Edecrin 25 mg
Images for reference only. Packaging will vary.
Ask A Pharmacist
Please feel free to ask our pharmacists any questions about Edecrin.
100 tabs for $135.76 ($1.36 per tab)
Edecrin from online pharmacy: Canada
Enjoy the convenience and discreet packaging when you order Edecrin 25 mg from The Drug Company. Treat diuretic with confidence, as per your doctor's advice, and save money by having your medications mailed to your home at a discount. If you require Edecrin 25 mg for your health and well being, there are several ways to save money and still order your prescription. One method is to order from a Canadian pharmacy. Another is to order a generic substitute. Speak with your doctor and view our selection of rx and otc items for sale at our online store. You also always have the option of calling toll free 1-888-254-3038, or using our online chat tool.
Pharmacology
Ethacrynic acid is a saluretic-diuretic agent with marked potency and rapid onset of action. It is chemically unrelated to other diuretics. Patients with congestive heart failure (including acute pulmonary edema), renal edema, hepatic cirrhosis with ascites, and other conditions involving fluid retention have responded well to ethacrynic acid.
Ethacrynic acid has the following major characteristics:
Water and electrolyte excretion may be increased several times over that observed with thiazide diuretics. The urinary output is usually dose-dependent and related to the magnitude of fluid accumulation.
Electrolyte excretion pattern differs from that of thiazides. Initially, sodium and chloride excretion is usually substantial, and chloride loss exceeds that of sodium. With prolonged therapy, chloride excretion declines, and potassium and hydrogen ion excretion may increase. In patients with increased diuresis excessive amounts of potassium may be excreted. Ethacrynic acid is effective whether or not there is clinical acidosis or alkalosis.
Rapid onset of action usually is observed within 30 minutes after an oral dose or within 5 minutes after an i.v. injection.
Duration of action is moderate following oral administration (6 to 8 hours). The peak diuretic-saluretic activity occurs in about 2 hours.
Sulfhydryl binding propensity differs in certain respects from that of the organomercurials. Its mode of action is not by carbonic anhydrase inhibition.
Multiple sites of action. Ethacrynic acid acts on the proximal and distal portions of the tubule, and also on the ascending limb of the loop of Henle.
Indications
Children
Ethacrynic acid has been found useful in patients of the pediatric age group with the nephrotic syndrome. This experience has been mostly of short duration, in hospitalized patients resistant to other therapy. Pediatric patients with congenital heart disease also have responded to this agent. Information in infants is insufficient to recommend therapy with ethacrynic acid.
Precautions
General
Weakness, muscle cramps, paresthesias, thirst, anorexia, and signs of hyponatremia, hypokalemia, and/or hypochloremic alkalosis may occur following vigorous or excessive diuresis and these may be accentuated by rigid salt restriction. Rarely tetany has been reported following vigorous diuresis. During therapy with ethacrynic acid, liberalization of salt intake and supplementary potassium chloride are often necessary.
When metabolic alkalosis may be anticipated, e.g., in cirrhosis with ascites, the use of potassium chloride with or without a potassium-sparing agent before and continuously during therapy with ethacrynic acid may mitigate or prevent the hypokalemia. If a potassium-sparing agent is used, continued monitoring of electrolytes is still required because of the possible occurrence in this case of hyperkalemia.
In a few patients this diuretic has produced severe, watery diarrhea. If this occurs, it should be discontinued and not readministered.
Ethacrynic acid has little or no effect on glomerular filtration or on renal blood flow, except following pronounced reductions in plasma volume when associated with rapid diuresis. A transient increase in serum urea nitrogen may occur. This is usually reversible when the drug is discontinued.
Deafness, tinnitus and vertigo with a sense of fullness in the ears have occurred, most frequently in patients with severe impairment of renal function. These symptoms have been associated most often with i.v. administration and with doses in excess of those recommended. The deafness has usually been reversible and of short duration (1 to 24 hours). However, in some critically ill patients the hearing loss has been permanent. A number of these patients were also receiving drugs known to be ototoxic.
Supplied
Sodium Edecrin
Each vial of dry white material either in a plug form or as a powder, contains: ethacrynate sodium equivalent to ethacrynic acid 50 mg. Nonmedicinal ingredients: mannitol.
Edecrin
Each white, scored tablet, with the MSD 65 on one side and EDECRIN on the other, contains: ethacrynic acid 25 mg. Nonmedicinal ingredients: colloidal silicon dioxide, cornstarch, lactose, magnesium stearate and talc. Gluten- and tartrazine-free. High density polyethylene bottles of 100. The splitting of Edecrin tablets is not advised. Store in the tightly closed container at room temperature (15-30°C).
Contraindications
All diuretics, including ethacrynic acid, are contraindicated in anuria. If increasing azotemia and/or oliguria occur during treatment of severe, progressive renal disease, the diuretic should be discontinued.
Until further experience in infants is accumulated, therapy with oral and parenteral ethacrynic acid is contraindicated.
(See also Warnings, Pregnancy and Lactation.)
Hypersensitivity to any component of this product.
Warnings
Lactation
Contraindicated in nursing mothers. If use of the drug is deemed essential, the patient should stop nursing.
Pregnancy
Not recommended for use in pregnant patients. Use of the drug in women of the childbearing age requires that its potential benefits be weighed against the possible hazards to the fetus. The safety and efficacy of the drug in toxemia of pregnancy have not been established.
Adverse Effects
Special Senses
Vertigo, deafness, and tinnitus, with a sense of fullness in the ears and blurred vision have occurred (see Precautions).
Other
skin rash, headache, fever, chills and hematuria.
Ethacrynate sodium occasionally has caused local irritation and pain, and a rare instance of local thrombophlebitis has been reported after its use.
A number of possibly drug-related deaths have occurred in critically ill patients refractory to other diuretics. These generally have fallen into two categories: (1) patients with severe myocardial disease who have been receiving digitalis and presumably developed acute hypokalemia with fatal arrhythmia; (2) patients with severely decompensated hepatic cirrhosis with ascites, with or without accompanying encephalopathy, who were in electrolyte imbalance and died because of intensification of the electrolyte defect.
Central Nervous System
fatigue, apprehension and confusion.
Gastrointestinal
anorexia, malaise, abdominal discomfort or pain, dysphagia, nausea, vomiting, and diarrhea. In a few patients, watery, profuse diarrhea, gastrointestinal bleeding, and acute pancreatitis has been reported.
Hematologic
Agranulocytosis, severe neutropenia, thrombocytopenia, and Henoch-Schönlein purpura have been reported rarely.
Metabolic
Reversible hyperuricemia, decreased urinary urate excretion, and hyperglycemia have been reported. Acute gout has been precipitated. Rarely acute symptomatic hypoglycemia with convulsions, jaundice and abnormal tests of hepatocellular function have been reported.
Overdose
For management of a suspected drug overdose, CPhA recommends that you contact your regional Poison Control Centre. See the eCPS Directories section for a list of Poison Control Centres.
No data supplied by the manufacturer.
Dosage
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.
Oral: The splitting of ethacrynic acid 25 mg tablets is not advised.
Dosage: To Initiate Diuresis: Adults: The smallest dose required to produce gradual weight loss (about 0.5 to 1 kg/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 might prevent a massive diuretic response.
The following schedule may be helpful in determining the smallest effective dose.
Day 1: 50 mg (single dose) 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.
Children: The initial dose should be 25 mg. Careful stepwise increments in dosage of 25 mg should be made to achieve effective maintenance. A dosage for infants has not been established.
Maintenance Therapy: It is usually possible to reduce the dosage and frequency of administration once dry weight has been achieved.
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 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. 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. Rarely, patients who failed to respond to ethacrynic acid have responded to older established agents.
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.
I.V: For i.v. use when oral intake is impractical or in urgent conditions, such as acute pulmonary edema.
Adults: The usual i.v. dose for the average sized adult is 50 mg, or 0.5 to 1.0 mg/kg of body weight. Usually only 1 dose has been necessary; occasionally a second dose at a new injection site, to avoid possible thrombophlebitis, may be required. A single i.v. dose not exceeding 100 mg has been used in critical situations.
Children: Insufficient pediatric experience precludes recommendation for this age group.
The solution may be given slowly through the tubing of a running infusion or by direct i.v. injection over a period of several minutes.
Ethacrynate sodium should not be given s.c. or i.m. because of local pain and irritation.
To reconstitute the dry material, add 50 mL of 5% Dextrose Injection or Sodium Chloride Injection to the vial. Occasionally, some 5% Dextrose Injection solutions may have a low pH (below 5). The resulting solution with such a diluent may be hazy or opalescent. I.V. use of such a solution is not recommended.
Parenteral Products: Do not mix this solution with whole blood or its derivatives. Because there is no preservative contained in the vial, a fresh solution should be prepared just prior to each administration. Any unused solution should be discarded.
