Ethacrynate Sodium (Intravenous)

Ethacrynate sodium is an intravenous diuretic which reduces edema in patients with congestive heart failure, liver disease or kidney disease.

Overview

Ethacrynate sodium is a loop diuretic which works to treat edema (fluid retention) caused by a range of medical conditions, such as kidney disease, liver disease and congestive heart failure. It acts on the kidneys in order to increase the flow of urine and remove excess fluid from the body.

In the US, ethacrynate sodium is known by the following names:

  • Edecrin Sodium
  • Ethacrynate Sodium Novaplus
  • PremierPro RX Ethacrynate Sodium
  • Sodium Edecrin

The medicine is only available with a doctor's prescription and is provided in powder form which is designed to be made up into a solution and injected into a vein (intravenously). It is therefore reserved for hospital or clinical settings and should only be administered by a trained healthcare professional such as a doctor or a nurse.

Conditions Treated?

  • Edema

Type Of Medicine?

  • Loop diuretic

Side Effects

Sometimes ethacrynate sodium can cause unwanted effects alongside its needed effects. Not all of these unwanted effects will occur and not all are harmful, but some are serious and require medical attention. Familiarize yourself with all potential side effects so that you can recognize the right time to seek advice from your doctor.

The following side effects are serious and should be reported to your doctor or nurse immediately:

  • Rare:

O Bleeding gums

O Unpleasant breath odor

O Itching

O Skin rash

O Large, flat, purplish or blue patches on the skin

O Pinpoint red spots on the skin

O Raised, red swellings on the skin, legs, ankles or buttocks

O Yellow skin or eyes

O Indigestion

O Bloating

O Nausea

O Constipation

O Clay-colored stools

O Dark urine

O Vomiting blood

O Loss of appetite

O Painful ankles or knees

O Pain in abdomen, stomach or side, possible radiating to back

  • Incidence unknown

O Black, tarry stools

O Blood in urine

O Painful or difficult urination

O Anxiety

O Depression

O Confusion

O Nervousness

O Nightmares

O Unusual tiredness or weakness

O Coma

O Sores, ulcers or white spots on lips or in mouth

O Abnormal bruising or bleeding

O Cool, pale skin

O Fever, with or without chills

O Cold sweats

O Flushed, dry skin

O Dizziness

O Blurred vision

O Slurred speech

O Convulsions

O Shakiness

O Joint pain, swelling or stiffness

O Swelling of lower legs or feet

O Cough or hoarseness

O Sore throat

O Dry mouth

O Fruit-like breath odor

O Fast heartbeat

O Shortness of breath

O Difficult breathing

O Headache

O Nausea

O Vomiting

O Severe, watery diarrhea

O Increased hunger

O Increased thirst

O Unexplained weight loss

The following side effects are minor and don't usually require medical attention unless they become very severe or prolonged. You may want to mention them to your doctor if they become very bothersome.

  • Ringing, buzzing or other unexplained noise in ears
  • Hearing loss
  • Feeling of fullness in ears
  • Trouble swallowing
  • Fear
  • Sensation that self or surroundings are constantly moving
  • Sensation of spinning
  • General feeling of illness or discomfort
  • Stomach soreness or discomfort
  • Mild diarrhea
  • Mild weight loss
  • Pain or irritation at injection site

This is not an exhaustive list of all possible side effects that ethacrynate sodium might cause. If you notice other effects not listed here, report them to your doctor or nurse as soon as possible. You could also report side effects to the FDA.

Symptoms of overdose

If you notice any of the following signs of overdose, tell your doctor straight away:

  • Decreased urination
  • Confusion
  • Dizziness, faintness or lightheadedness when arising
  • Increased heart rate
  • Irregular heartbeat
  • Rapid breathing
  • Numbness, tingling, pain or weakness in hands or feet
  • Heaviness and weakness in legs
  • Muscle cramps or pain
  • Trembling
  • Sunken eyes
  • Thirst
  • Wrinkled skin

Dosage

The amount of ethacrynate sodium that you will be prescribed will depend on the severity of your edema, the underlying condition that is causing it, and a variety of other factors such as your age, weight and medical history. The average starting dose is 50 mg, or 0.5 to 1.0 mg per kg of body weight. In critical situations where fluid retention must be alleviated quickly, doctors may administer up to 100 mg in a single dose.

Usually, only one dose of ethacrynate sodium is required, but if a second dose is needed it will be administered in a new injection site. Each intravenous injection is given slowly over the course of several minutes and must be administered by a doctor or nurse.

Interactions

There are many medicines that interact with ethacrynate sodium and it is very important that your doctor knows about all prescription and over-the-counter medicines you take. This includes herbal supplements and vitamins.

It is particularly important to tell your doctor that you are taking the following medicines:

  • Digoxin (Lanoxin, Digitek)
  • Lithium
  • Warfarin (Coumadin) or other blood thinners
  • Diuretics, such as:

O Hydrochlorothiazide

O Furosemide

O Torsemide

O Demadex

O Lasix

O Aldactone

O Maxzide

O Lozol

  • Steroid medicines, such as:

O Dexamethasone

O Prednisolone

O Prednisone

O Medrol

  • Blood pressure medicines, such as:

O Atenolol

O Metoprolol

O Lisinopril

O Quinapril

O Accupril

O Cozaar

O Diovan

O Lotrel

O Norvasc

O Toprol

O Zestrol

Warnings

Contraindicated medical conditions

It is vital that your doctor knows about all the medical conditions you suffer from or have suffered from in the past, as ethacrynate sodium could worsen these conditions or cause other severe side effects or complications.

Ethacrynate sodium should not be given to people with the following medical conditions:

  • Anuria (inability to form urine)
  • Severe electrolyte imbalance (high or low levels of minerals in the blood)
  • Severe, watery diarrhea

The following conditions may be worsened by ethacrynate sodium, and depending on the severity of them doctors may avoid using ethacrynate sodium or they may request closer monitoring of the patient:

  • Hearing problems
  • Advanced liver disease (cirrhosis)
  • Hypervolemia (low blood volume)
  • Hypomagnesemia (low magnesium levels)
  • Hypokalemia (low potassium levels)
  • Hyponatremia (low sodium levels)
  • Hypochloremia (low chloride levels)

In diabetic patients, ethacrynate sodium should be used with caution because it may increase blood sugar levels. Diabetic patients will require close monitoring and the doses of their diabetes medicines may need to be adjusted if blood sugar levels change a lot.

Patients with hypoproteinemia (low protein levels) may be more sensitive to the effects of ethacrynate sodium. Lower doses may therefore be administered to compensate for this.

In people with kidney disease, ethacrynate sodium will remain in the body for longer since the kidneys will remove the drug from the body at a much slower rate than normal. This can mean the effects of the drug are increased. Depending on the severity of the kidney disease, doctors may avoid prescribing ethacrynate sodium, or they may administer lower doses to compensate for slower removal.

Low salt diets and potassium salt

You should make sure your doctor knows if you are following a low-salt or no-salt diet, or if you are using salts which contain potassium. This is because you may experience unwanted side effects or complications if you have treatment with ethacrynate sodium.

Pregnancy and breastfeeding

Ethacrynate sodium is a pregnancy category B drug, which means it should be used with caution in pregnant women during all trimesters. Animal studies have demonstrated that the drug may cause reduced fetal body weights. There have not been adequate well-controlled studies in pregnant women to determine fetal risk. If you are pregnant your doctor will discuss potential risks of ethacrynate sodium with you before administering it.

It is not known whether ethacrynate sodium is excreted in human breast milk and, if so, what effects it may have on nursing infants. Patients are therefore recommended to either avoid ethacrynate sodium or discontinue breastfeeding while treatment with ethacrynate sodium occurs.

Pediatric use

Ethacrynate sodium is not recommended for infants. In older children, the safety and efficacy of the drug has not been established and pediatric use is therefore determined by doctors on a case by case basis.

Geriatric use

There is no evidence to suggest that ethacrynate sodium is less useful in elderly patients than it is in younger adults. However, since elderly patients are more likely to have reduced kidney function due to their age, doctors may administer lower doses initially until they can see how the patient reacts to the drug.

Allergy

Make sure your doctor knows about all allergies you have suffered from in the past, particularly if you have been allergic to drugs similar to ethacrynate sodium. If you notice any of the following signs of allergy, tell a doctor or nurse right away:

  • Itching
  • Rash
  • Hives
  • Wheezing
  • Chest tightness
  • Shortness of breath
  • Cough
  • Swelling of face, eyelids, lips, tongue or throat

Storage

Since ethacrynate sodium is administered intravenously, it must be given in a hospital environment by a doctor, nurse or other trained healthcare professional. Patients will therefore not be required to store the medicine at home.

Summary

Ethacrynate sodium is a loop diuretic which treats edema (fluid retention) caused by congestive heart failure, liver disease and kidney disease. It acts on the kidneys to increase urine flow in order to remove excess fluid from the body.

Ethacrynate sodium is designed for intravenous use, meaning that it is reconstituted into a solution and injected directly into a vein over the course of several minutes. It should only be administered by a trained healthcare professional such as a doctor or nurse, and is only given in a hospital or clinic environment. Usually, one dose is adequate to reduce fluid retention, but in some instances a second dose will be administered.

This drug should not be given to people who have severe diarrhea, to those who cannot urinate properly, or to those with severe electrolyte imbalances. It should be used with caution in pregnant women and elderly patients. The drug is not suitable for infants, and its safety and efficacy have not been determined in older children.

Common, minor side effects of ethacrynate sodium include dizziness, ringing in ears, mild diarrhea and mild weight loss. Tell your doctor right away if you experience severe diarrhea or vomiting, pain in joints or muscles, swelling in the legs, convulsions, rash, vomiting of blood, dark urine, or difficulty urinating. Since the drug is administered in a hospital environment, you should be able to report severe effects to a doctor or nurse immediately.