Ethacrynic Acid (Oral)

By causing excess amounts of salt to be passed out in urine, ethacrynic acid helps to prevent the buildup of too much fluid in the body.

Overview

Ethacrynic acid is commonly used to treat patients who have gone through congestive heart failure, liver disease, or who have kidney disorders. In such patients, it is very important that edema (fluid retention) is not allowed to occur, so this medication is frequently used to prevent that from happening.

Because it is a very powerful medication, it can in some cases trigger excessive loss of fluids and electrolytes, leading to an equally dangerous situation. For this reason, close medical supervision is necessary for patients being treated with ethacrynic acid. The medication is usually made available in 25 mg tablets, and is intended to be taken orally once or twice daily, after having eaten a meal.

Ethacrynic acid also helps your kidneys to be more effective at eliminating fluids, because it removes some of the buildup, and allows the kidneys to have less of a load to handle. This in turn relieves some of the most common symptoms that patients have after liver failure, cancer, or congestive heart failure. It is typical for these patients to have swelling in the feet, hands, ankles or belly, and this swelling is substantially reduced by a regular program of treatment with ethacrynic acid. There are also cases where difficulty with breathing is resolved or significantly improved by treatment with this medication.

Condition Treated

  • Prevents fluid retention, especially after congestive heart failure, kidney disorders, and liver disease

Type Of Medicine

  • Loop Diuretic

Side Effects

There are a number of known side effects which frequently accompany treatment with ethacrynic acid in addition to the intended effects which it imparts to a patient. Some of these side effects are relatively mild in nature, and will simply subside on their own accord as the body adjusts to the medication. Others can be fairly severe and may even call for immediate medical attention due to the severity of the symptoms. If you should observe any of the side effects listed below after taking ethacrynic acid, you should contact your doctor as soon as possible to discuss the situation.

In the case of an allergic reaction to this medication, you should immediately seek medical assistance because the symptoms which may appear have the potential of becoming life-threatening if left untreated. The things to look for when you suspect you are having an allergic reaction to this medication are as follows:

  • Hives and/or rashes which appear on the skin in various locations around the body
  • Tightness in the chest, often accompanied by other symptoms of breathing difficulty
  • Extreme and/or persistent itching
  • Pronounced disorientation or dizziness
  • Swelling which primarily appears in the area around the face, affecting the tongue, lips, or throat.

Since ethacrynic acid is a powerful water pill which depletes fluids in the body as part of its normal function, there is a possibility that you can become dehydrated soon after taking this medication. There may also be some related side effects with this condition, such as a strong sensation of dry mouth or thirst, a fast or irregular heartbeat, severe lightheadedness, decreased urination or no urination at all, and lack of sweating, even when it would be normal for a given situation.

Another set of side effects which are considered fairly severe, and should be reported immediately to your doctor, include all of the following:

  • Any signs of liver problems such as loss of appetite, dark-colored urine, a yellowish tinge around the eyes or on the skin, or unabated nausea and/or vomiting
  • Unusual bruising or bleeding which seems to have no apparent cause
  • Loss of hearing, possibly with temporary deafness
  • A sensation of spinning which is referred to as vertigo
  • Stools which are blackened or bloody
  • Stomach pain and/or abdominal pain
  • Vomiting up material which looks like coffee grounds
  • Changes in hearing, such as persistent ringing in the ears or a sensation of fullness.

Another group of side effects which may occur, and which may have varying degrees of severity are listed below. If you experience any of these side effects and they should become uncomfortable to the point where it bothers you, your doctor should be notified immediately so that some kind of treatment can be considered.

  • Anxiety or irritability
  • Blurry vision
  • Cold sweats
  • Watery, severe diarrhea
  • Unusual weakness or fatigue
  • Difficulty with breathing
  • Sudden weight loss
  • Swelling which may appear in the lower legs, ankles, or feet
  • White spots, sores, or ulcers which may appear in the mouth or on the lips
  • Persistent shakiness or trembling
  • Paleness of the skin
  • Frequent shortness of breath
  • Speech which is slurred and difficult to understand
  • Sore throat
  • Profuse sweating
  • Increased urination and/or increased urgency to urinate
  • Pain in the lower back, stomach, or at your sides
  • Stiffness or swelling of the joints
  • Increase in thirst or hunger
  • Persistent headaches
  • Bad breath
  • Fevers which may or may not be accompanied by chills
  • Flushed skin
  • Dry skin
  • Persistent coughing or hoarseness
  • Seizures or convulsions
  • Coma

Dosage

For adult patients being treated for edema, a standard dosage of ethacrynic acid would normally be between 50 mg to 200 mg taken orally each day, either in a single dosage or in two dosages which are equally divided. Typically, most patients respond to a dosage level between 50 mg and 100 mg, and in cases where this is not true, 25 mg increments can be tried.

Once the desired level of diuresis has been accomplished, and it is clear that fluid retention has been relieved, the dosage can be adjusted downward by either 25 mg or 50 mg increments until the minimum dosage possible is found. As with all medications, the least amount of ethacrynic acid which can be given to a patient and still accomplish the desired effect, will be the ideal dosage.

Once this minimal effective dosage is arrived at, the frequency of dosages can be continued either on a regular schedule or on an intermittent schedule as needed. If ethacrynic acid is being used in conjunction with another diuretic, it would most commonly be administered in 25 mg dosages. Intermittent dosages might consist of alternate daily dosing, or possibly dosing every third day with ethacrynic acid. Because of this variability of effectiveness, it will be necessary for most patients to be carefully supervised by their doctor, so that body tolerance and reaction can be closely observed.

It may be necessary to initially administer as much as 200 mg of ethacrynic acid daily, especially for patients experiencing severe refractory edema. It may also be necessary to at least temporarily continue with the maintenance schedule of 200 mg daily dosages of ethacrynic acid in order to achieve maximum effectiveness.

Children who are being treated for edema would normally be prescribed a dosage of 25 mg taken as an oral tablet, both as an initial dosage and as a maintenance dosage. However, depending on the effectiveness of the medication, it may be necessary to adjust this dosage upward in 25 mg increments to achieve the desired results.

Interactions

There are a number of other medications which ethacrynic acid is known to interact with, and since this could create problems for a patient being treated, your doctor will take all steps necessary to avoid these kinds of interactions. To help with this process, you should prepare a list of all the other medications which you are currently taking so this list can be reviewed, and steps can be taken to prevent interactions with those drugs known to be impacted by ethacrynic acid.

If your preparing this list, you should include all over-the-counter drugs, other prescription medications which you are taking, all vitamins and herbal supplements, and all the dosages of each item on this list. After reviewing this list, your doctor may want to discontinue your usage of some of these other medications, or at least reduce your dosage level. The same list can also be used if you should ever need to visit an emergency room for treatment, or a healthcare clinic where your primary care doctor is not in residence. Any doctor would be able to consult this list and have an understanding of which medications to avoid when treating the condition you came to the emergency room for.

Some of the medications which are known to interact with ethacrynic acid are the following:

  • Blood thinners such as Jantoven, Coumadin, and warfarin
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, meloxicam, celecoxib, diclofenac, naproxen, and indomethacin
  • Any medication in the class of antibiotics
  • Medications used to treat high blood pressure
  • Lithium
  • Digitalis
  • Digoxin
  • Any kind of medication considered to be a steroid, such as prednisone and dexamethasone
  • Benadryl
  • Demerol
  • Flonase
  • Wellbutrin
  • Vitamin D2
  • Vitamin B6
  • Tylenol
  • Symbicort
  • Paracetamol
  • Spiriva
  • Tegretol
  • Artane
  • Co-Trimoxazole
  • Invega Sustenna
  • NovoLog
  • Lipitor
  • Klor-Con M 20

In addition to the medications which are known to interact with ethacrynic acid, there are several diseases which are strongly impacted by this medication, so if you have a medical history which includes any of the following diseases, you should make sure your doctor is aware of this.

  • Diabetes
  • Hyperuricemia
  • Any kind of kidney disorder or dysfunction
  • Cirrhosis
  • Anuria
  • Ototoxicity
  • Electrolyte loss

Warnings

When consulting with your doctor about the possibility of taking ethacrynic acid, you should have a full review of your medical history so that any conditions you may have experienced in the past will not be triggered into re-emergence, and no existing condition will be exacerbated.

If you know that you are allergic to ethacrynic acid or any of the ingredients used in its manufacture, you should point this out your doctor right away so that an alternative medication can be considered. If you are allergic to any foods, preservatives, pets, or fabrics, you should also alert your doctor to the situation, since some of the inactive ingredients included in ethacrynic acid may trigger your other allergic reactions.

It is possible that ethacrynic acid will cause you to become dizzy or disoriented after dosing, so it is highly inadvisable for you to be operating a motor vehicle after taking this medication, or of operating any machinery which might cause a danger to yourself or others.

Ethacrynic acid can seriously reduce the level of minerals such as sodium and potassium in your bloodstream, so your doctor may advise that while being treated with this medication, you ingest more foods which are rich in potassium, such as orange juice and bananas, or that you take a potassium supplement.

Ethacrynic acid has the potential of impacting your blood sugar levels, so if you are a diabetic you may need to check your blood sugar level more frequently than you currently do, and your doctor may want you to keep him/her apprised of all readings taken. It may also be necessary for your diabetes medication to be adjusted while you are concurrently being treated with ethacrynic acid.

If you have any surgeries which are scheduled during the time frame you expect to be treated with ethacrynic acid, you should alert your doctor and/or your dentist to the fact that you are being treated with this medication. Even oral surgery can be impacted by the medication, so alert your dentist if any oral surgeries are scheduled.

Historically, older adults are more typically affected by the side effects produced by ethacrynic acid, so close monitoring may be necessary for seniors being treated with this medication.

It is not recommended that pregnant women be treated with ethacrynic acid because animal studies have suggested that reduced body weights can occur in fetuses. Similar studies have shown that animal fetuses are also subject to certain defects or malformations. While no corresponding human studies have been performed, it is still highly inadvisable for pregnant women to be taking this medication.

It is also known that ethacrynic acid is passed through breastmilk to an infant, so any pregnant woman should not be breastfeeding while being treated with ethacrynic acid. If you should become pregnant while being treated with this medication, you should immediately consult with your doctor.

Storage

This medication should be stored in a room which is not subject to extremes of temperature or humidity, as this may impact its effectiveness. It should also be kept well out of reach from children and pets, and should not be stored in a weekly pill reminder container, since these have no effective locking mechanisms. Unused or expired ethacrynic acid should not be flushed down the toilet or sink, but should be disposed of in a safe manner, per your doctor or pharmacist.

Summary

Ethacrynic acid is a water pill which is most often used in treating patients who have experienced congestive heart failure, cancer, kidney disease, or liver disease. It works by causing the body to eliminate excess fluids so that there is no buildup of fluid in the body, which can lead to swelling in the feet, ankles, and legs.

Any patient taking ethacrynic acid needs to be carefully supervised by a doctor, because the fluid loss triggered by this medication can cause a patient to become dehydrated and suffer related symptoms such as thirst, dizziness, and a cessation of urination. The medication is easily ingested along with a meal in 25 mg tablets, with the precise daily dosage to be determined by your doctor to achieve the desired results.