacrynic acid, and how will my potassium be checked?
3. 3.Which of my other medicines, such as lithium, warfarin, digoxin or an anti-inflammatory, interact with it?
4. 4.What signs of hearing change or dehydration mean I should stop and call my prescriber?

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